Healthcare cost Archives - Marilyn Singleton, MD JD

Culture & Society, Doctors, Featured, Health Policy, Healthcare Reform, Medicine, Politics, What's New

America Out Loud PULSE: Save Money on Your Medical Bills

August 8, 2023 No Comments

From my America Out Loud Pulse podcast with Marshall Allen –https://www.americaoutloud.news/how-to-take-charge-of-your-medical-bills/

According to the Congressional Research Service (CRS), health spending represents 18.3 percent of our gross domestic product (GDP). Americans whether individually, through insurance, or through the government spent $4.3 trillion ($4,255.1 billion) or $12,914 per person in 2021. Out of pocket spending was 10.2 percent or $433.2 billion. Out of pocket expenses are coinsurance, deductibles, and services not covered by insurance but does not include insurance premiums.

As health expenditures grow year after year, politicians relish using costs and access as a campaign issue but only in the last few years have pushed for price transparency – that’s the buzzword of the day. Only in health care do we routinely make use of a product or service without knowing the cost beforehand. According to one study, employees who used a price transparency tool paid between 10 percent and 17 percent less than employees who did not have access to the service.

For the last few years, hospitals have been required to post online, in a consumer-friendly format, the rates they’ve negotiated with insurers for 300 common medical services. Unfortunately, these prices are written in billing jargon and hard to understand. Moreover, the prices differ within the same institution depending on whether the bill is paid by Medicare, private insurer or self-pay.

One thing we’ve learned so far with this data is that physician-owned hospitals both commercial negotiated prices and cash prices in physician-owned hospitals were about one-third lower than their competitors across eight common services and have higher quality care.

Recently, Congress has put forth a few transparency bills designed to let the consumer know the inner workings of their insurance contract. The Hidden Fee Disclosure Act (HR 4508) requires disclosure of the details of contracts of pharmacy benefit manager and third party administration services for group health plans contracts. The Health Data Access, Transparency, and Affordability Act or Healthcare DATA Act (HR 4527) would ensure that a group health plan’s fiduciaries may access de-identified information from providers, third party administrators, and pharmacy benefit mangers relating to health claims. The Transparency in Coverage Act (HR 4507) would convert a 2019 rule into a law requiring health insurance plans to publicly share negotiated rates and cost-sharing estimates, and the number of claims that are denied, among other things.

But it could be that insurance is the root of cost evils. Even with the inappropriately named Affordable Care Act, the premiums have gotten higher every year. The average person in America pays $456 per month for marketplace health insurance. According to the Kaiser Family Foundation (KFF), in 2021, the average cost of employee health insurance premiums for family coverage was $22,221. The average annual premium for a self-only plan was $7,739. Employers paid about 80 percent of those premiums.

Surveys published by the American Hospital Association in July 2023 looked at the effects of the practices of commercial insurers. The surveys found that some 80 percent of patients, nurses and physicians say insurer policies and practices are reducing access to medical care, driving up health care costs and increasing clinician burden and burnout.

So, what is the immediate answer for you to pay less for your medical care? My guest will discuss some tools for fighting a system that is not looking out for you.

Key websites to visit:

https://www.marshallallen.com

Newsletter – https://marshallallen.substack.com

Allen Health Academy (videos) https://www.allenhealthacademy.com

Medical Care Prices – https://www.fairhealthconsumer.org;
https://www.healthcarebluebook.com/explore-home/;
https://turquoise.health;
https://healthcostlabs.com.

Bio

Marshall Allen is a journalist who has spent more than fifteen years investigating the health care industry, exposing the insidious ways the system preys on vulnerable Americans: price gouging, sloppy billing, fraud, insurance denials, unnecessary treatment and more. He is also the founder of Allen Health Academy, which produces a curriculum of short on-demand videos to equip and empower employees to navigate the health care system. He is the author of “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.” Mr. Allen’s work has been honored with several journalism awards, including the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting and coming in as a finalist for the Pulitzer Prize for local reporting. He also has a master’s degree in Theology. Before he was in journalism, Mr. Allen spent five years in full-time ministry, including three years in Nairobi, Kenya.

Culture & Society, Current Events, Health Policy, Healthcare Reform, Politics, What's New

America Out Loud PULSE: Six Lessons in Healthcare Mythology

May 30, 2023 No Comments

From my America Out Loud Pulse podcast with Robert Graboyes, PhD – https://www.americaoutloud.com/six-lessons-in-healthcare-mythology/

The cost of medical care is a big topic in healthcare policy discussions – whether in Congress or in think tanks. Over the last few years costs for medical care have continued to rise. Until 2021 with the out-of-control inflation medical care prices have generally grown faster than overall consumer prices. From 2000 to 2022, the price of medical care, including services, insurance, drugs, and medical equipment, has increased by 115.1 percent, whereas prices for all consumer goods and services increased by 78.2 percent.

Hospitals “facility fees” are of particular concern. Facility fees are generally the price for using the hospital premises – the overhead charge in addition to professional charges. Some hospitals are charging such fees for telemedicine. Additionally, one large private insurance data analysis showed that the facility fees for emergency department use from 2004 to 2021 increased four times faster (531%) than professional fees (132%) for emergency department evaluation and management services. And until 2021 with the out-of-control inflation medical care prices have generally grown faster than overall consumer prices.

Healthcare policy isn’t just about saving money. Otherwise, we would simply ration care. Real human beings underlie the reason we provide medical care in the first place. Accordingly, we have to look at limitations on access for certain groups, the impact of cost-cutting on quality, the ethics of rationing, and many other factors affecting the individual patient.

My guest taught the economics and ethics of healthcare for 20 years and his overriding theme throughout those years was, “Always be skeptical.” He notes that “healthcare policy debates tend to be drenched through-and-through with myths, opinions, and politics—all masquerading about as scientific facts.”

Halloween’s Over: Take off the Masks

November 12, 2019 No Comments

At a graduation of a family friend, out of the blue, one in our group began lamenting that progressives tended to live in cities. She proposed that progressives should move to rural areas and “purge [such areas] of those awful conservatives.” Thus spake the tolerant Left. I was stunned. Given the festive occasion, I kindly reminded her that this is America and we are lucky that we have all kinds of people. I wanted to ask her what we should do with the conservatives. Re-education camps? Death by a continuous loop of Bernie Sanders speeches?

It is unfortunate that such unreasonableness isn’t isolated within the D.C. swamp containment zone.

These pied pipers who offer free college, free food, free medical care, and free money for simply having a pulse freely admit they have no idea how to pay for it. Oh, yes: tax the “rich” and corporations who will pass the tax on to consumers and employees in the form of higher prices and lower wages. And eventually the heretofore untouchable middle class will be taxed directly. Let’s not forget that free food and housing are components of slavery.

These Einsteins are scientists when it comes to global warming and evolution but think it’s medically acceptable to permanently sterilize 7-year olds to avoid appearing like a “transgender” bigot. Science lesson: there are 2 genders. Every human has 23 pairs of chromosomes. The X chromosomes and Ychromosomes determine sex. With rare exceptions of random abnormalities, female is XX and male is XY.

These self-described health care experts try to debunk innovative medical care delivery methods like direct pay and direct primary care subscription practices by claiming these are reserved for the rich. A mere $1,500 per year ensures that you and your doctor, make your medical decisions—not the government. These “experts” are the same people who prop up the medical-insurance-government industrial complex at the expense of private physicians, writing laws that favor big-box retail clinics staffed by non-physicians. These swamp creatures equate physicians with “mid-level” practitioners with one fifth the training and education as physicians—but likely demand the chairman of the department when they themselves need medical services.

These compassionate legislators are keen on the government taking over the “social determinants of health,” including loneliness. I anxiously await an army of a government operatives coming to our homes and telling us to be happy or else. Most people just want to control their own lives, even if their life does not fit the government blueprint. If you want your life to be your own, and your body to be your own, then you cannot let the government’s foot in the door.

These forward thinkers decided it was good public policy to ban children’s fathers from the home in order for the family to receive government funds. It became normalized for the federal government to be the daddy.

These elitists castigate the middle class for not wanting homeless people sleeping and defecating in front of their houses for which they worked two jobs, saved, and sacrificed for years. Their remedy is a tent city in a middle-class neighborhood that is nowhere near theirs. These people do not want to admit that the disintegration of the family and the moral decay leading to drug use and detachment from society is the first problem that must be addressed.

And the biggest hobgoblins of them all are the peddlers of faux racism. Americans do not wake up every morning hating on each other. They ponder their family’s safety and keeping a decent job to pay their bills. Something is seriously wrong, indeed demented, when a former First Lady—unchallenged—claimed that white Americans are “still running” from minority communities when they move to another neighborhood. Perhaps they are getting away from homeless encampments (with mostly white people) or poorly run government schools in Democrat-controlled cities. Get over yourself.

Everything is not about race. Get out in the real world and sit at a local bar or cafe in central Mississippi and watch blacks and whites eating and laughing together. Who is the hatemonger?

America has had a few tragic well-publicized racially motivated incidents. Undaunted, we continue to strive for liberty for all—despite the calculated enmity and scab-picking by rich and famous black people who ran away from minorities to live on a $15 million estate on Martha’s Vineyard (and not in Oak Bluffs) and who expect us to swallow their vitriol-laced baloney.

This insanity is patently sick and sickening. It is about power at any cost and not what can help move America forward.

Health Policy, Healthcare Reform, Law, Medicine, Op-eds, Socialized Medicine

Fraud and Anonymity: The Perils of Medical Care Bureaucracy

October 8, 2019 No Comments

By Marilyn M. Singleton, MD, JD

The high cost of medical care is on the lips of every politician and draining the pocketbooks of most Americans. After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance. Piling on more laws, regulations, and agencies is not the answer.

Anonymity, complexity, and opacity invite shady behavior. Individuals, companies, and patients who defraud the massive federal “health system” would never dream of lifting money from their patients’ wallets or stealing from their doctors’ cash drawer.

The government’s track record does not bode well for imposing more bureaucracy to remedy a problem created by the layers of third-party payer bureaucracy. Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments. By contrast the typical private business loses 5 percent of its revenues to fraud. Unfortunately, since its inception in March 2007, the Medicare Strike Force has recouped less than $2 billion per year in misappropriated funds.

Medicare’s $16.7 billion per year hospice program is fertile ground for the unscrupulous. Hospices are paid a fixed daily sum for each patient enrolled “regardless of the services provided.” One amoral scheme recruits patients who unknowingly forgo curative treatment options by joining hospice. A recent Office of Inspector General (OIG) report revealed that in 2012 hospices billed Medicare more than $250 million for services to patients in long-term care or assisted-living residences who did not require hospice care, costing four times more than the appropriate level of care. Even worse, the OIG found that the quality of care suffered in 31 percent of programs. The bureaucratic morass allows the perpetrators to pocket the fixed fee and skimp on the services.

Further, the government cannot keep track of its program dollars. According to another OIG audit, in 2009, Medicare Prescription Drug program paid $33.6 million and hospice patients paid $3.8 million for medications that should have been included in the hospice daily fee. Even after discovering the snafu, the problem got exponentially worse. In 2016 the government paid $160.8 million for drugs that hospice organizations should have paid for from its fixed daily fee. Our tax dollars paid for the drugs twice.

Physicians know what patients want and are acting on it. Free from the restraints of government “healthcare” programs, the physician-led, price-transparent, direct-pay Surgery Center of Oklahoma performs some surgeries for less than the copays of some insurance policies. Direct Primary Care physicians provide 24/7 access and basic labs for as little as $50 per month with at-cost medications and low-priced x-rays.

The corporate private sector has learned a thing or two from innovative physicians. Care Accelerator is Sam’s Club’s version of “affordable [medical care] options with transparent pricing.” To offer relief from high out-of-pocket costs, $50 (individual) to $240 per year (families) buys access to lab screening for diabetes and heart disease, free generic drugs, telehealth, and up to a 30 percent discount on vision, dental, and other ancillary services. Additionally, Walmart is training its own employees for jobs in the health sector and ideally to staff Walmart’s own medical services. For their employees, Apple has “health care built around you” with its AC Wellness that offers office and home visits; Amazon launched its Amazon Care telemedicine services.

Given the outrageous price of drugs—largely due to the pharmacy benefit manager middlemen—Good Rx discount coupons are just what the doctor ordered. Good Rx is free to the consumer and makes money from advertisements on the website and referral fees. One typical victory is a Medicare patient whose neurologist prescribed a drug for his Parkinson’s disease symptoms. The government demanded testing that could not be done because of the patients debilitated condition. Despite a sympathetic ear and supporting research, the government arbiter could only parrot the party line: because the drug was not on the “list,” it was not covered by Medicare. In a fortunate twist of fate, with a Good Rx coupon the patient paid $34 per month cash instead of the drug’s $1,100 per month price with 20 percent patient co-pay that would have been charged through the Medicare Prescription Drug program.

Congress claims it plans a full-frontal attack on the high cost of medical care (with the same results as the war on poverty and drugs?). Frankly, we are better off with Congress engrossed in its impeachment clown show and keeping its nose out of our medical business.

Bio: Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

Media & Press, Medical Ethics, Medicare, Medicine, Op-eds, Politics

Propaganda, Pandering, and Politics

July 23, 2019 No Comments

By Marilyn M. Singleton, MD, JD

For the next one and a half years we will have to endure the hyperbole, apocalyptic predictions, fake outrage, half-truths, and frank lies of politicians. Some kind soul should take pity on us and pass out beans to put in our ears.

Of course, we should expose ourselves to many opinions, but we have to be careful about propaganda. Propaganda, an ugly word, is viewed as more than mere opinion but information that is somehow manipulative, misleading, or not telling the whole truth.

Propaganda came to mind during a meeting I attended where well-heeled teenage girls sporting AOC for Congress T-shirts preached to the captive audience about how the government should pay for college tuition, books, and housing for everyone, while extolling the virtues of socialism. Had their parents heeded Vladimir Lenin’s “Give me four years to teach the children and the seed I have sown will never be uprooted”? Then some adults with vapid smiles admonished us that we should believe the young ladies, not because they provided statistics or pros and cons of the value of college for everyone, but because they are young and our future. This brings out one propaganda tool: it’s for the children.

Why would we willingly give up any of our freedoms and turn over our pocketbooks to the government because some nouveau socialists fed us propaganda? Because it works.

Look at the Social Security Act. No one would turn down the promise of financial security in old age, or as President Roosevelt said, a safeguard “against the hazards and vicissitudes of life.” I question if people think it is a good deal to pay more than 15 percent of your paycheck (including employer’s “contribution” and Medicare tax) to the government, thus taking your future savings out of your control. If you die young you get nothing; your savings go, not to your children, but into the government’s black hole.

Patients and doctors alike have been sucked in by statements of questionable accuracy. In promoting the Affordable Care Act, President Obama on multiple occasions assured us, “if you like your doctor you can keep your doctor, if you like your health plan you can keep your health plan.” The ACA likely would not have gotten traction if he had said, “We don’t know what the insurers will do after the ACA is passed, so good luck.”

Electronic Medical Records (EHRs) were part of the bumpy road to the ACA. President Obama, promised that EHRs would “cut red tape, prevent medical mistakes and help save billions of dollars each year.” The unwary believed the puffery versus the facts.

The promise: EHRs are efficient. Reality: Hundreds of different brands mean that the records cannot be exchanged between physicians, but they can be sent to the Office of the National Coordinator for Health Information Technology.

The promise: EHRs save time. Reality: Doctors spend half their time on the computer rather than talking with patients.

The promise: EHRs save lives. Reality: Software problems have memorialized incorrect information. One in 5 people surveyed by Kaiser Family Foundation has found a mistake in their records.

The promise: EHRs are private. Reality: There were more than 2,000 data breaches of 176.4 million patient records between 2010 and 2017.

It sounds so virtuous to insist that “healthcare is a right.” Thus, if you do not believe medical care should be free, you are not a moral person. This technique echoes Aldous Huxley’s view that “the propagandist’s purpose is to make one set of people forget that the other set is human.” (Of course, bearing arms is a constitutional right, but guns are not given away for free. Indeed, gunowners are thought by some to be horrible people). Free medical care for all is short, simple, and seductive.

The promise: Medical services are free. Reality: Government may deny the request for prior authorization for your treatment, or ration treatments for older folks, such as hip and knee replacements and cataract surgery. In the government health system 307,000 Veterans might have died waiting for medical care.

The promise: Drugs are free. Reality: The medication your physician thinks is best for you is not on the government’s formulary.

The promise: There are no without out-of-pocket costs. Reality: Private health insurance is abolished, leaving no consumer choice.

The promise: It’s free! Reality: Your taxes will be raised to heights unknown.

“Free” is America’s new verbal Potemkin village of health care, where Susie gets a free birth if she survives her abortion, free medical care for life, and even free food. All Susie has to do for herself is breathe. This is a panderer’s view of America. In fact, we are a country of individuals who want to govern their own lives and of physicians who want the freedom to properly care for their patients.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Healthcare Reform, Medicare, Medicine, Op-eds, Socialized Medicine

Hoaxes, Scams, and Your Medical Care

April 10, 2019 No Comments

By Marilyn M. Singleton, MD, JD

Hoaxes and scams have been dominating the news lately. We have a marginally known actor faking a hate crime supposedly to raise his Hollywood profile. His attempt to claw his way to the middle could have resulted in race riots, injury, and death. His punishment? All charges dropped.

The scandal about Hollywood and other elites buying their children’s way into top-rated universities really hit home. I remember when I had tutored some recent Vietnamese immigrants for a debate contest to win a scholarship for college. I could only hope that their hard work was rewarded and not wiped away by special favors bestowed on the “haves.”

Now we continue to have a slew of healthcare hoaxes: corporate stakeholders, legislators, and government agencies promise everything and have no accountability for their failure to keep their promises.

Take the large health systems’ claim that hospital consolidation and buying up physician practices would benefit consumers with cheaper prices from coordinated services and other unspecified savings. A major study of California hospital mergers found just the opposite. The analysis showed that the price of an average hospital admission went up as much as 54 percent. When the large hospital systems bought doctors’ groups, the prices rose even more. There was as much as a 70 percent increase in prices of medical services in geographic areas with minimal competition. This finding seems obvious to any of us who has the choice of shopping at Walmart or Target or Costco.

