Friday, February 3, 2017

Obamacare Replacement

Obamacare was set up to have healthy people pay for the healthcare of sick people. It was a bad deal for most Americans, so they voted for Trump. The US population is 325 million and the average cost of healthcare is $10,000 per year. The total healthcare spending in the US in 2015 was $3.25 trillion.

50% of the US population are healthy and only spend $264 a year on healthcare. They may not even buy any health insurance or they might set up a pre-tax medical savings account.  They might buy a policy that limits their exposure to catastrophic injury or illness, if it’s cheap enough.  They are happy to see the end of Obamacare and look forward to cheaper insurance that is customized to fit their needs. Obamacare was loaded with “one size fits all” unnecessary coverage and nobody really needs that. Obamacare

The sickest 1% of the population or 3 million people spend 25% of total healthcare spending.

The sickest 5% of the US population or 15 million people spend 50% of total healthcare spending.

Medicare was adopted because insurance companies couldn’t handle the high expense of the really sick people and a lot of them are over age 65. 

Medicaid was adopted because insurance companies couldn’t handle the very sick who are also poor.

Insurance companies will have to return to offering policies for catastrophic coverage, but the really sick folks will need to go somewhere. If they their premium matches their medical bills, that premium could be $100,000 per year.

These are the folks Congress is trying to figure out how to handle. These are the folks who need to have their illnesses treated at a much lower cost. I would look at the sickest 5% and put them in a reformed Medicaid program, cancel funding for non-critical federal programs and transfer those funds to Medicaid block grants to handle the sickest 5%. Many of these folks are in Medicare and Medicaid already, but their treatment plans should be cost reduced.

There is a lot of unnecessary costs in healthcare.  The healthy people don’t really need doctor’s visits and they don’t need to get expensive screenings. Self-exams work fine.

Hospitals are making an unnecessary fortune giving cat scans, MRIs, stress tests and bouncing patients around to specialists. They do this as part of hospital admission and don’t give patients a quote. Determining a diagnosis should start with the cheapest test. Multiple diseases have the same symptoms.

Malpractice lawsuits need to be replaced by complaints to County Medical Associations. Defensive medicine needs to end.

Big Pharma is gouging patients with unjustified costs of medicines needed for critical care.

Pain usually means inflammation and that is treated with anti-biotics.  It makes more sense to get a doctor to prescribe a $6 bottle of anti-biotics than it is to go to the hospital for $40,000 worth of tests that don’t identify the problem.

Type II Diabetes is treatable by the patient cutting meals in half to lose 30 lbs. Hernias can be treated the same way by building up stomach muscles..

A self-exam for breast lumps is cheaper than a mammogram. Taking eye vitamins is cheaper than having cataract surgery.

Post-op infections are common; they add to unnecessary costs and need to be prevented.

Non-targeted radiation and chemo treatments have failed to save cancer patients. More targeted treatments may work, but it’s too soon to tell.

The new healthcare law needs to make providers quote the cost of treatment and quote lower cost alternatives so patients can shop around.

Data Sources: See Healthcare Cost Solutions, January 28, 2017 on this blog


No comments: