Tag Archives: healthcare

Three large companies want to disrupt healthcare. Don’t hold your breath.

I’ve been waiting to write about this until I could consider all sides of the story. Now that I’ve had a few days to mull it over, here are my thoughts about the Jeff Bezos/Warren Buffett/Jamie Dimon healthcare whoziwhatsis.

Let me preface my remarks by saying that this is NOT financial advice. I don’t know squat about what you should do with your money.

Now, some basic facts: The companies that are run by the three business titans noted above are partnering to explore ways to reduce the cost of healthcare, first for their own employees, then, potentially other companies’ employees. After the announcement, the Dow Industrial Average lost over 300 points. Since then, over 1500 more points have been shaved off the Dow.

The initial selloff last Tuesday affected insurance company stock as much as anything, and that’s understandable to a degree. But to this observer, the panic seems to be a little premature. Right now, to borrow a little political vernacular, this announcement is a big nothing burger.

I mean, sure… Amazon has made a mountain of money changing the way people shop. Berkshire Hathaway has made investors rich for over 40 years. And JPMorgan Chase is America’s biggest bank. However, healthcare in these United States is full of layer upon layer upon layer of complexity, and getting through all that complexity will take time. Maybe a lot of time.

At the federal level, there is government regulation and government regulators. Healthcare is regulated in the individual states too, and sometimes, even at the local level.

How about doctors, nurses, and other medical professionals? Some of them charge so much for their services only because the cost of their education was so high they have to charge extra just to break even after paying on their student loans.

And since we’re in the 21st century, we have to consider technology. Not the kind that helps us deliver insulin or tells us our glucose levels. I mean the kind of technology that intersects patients all over the country, and for now at least, allows providers to get paid based on medical codes entered through software designed to help them figure out what each treatment is worth.

Hey, guess what? I haven’t mentioned a thing yet about insurance companies or drug prices. Like I said, layer upon layer upon layer of complexity.

If Bezos, Buffett, and Dimon are going to revolutionize healthcare in the USA, they have their work cut out for them. It’s going to take a while.

Insurance premiums are three times more expensive than they were 18 years ago. Out of pocket deductibles for these plans are three times more expensive than they were 12 years ago. There’s a sea of red tape to wade through to help companies and patients get affordable, accessible, compassionate healthcare.

But… we won’t really know whether the cycle of escalating costs can be broken unless someone actually tries. Whoever tries will need deep pockets to succeed. And a fair amount of patience. This triumvirate of business tycoons has the money. Let’s hope they have the intestinal fortitude to see it all the way through.

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Same lies, different week.

They’re back.

Lawmakers in the U.S. Senate are trying to take away health care from the Americans they represent. Again.

The newest effort, the Graham-Cassidy-Heller-Johnson proposal, or Graham-Cassidy, as many are calling it, is pretty much the same effort that failed earlier, in a different package. I guess the only thing different about this one is that this time, four guys are actually stupid enough to attach their names to it.

But the basics of the bill are the same as others: Remove Affordable Care Act subsidies and replace them with block grants. Nice idea, but it really never works. And even if it sort of works, it only works on a state-by-state basis. So the truth is that, best case scenario, many patients in many states would have significantly reduced access to care. Even less access to care than before Obamacare was passed.

The bill also proposes to defund Planned Parenthood (again). Like I’ve said before, you can’t do that without saying to millions of American women that breast cancer screenings and other preventative procedures aren’t important to you. That’s a hard sell.

The bill also states that it will “protect patients with pre-existing medical conditions”. Well, excuse, me, but I already have that protection today. This bill doesn’t promise anything new on that, except the assertion that this “protection” they speak of would also come with significantly increased premiums for people living with pre-existing conditions like diabetes, high blood pressure, and yes, pregnancy.

Senator Lindsey Graham, in repeated interviews, has stated that I don’t have to worry, that I would still be able to purchase insurance if this passes. Hey, look, I can still purchase a $120,000 Tesla, but I can’t afford it. This is the same thing: Making health care a luxury product, rather than a right for all Americans.

It still comes back to the same thing for me. If a “repeal and replace” bill can’t offer at least the same access to coverage, at the same cost, as the Affordable Care Act does today, it’s going to be a non-starter for Americans. Especially since half or more of us live with those pre-existing conditions.

We’re tasked once again with defending our right to health care. Contact your elected officials right now. Once again, American lives are at stake.

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I admit it… I’ve got a great endocrinologist.

I like my endocrinologist. There, I said it.

Endos are sometimes a source of dread, or frustration, and some people wind up having to explain a lot about newer technology or drug developments to theirs because, let’s face it, diabetes changes sometimes move faster than their doctor.

But I don’t experience any of that. My last appointment a couple of weeks ago included the typical A1c, and a little blood work. Cholesterol, kidney function, that kind of thing. Vital signs, download of the pump data. Everything checked out okay, though I’m carrying around slightly more calcium than I should be. Who knew you could have too much?