Logic aside, some legislators believe that having the government take over medical care would solve our access and cost problems. Single payer means no competition whatsoever. The single payer plans (H.R. 1384 and S. 1804) that abolish private insurance leave patients with an empty choice. Patients can contract with a physician to pay cash for government medical services covered by the government. But if the physician contracts for such services he cannot be part of the government program for any patient for 2 years. Realistically, these single payer bills make it financially unfeasible for physicians to privately contract with patients. Thus, only well-heeled patients, along with independently wealthy doctors, can buy their way out of the system.

There are variations on the theme of government involvement that allow buy-ins to Medicare, Medicaid, or iterations of the Affordable Care Act marketplaces. All of these all have the same defect: expanding the government healthcare monopoly.

The opioid crisis is an example of the unintended consequences of intervention by oversight agencies not directly involved in patient care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), now the Joint Commission, a nonprofit organization that accredits more than 20,000 healthcare organizations and programs in the U.S, is for all practical purposes a government surrogate. In 2001, JCAHO declared that pain was the “5^th vital sign” that had to be addressed or face consequences. The Federation of American Medical Boards told physicians that “in the course of treatment,” large doses of opioids were just fine. Moreover, Medicare has a hospital payment formula that relies on patient satisfaction surveys. If the patients are satisfied, including being so zoned out on opiates that they can’t taste the bad food, the hospital is paid more. The hospital is penalized for a bad rating.

And now to deal with the opiate issue, the government has issued guidelines that have been found to be harmful to some patients. One-size-fits-all restrictions have caused physicians to fear being flagged as over-prescribers by the medical board. Consequently, some physicians are tapering patients off opioids more quickly than they would ideally like. And in the public eye patients have been transformed from objects of compassion to criminal drug addicts.

Individualized medical care must not be reserved for the chosen few. Patients need physicians who are empathetic, thorough, and not married to a medical cookbook written by disinterested third parties. Perhaps this is why Mick Jagger of the Rolling Stones chose to have his heart surgery in the U.S. and not with his British homeland’s National Health Service.

Central control is not a good idea. Period. Do not believe the hoax perpetrated by the ruling class who will never have to live by their own rules. It is highly unlikely that Venezuela’s President Maduro is starving along with his people.

BDr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. She lives in Oakland, Ca.

Health Policy, Healthcare Reform, Medicine, Op-eds, Politics, Socialized Medicine

Jumping Into Medicare For All With Eyes Wide Shut

February 27, 2019 No Comments

by Marilyn M. Singleton, MD, JD

The unveiling of the ballyhooed House of Representatives Medicare for All Act of 2019 bill will be met with chants of “equal healthcare for all!” While the country will be forced into a government-run program, the limousine liberals and champagne socialists will keep their array of medical care choices — whether on or off the record.

A key feature of the Medicare-for-All bills is the elimination of private health insurance that duplicates benefits offered by the government. Given the coercive nature of the existing Medicare program, we should be very concerned. Medicare Part A (hospital insurance) is mandatory for those eligible for Medicare who receive Social Security payments. If beneficiaries want to opt out of Part A, they must forfeit all of their Social Security payments — including paying back any Social Security benefits received up to the time Part A was declined. So a “beneficiary” is punished for saving federal dollars by declining to be on the government healthcare dole.

Enrollment in Medicare Part B (all physician and most outpatient services) is not mandatory but beneficiaries are financially coerced to enroll. The standard 2019 Part B premium amount is $135.50 per month, progressing to $460.50 based on income. But if a beneficiary doesn’t sign up for Part B when first eligible, he must pay a lifelong penalty of 10 percent for each full 12-month period that he could have had Part B. So if the beneficiary waited 3 years before signing up, he would pay a 30 percent higher premium throughout his lifetime.

Medicare Part D (prescription drugs) also imposes penalties on those who do not sign up when eligible unless they are in a Medicare Part C/Medicare Advantage HMO that covers drugs. The lifetime penalty is not trivial: one percent per month of the average monthly premium (currently about $33) for all the months they were not signed up.

Will we be somehow punished if we do not want to enroll in the new government program? Will there be an “individual mandate” penalty? Hopefully we’ll know before the bill is passed and we can find out what’s in it.

Another troubling aspect of a new government health program is the lack of an articulated budget or cost controls. According to the Medicare Board of Trustees 2018 Report, Medicare’s Part A trust fund will be depleted in 2026, three years earlier than the 2017 projection. Our 2017 healthcare costs were $3.5 trillion with $1.2 trillion attributed to Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Apparently, financing would depend on monies earmarked for existing federal health programs, heavily taxing “the rich” and an unspecified increase in everyone’s taxes.

In addition to notoriously underestimated cost projections, Medicare underpayments to hospitals must be addressed. Hospitals receive 88 cents on the dollar from Medicare and 90 cents on the dollar from Medicaid for their expenditures on these patients, translating to reimbursements of $41.6 billion and $16.2 billion, respectively, below actual costs. Currently, hospitals make up the shortfall with higher payments from private insurance — which will no longer exist. Slashing oft maligned CEO salaries would be a drop in the bucket. Hospital workers — unionized or otherwise would not accept pay cuts.

So how will the inevitable funding shortfall be addressed? Private practitioners may be enticed by the promise of a steady stream of patients and income or strong-armed into submitting to lower reimbursement or by new licensing requirements. Of course, many of us remember being paid with IOUs from the California Medicaid program.

The promise of completely “free” medical care of every sort imaginable gives one pause. What happens when the money runs out? Because Medicare defines what care is reimbursable as “medically necessary,” the simple answer is to decrease covered services. But by then, the private health insurance industry would be decimated and our options limited.

Proponents of government-sponsored healthcare say people want it. But a 2019 Kaiser Family Foundation survey found that enthusiasm wanes when folks are told they would (1) lose their private insurance, and/or (2) pay more taxes and/or (3) have longer waits.

Direct pay independent physicians may be the salvation. Many Medicare patients are paying for direct primary care where a modest monthly fee direct to the physician guarantees full access to a physician, inexpensive medications and lab tests. Some specialists treating various chronic conditions such as diabetes also use this model to provide patients with timely individualized quality care.

The same people who clamor for a woman’s reproductive choice are strangely silent about everyone else’s freedom to choose the type of medical care they want. Patients and physicians should be free to pay for services and accept payment for services without being subject to penalties.

Medicare for All could be one of those concepts that “seemed like a good idea at the time” – just like diving head first off a cliff into an inviting but shallow pool of water.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Health Policy, Healthcare Reform, Law, Medicare, Medicine, Op-eds, Socialized Medicine

The Healthcare Revolution: More Choices, Not More Taxes

December 20, 2018 No Comments

By Marilyn M. Singleton, MD, JD

Paris is in flames over a fuel tax increase that would pile 30 cents onto the $7.06 per gallon price paid by citizens whose average monthly salary is $2,753.This burdensome “carbon tax” on the middle class is intended to help meet Europe’s commitment to reduce carbon dioxide emissions and thereby halt global warming or climate change. It appears that the 21^st century French Revolution has begun. This time, Brussels is sending in tanks to protect the new elite and its agenda.

Back in the states, some well-heeled, presumably well-intentioned Medicare-for-All advocates from California, New York, and New Jersey are grousing about how “Trump took away my homeowners tax deduction!” The Tax Cuts and Jobs Act now caps the previously unlimited federal tax itemized deductions for the combined state, local and property taxes at $10,000. The portion of a mortgage on which interest can be deducted is limited to $750,000, down from the current limit of $1 million.

Folks with million-dollar homes who continue to vote for legislators who impose high state taxes to finance their pet social programs are less sympathetic than the French Yellow Vests—especially when these same elitists want to take away the “crumbs” from the 80 percent of taxpayers who are receiving some relief from the near doubling of the standard deduction.

But everyone will face still more taxes to fund Medicare-for-All. Bernie Sanders’s financing plan would “limit tax deductions for the wealthy,” defined as $250,000 per household. Sanders also proposes eliminating health savings accounts (HSAs), which allow patients to take charge of their own care. And it won’t stop there—or at the equivalent of 30 cents per gallon.

It’s not just the taxes: it’s the loss of the freedom to choose. The M4A bills prohibit virtually all private health insurance. M4A promises “free” access to “willing healthcare providers”—but robs us of choice. Even existing Medicare offers 11 supplemental insurance programs with options for different premium structures. Purchasers can decide to pay a little more now for a stable premium price as they age, or pay quite a bit less and anticipate the age-related increase over the years. But, you say there would be no premiums with M4A. Wrong. The “premiums” are increased taxes. And taxes are not optional. You must obey.

We should take a cue from the French (minus the fires and looting). We need a middle-class medical care revolt against the elitists and politicians who think more government through high taxes is The Answer while ignoring community solutions. For example, We Do Better, a humanitarian movement, seeks out solutions to social problems based not on a particular political ideology or lobbyist’s effort, but on what works. In Southern California eight Clinica Mi Pueblo (CMP) clinics accept only cash, have transparent pricing on their website, and their services cost less than half of the price set by third parties. Where the average charge for an X-ray is between $260 and $460, CMP charges only $80. Utah’s Maliheh Free Clinic (MFC) serves low income and uninsured residents who are ineligible for Medicare, Medicaid, or any government subsidized healthcare. The MFC provided free healthcare to more than 15,000 patients in 2016 at an average cost of only $56 per patient, and 95% of donations to MFC go to providing medical services. New Jersey’s Zarephath Health Center is a volunteer-run and funded facility for patients who cannot find care “in the system.” Here it costs $15 to see a patient, versus $160-$280 at the Federally Qualified Health Center down the street.