We spent the rest of the time talking about a clinical trial I’m considering, about insulin pricing, and about a recent NBC Nightly News story on a family that peruses Facebook groups to find insulin their child needs, trading insulin their family’s insurance covers but their child is allergic to (“I wish some of my patients would ask about freebies… I have lots of samples!”).

Yes, she told me that she wished more of her patients would ask about insulin samples, if that’s what we’re even calling them now. Funny, I didn’t think to ask why she doesn’t suggest freebies for her patients. I’ll put that on the list to ask her next time.

We talked about starting on my Dexcom, since I was only about two weeks in when I saw her the last time. I told her, honestly, that wearing it on my arm has made it seem far less intrusive than if it were in my midsection. Which, by the way, is part of my trepidation of doing this clinical trial, because I’d be required to attach both the pump and the CGM around the middle of my body for the duration of the study.

I also mentioned that the CGM has given me real confidence that my basal rates are still very good, because once my trend graph lands in a good place, it tends to stay there for hours at a time. “But you’re going to let me know if you start training for something again, right? I remember that’s when you’ve had real trouble in the past”.

She knows me well.

We also talked about Dexcom Share. I don’t have an Apple phone, or a Pebble watch, and I’m not sure if the G5 is compatible with that anymore. We don’t agree on everything. But I trust her judgement enough that when she suggests something, even if I have questions, there’s a pretty good chance I’m going to do it and do it with gusto, because I trust her judgement that much.

Working with a medical team you can trust means a lot. The give and take between patient and doctor is a relationship that requires a fair amount of nurturing. And it’s changed over the two and a half decades I’ve been living with Type 1 diabetes.

But when it works out, the end result is terrific. It happens when both sides of the conversation engage freely and openly. It’s really great being with People With Diabetes, because they just get it. I consider myself quite lucky because I have an endo who gets it too. If you can’t talk about diabetes with another PWD, or your endocrinologist, who can you talk about it with?

I feel like I’m healthier, and making better, more well informed decisions than I’ve made under any other medical care team, endocrinologist or not. Finding people who help you with your diabetes and your diabetes knowledge are worth the effort. YOU are worth the effort. And I support you… no conditions.

Nobody ever died from Obamacare.

This week, Republicans in the House of Representatives rolled out what they had been trying to hide from the public for about a week: the “repeal and replace” legislation for healthcare.

Known as The American Health Care Act, the bill covers many things. In time-honored Republican tradition, it wants to eliminate the right to coverage in exchange for tax breaks. And that’s just the beginning.

What’s surprising to me though, is how much resistance to this legislation has materialized from nearly everywhere, including from conservatives. And I’m left wondering: why is the response to this different?

“We want a system that is affordable and accessible.”
Tom Price, Health and Human Services Secretary

I could write 10,000 words on how this bill would make health care unaffordable and inaccessible for millions who depend on Obamacare plans right now. Not to mention the incredible balloon to the federal deficit this bill would undoubtedly unleash.

But that’s not all. The bill also wants to reduce Medicaid expansion, putting a lot of the burden on individual states, which creates an atmosphere where health care could be more affordable in one state and less affordable across the state line; and mostly, on the people most likely to be hurt by that—the poor. These are not the people many decry as just taking a handout while providing nothing in return. Trust me: you don’t want to be a Medicaid recipient. But it’s better than nothing.

The bill also defunds Planned Parenthood. Now, you may not like Planned Parenthood, and I won’t try to change your mind on that, but if you want to put them out of business, you’ll have to find another way for women to get cancer screenings. Or women will die who otherwise don’t have to.

That’s a lot of what I think is missing from this debate. All I’m hearing is political spin about choice and tax incentives. Nobody seems to be talking about the people who will be bankrupted or killed as a result of the havoc that this legislation would enact. I’m not stretching to say that. Even Republican lawmakers admit that it will cost more.

“So rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on that, maybe they should invest in their own health care. They’ve got to make those decisions themselves.”
Rep. Jason Chaffetz, R-Utah

Well, representative Chaffetz, I do not have an iPhone. I do know many people who have iPhones because it’s the only mobile platform that will allow them to see real time blood glucose data on their children living with diabetes. You know, the disease they did not “make a choice” to get. Many of these parents are Republican, many are not. Their children still have diabetes.

He’s tried to walk that statement back after some initial uproar over its insensitivity, but even the walkback didn’t sound like much of a mea culpa. Overall, it still sounds like he’s repeating the stupid sound bites he’s been fed by his friends over drinks at the country club.

“If we did nothing, the law would collapse and leave everybody without affordable healthcare. We are doing an act of mercy by repealing this law and replacing it with patient-centered healthcare reforms.”
Rep. Paul Ryan, R-Wisconsin, Speaker of the House of Representatives

Failing after seven years. Seven. Not six months. Not a year or two. Seven. Years.

I know he and his Republican colleagues in congress have been trying to kill this law for seven years, and with all the power in the U.S. government at their disposal, they still can’t get it done. Why?

People and patients, conservative and liberal, can see right through the arguments. Not because of their political leanings. What’s missing here is the acknowledgement that both Republicans and Democrats have children, spouses, and parents who need and deserve care. They all have the same needs, and the number one need of all is to keep their loved ones alive. The number two priority is to keep them as healthy as possible without going broke.

People don’t need detailed actuarial analysis. They don’t need political spin. They need to answer three questions: Will I keep my coverage? Will it at least cover the same things that are covered today? Will it cost more?

So far, the answers to those three questions is Maybe, No, and Yes.

People understand that Obamacare isn’t the best thing ever. Many would like to chuck Obamacare into the river and start over with something new. Many are eager for that. But… they’re going to take care of themselves and their loved ones first. The reality is, if you can’t at least give people the same access to care without it costing thousands of dollars more, they’d rather have the devil they do know as opposed to the devil they don’t.

Bottom line: the proposed legislation needs to be at least as good as the legislation it wants to eliminate. Otherwise, if you’re one of the 20 million with coverage through Obamacare, or one of the tens of millions with a loved one being helped through Obamacare, why would you want a change? Don’t forget, there are Republican as well as Democrat voters in this group. By and large, the message I’m hearing from both sides is:

It’s not Repeal and Replace. It’s Repeal and Deny.

It’s not Repeal and Replace. It’s Repeal and Bankrupt.

It’s not Repeal and Replace. It’s Repeal and Kill.

No one ever died from Obamacare. As the debate on health care rages, let’s keep the focus right where it belongs. On American Lives.

It’s Thursday of #dBlogWeek. This is the post about The Healthcare Experience.

2016DBlogWeekBanner
Welcome to Diabetes Blog Week! Diabetes Blog Week is just like it sounds… diabetes bloggers all blogging on daily topics for an entire week. Or, in this year’s case, for five days. To find out all about Diabetes Blog Week and to sign up,
CLICK HERE.

As always, thank you to Karen Graffeo, creator and curator of Diabetes Blog Week. She’s awesome.

It’s Thursday… today, we’re covering The Healthcare Experience.
 
 
Most people who live with a chronic illness end up with a lot of experience when it comes to dealing with healthcare. How would you improve or change your healthcare experience? What would you like to see happening during medical visits with your healthcare team? How about when dealing with your health insurance companies? What’s your Healthcare Wish List or Biggest Frustration? Today is the day to share it all!
 
 
Today, I’m going with a suggestion from a Facebook friend whom I’ve never met, who would like me to talk about CGM coverage for Medicare recipients in the United States. They’re concerned that a recent story out at Insulin Nation, plus a couple others here and there, might be giving people the idea that Medicare coverage for continuous glucose monitors is a done deal, or a nearly done deal.

As much as I would like that to be true, the facts are that this is not true.

And that makes this issue similar to many issues when it comes to living with diabetes and getting the coverage for things that will help us live a better, healthier life.

You name it, insurers are doing their best to keep from covering it: the insulin of our choice, coverage to see a psychiatrist for our mental well being, coverage to see an orthopedist to look at frozen shoulder problems, and yes, Medicare CGM coverage.

Even when one patient wins a case, do you think that ends it? No… insurers are still going to try to appeal and get a legal authority somewhere who will agree with their point of view. Even when their point of view is not backed in science, or even recent science.

If I were to improve healthcare in this country, I would start by disassociating the budgetary (and for companies, profitability) concerns of every facet of managed care. The first question should always be, “what will help the patient the most?”. Only after that question has been answered should we begin to ask how expensive something truly is. And once we have determined how expensive the best treatment will be, we should commit ourselves to making it affordable for patients. Not if we can make it affordable; we should commit our resources and our best minds toward making it affordable. And accessible. For everyone.

When we dedicate ourselves to the idea that everyone deserves the best care, period, not the best care one can afford, we free ourselves from the burden of “how are we going to pay for it?” or “how can we get someone else to pay for it?”. It will happen. It will happen through grants for healthcare innovation, additional competition from insurers (not less, as some politicians are suggesting, unless they want to go single-payer-all-in), and through price controls. I still believe that the part of our government designed to protect the people should be bigger than the part that wants to help companies prosper. Companies never cured a soul.

Companies pursue mercenary agendas based on profitability. They will keep defending their right to do so. All I’m doing is defending my own right to manage my care with the tools I need to be successful. At a fair price, which, in case anyone is wondering, is a lot less than what I’m paying now.

So friends, don’t be fooled by the “Medicare might be covering CGM!” rhetoric you might read from time to time. Our issues are not going away until we collectively knock out every brick in the wall of managed, for-profit care that so many of us have run into during our lives with diabetes. Patients over profit, every time.
 

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