Another increasingly popular model is direct primary care (DPC). Here, patients pay a monthly subscription fee to the practice (between $40 and $100 depending on age and family size), which covers all primary care services, certain laboratory tests, and at-cost pharmaceuticals at as much as 15 times less than the price at the pharmacy. The personal relationship with a physician enhances the care to patients with chronic conditions, reducing costly hospitalizations. Catastrophic insurance can cover major medical expenses. St. Luke’s Family Practice in Modesto, California is a DPC non-profit organization. Here, “benefactors” pay the fees for the “recipients” – those who cannot afford the fees.

Then there are many health care sharing ministries where members engage in voluntary sharing of costs for its members’ health needs. One such model, the Christian Healthcare Ministries (CHM), has plans that cost half as much as ACA Marketplace plans. It has more than 279,000 members, and has covered more than $1 billion in medical bills since 1981.

Americans want authority over our own lives. Our innovative spirit and generosity have created and will continue to create ways to deliver medical care to the most people without sacrificing choice—and at a more affordable cost.

Dr. Singleton is a board-certified anesthesiologist. She is also a Board-of-Directors member and President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

Doctors, Health Policy, Healthcare Reform, Medicine, Op-eds, Politics

Judge Kavanaugh’s Character Assassins Could Be Controlling Your Medical Care

September 24, 2018 No Comments

by Marilyn M. Singleton, MD, JD

Our legislators have been at their worst over the Supreme Court confirmation of Judge Brett Kavanaugh. What a shameful display: condescending, arrogant show-boating senators questioning him in a manner reminiscent of the Grand Inquisitor. The only things missing from this B-grade movie were the rubber hoses and interrogation lights. Some of us remember that you could count on one hand the “nay” votes for the confirmations of ACLU attorney Ruth Bader Ginsberg and known conservative Antonin Scalia.

This last-ditch effort to derail Judge Kavanaugh’s confirmation is more than mere political theater; the interrogators are immoral and beyond hypocritical. The “Lion of the Senate,” Ted Kennedy, killed a woman and former Senate majority leader Robert Byrd was an Exalted Cyclops in the Ku Klux Klan, and we all know about President Clinton. But that’s okay; their lapses in judgment were somehow worth our compassion and forgiveness.

Imagine if these political hacks were in charge of your medical care. Medicare-for-All as planned is the exclusive purveyor of medical “benefits.” If you want a medical service they do not want you to have, you are on your own.

The government is already shaping the way we use medical services. The Palliative Care and Hospice Education Training Act (PCHETA), S. 693 and the companion bill H.R. 1676 passed by the House and is now before the Senate Health, Education, Labor, and Pensions (HELP) Committee. This bill dedicates $100 million in additional taxpayer dollars to persuade patients to forgo treatment that might prolong life in exchange for a steady stream of increasing doses of narcotics. Perhaps knowing that many physicians still adhere to the Oath of Hippocrates, the legislators included multiple non-physicians and non-medical personnel as recipients of these funds.

Including outsiders in decision-making must be undertaken with caution. Hospice/palliative care has become the new growth industry in our “health system.” Compared to home health care, hospice had significant growth in 2017 – increasing 6.5 percent in one year. Further, according to the Medicare Payment Advisory Commission the “Increase in hospice is driven by for-profit providers” which made up two-thirds of the 4,400 hospices in 2016.

Why direct $100 million for a new medical specialty in relieving pain and suffering, a skill all physicians should embrace as part of a comprehensive treatment plan? The focus on palliative care may be one more bipartisan incremental under-the-radar step along the road to government control of our medical care. Subtly devaluing life softens us up and primes the pump for rationing – without having to pass a sweeping single payer bill that is bound to draw attention and criticism.

Ironically, within days of passing the Palliative Care bill, the Senate passed a huge package of some 70 bills designed to reduce opiate abuse. Unafraid to practice medicine without a license, the Senate legislated prescribing mandates and penalties for failure to comply. And the government is developing a “system of care” where all people will receive “appropriate” and “evidence-based” care for pain.

So now physicians may be under pressure to relinquish their patient to a palliative care specialist and prescribe medications according to government dictates. This is wrong. Our patients must never have any doubts that every treatment their physician administers is in their best interests.

We must not allow the whims of politicians to direct our medical care. Physicians must refuse to be tools of the government. Patients must decide whether they want their tax dollars spent on developing cures and life-saving treatment – or programs that steer them toward the least costly alternatives.

Can we trust our medical care to legislators who are willing to sacrifice their integrity on the altar of partisan politics — legislators who are willing to destroy a man’s life in their naked quest for power? Can we trust that doctors who oppose their agenda will not be treated like Judge Kavanaugh by medical boards, hospitals, and courts?

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Doctors, Health Policy, Healthcare Reform, Medical Ethics, Medicine, Socialized Medicine

Medical Care in 2018: Ring Out the Broken Promises and Bring In Solutions

January 9, 2018 1 Comment

By Marilyn M. Singleton, M.D., J.D.

The U.S. “health care system” continues to be a costly behemoth. Health care costs were the number one financial concern for 17 percent of families in 2017—the same level as it was in 2007 pre-Affordable Care Act era. And only 18 percent of those polled said the Affordable Care Act helped their family.

The ACA did not work as promised.

“If you like your health care plan, you can keep it.” Unfortunately, health insurance companies canceled plans for 4.7 million people. Many insureds chose to have inexpensive, limited plans to cover major expenses. These plans however were not ACA-compliant as they did not contain the mandated 10 “essential health benefits” with no copays or deductibles. While many of these required “benefits” are medically useful, many (e.g., pediatric vision and oral care, maternity care, breast cancer genetic screening, mammograms, and female contraception) are superfluous for childless unmarried men.

“I’ll also bring Democrats and Republicans together to provide every single American with affordable, available health care that reduces health care costs by $2,500 per family.” Kumbaya? The ACA was passed in the dark of night with only Democrat votes. Affordable? Overall costs to the consumer have risen dramatically.

In 2008, the cost of the average employer-sponsored family plan was $12,680, with an employee share of $3,354. The 2016 cost topped out at $18,142 with a $5,277 employee cost. In the individual market, the biggest losers are those who earn a little too much to qualify for federal premium subsidies, particularly the self-employed in their 50s and 60s. For a bronze-level plan with a health savings account, a three-person family can pay $15,000 a year in premiums and paid out-of-pocket for the first $6,550 of medical expenses for each family member.

Moreover, many insurers have requested—and will likely receive—double-digit premium increases for 2018. Nationally, the increases between 2017 and 2018 for unsubsidized premiums for the lowest-cost bronze plan averaged 17 percent, the lowest-cost silver plan averaged 32 percent, and the lowest-cost gold plan averaged18 percent.

“We’ll start by increasing competition in the insurance industry.” That was a colossal failure. Overall, the number of insurers in the individual market has decreased since 2014. In 2017 UnitedHealth Group eliminated ACA Exchange plans in 31 of 34 states and Aetna remains in only four states. Humana and Aetna plan to exit all ACA Exchanges in 2018.

Agreed, some Americans gained health coverage. Medicaid and the Children’s Health Insurance Program (CHIP) accounted for 14.5 million of the 20 million of newly covered. The 2014 cost per non-disabled adult and child enrollee was $3,955 and $2,602, respectively. Some 27.5 million people remain uninsured with cost cited as the main problem.

Further, being “covered” was meant to keep emergency departments (EDs) from being used as an alternative to primary care. But according to the federal Agency for Healthcare Research and Quality (AHRQ), the number of emergency department visits covered by Medicaid increased by 66.4 percent between 2006 and 2014, outpacing population growth by a factor of two, making Medicaid the leading payer for ED visits.

These data tell us we must have a serious conversation, not intellectually lazy political slogans, like “Repeal and Replace!” Instead of ruminating about how to modify the government’s involvement in medical care, Congress and policymakers should ask how can we take better care of more patients and be open to all suggestions.

One successful model is direct primary care (DPC) mainly seen in solo and small medical practices. Here, patients pay a monthly fee (generally ranging $75 to $150) directly to the physician’s office for 24/7 access, and in many cases, basic labs and medications, and steep discounts on radiology and pathology services. Also growing are direct pay specialty and surgical practices where the fees for the operating room, surgeon, and anesthesiologist are included in one low price. And yes, many of these practices (even in California) offer sliding scales and charity care without running afoul of rigid federal regulations.

With DPC, patients spend more quality time with their doctors and physicians can shed the administrative burdens of government programs and insurance companies and treat patients according to their best judgment. A testament to the success of this model is the University of Michigan offering such a program this spring. Hopefully, the big boys won’t ruin a good thing.

ObamaCare’s individual mandate is dead. It’s time to use our healthcare dollars wisely and pay for the medical care, not the middlemen.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton