The Progressive Ensign

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Category: Health

Hospitals Cut Non-Compete Deals With Insurers

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab. Click on the Index Topic Name at the beginning of each post to see more posts on that topic on PC or Laptop.)

Image: wbur.org

Hospitals are the number one cost in health care nationwide at $1 trillion per year.  Healthcare is close to 20 % of the U.S. annual GDP.  Physician and clinical services are second followed by prescription drugs.

Sources: Centers for Medicare and Medicaid Services, The Wall Street Journal – 9/19/18

Hospitals are at the center of the most intense and high care treatments for surgeries, interventions, procedures and emergency care.  Most must take Medicare payments if they are to have a wide enough patient population to support their business. Yet, Medicare reimbursements often don’t cover the actual costs of treatment.  Hospitals look to employer – insurer plans and cash customers to make up the difference.

The Wall Street Journal investigated a number of hospital – insurer contracts and found in some cases the hospitals and insurers were cutting contracts which included non-compete clauses.  Thus, if a hospital had a dominant position in a patient market, it would require that the insurer not insure patients of their competitor.  Clearly, a restraint of trade, causing employer plans to pick up the balance, and in some cases where doctors were affiliated with hospitals employees were having to pick up the extra cost. Employers have seen premiums from insurers going up to handle the extra cost of these sweetheart deals.

These close partnership deals between hospitals and insurers create higher costs where services are much cheaper outside of the hospital in a doctor’s office.

Sources: Health Care Cost Institute, The Wall Street Journal – 9/19/18

Instead of hospitals steering patients to their doctors for many services, they provide the services on an outpatient basis at a much more expensive price. Insurers pick up the outpatient cost and then charge employers and patients higher premiums than necessary.

Next Steps:

 We have supported the Affordable Health Care Act provisions requiring insurers to insure all patients with existing conditions, and other patient oriented options.  However, this law is only the first step in reforming the healthcare industry, rigorous enforcement of anti-trust laws needs to take place to eliminate practices like these non-compete agreements.  We call for transparency in pricing of all drugs, and the relationship between drug manufacturers and pharmacies. We recommended in earlier posts that all Americans should have access to good quality health care, beginning with a healthcare account at birth. Then, as the patient takes a job, employer plans can be used, but always between jobs or disability the patient is covered.  Medicare should be the first line of insurance for all from birth with employer plans supplementing the main plan.  Medicare should have complete negotiating rights with drug manufacturers to get the best price for all patients.  All health care for profit companies should be barred from buying back stock and wasting money on executives which is better spent reducing prices and increasing the quality of care.

Driver Connects Patients with Cancer Treatments

Image: wahospitality.org

Cancer treatment in the U.S. cost $87.8 billion in 2014, with 1.7 million new cases being diagnosed each year.  In a analysis by the American Cancer Society, patients paid $3.8 billion in out of pocket expenses for their care in 2014.

Source: American Cancer Society – 4/2017

One of the major problems in cancer care is the physician centric model the U.S. has today, which can create major delays in treatment and sometimes mismatches the patient with a specific type of cancer with the correct care program.

Driver, a startup with over $100 million in venture backing has developed an application on the Internet to help patients correctly identify the type of cancer they have and match them to clinical trials and treatment programs. The software allows the patient to be proactive about managing the course of treatment without being totally dependent the treatment processes of their healthcare provider. Driver has partnered with the National Cancer Institute (NCI) to provide access to the latest information on cancer treatment trials. NCI has also validated the matching process that Driver employs.

“There is an air gap between knowledge and patients that has existed in cancer care since the 1850s,” said Driver co-founder Will Polkinghorn. “We want to close that space, “ in a recent Bloomberg interview.

The Driver app puts the patient in the driver’s seat so they are empowered to take command of their care.  As time is of the essence in cancer care, educating patients and giving them access to the information to initiate their care is crucial.  While the target is to provide the application and cancer identification workup at low cost, the initial trial starting this month in the U.S. and China will cost patients $3,000.

We have been an advocate of innovative ways to provide health care to patients.  Empowering patients to take direct management of their care instead of being dependent on a bureaucracy in a health provider network is an interesting approach.  Providing updated information, access to clinical trials with direct identification of the specific cancer the patient has, will possibly ensure greater accuracy and speed in the treatment process, thus saving more lives and reducing costs. Innovative solutions that disrupt the present status quo of extremely expensive health insurance, provider, drug manufacturers and federal government complex need to shift if we are to see a lower cost, higher quality healthcare system.  In particular, our Heartland healthcare providers are falling behind in providing standard health care to our people.  We need to turn this spiraling down in care with soaring prices, now.

Health Providers Not Paying Care Workers Enough, Administrators Too Much

 

Photo: aarp.org

There are 3.5 million direct health care workers in the workforce today. The Bureau of Labor Statistics estimates that another 1 million direct health care workers will be hired by 2024.  Direct healthcare workers include mostly all the assistant positions except a registered nurse: personal care workers, home health aides, and nursing assistants.

Sources: Bureau of Labor Statistics, Vox – 7/3/2017

Direct care workers often receive a wage below $15.00@hr.  About 90 % of  personal assistants receive $30,000 or less per year in income.  One reason wages are so low is that 70 % of all long term care costs are paid by Medicare and Medicaid.  These agencies reimburse care providers on a fixed cost basis. There is another reason. A high number of administrators are being hired rather than physicians, nurses or direct care workers.

Sources: Bureau of Labor Statistics, National Center for Health Statistics – 2010

When viewed from the perspective of healthcare spending per capita, administrator hiring was about 650 % more than overall per capita services.  Healthcare is a lucrative sector for business, so they focus on hiring more administrators and managers rather than nurses and direct care workers. Healthcare providers can take the wages they pay too many administrators and give caregivers the wages they need to take are of themselves and their families. The byzantine way the healthcare industry is structured with insurance companies between the providers and workers when we only need one government agency to manage insurance is a good example.  Most providers have who departments devoted to interacting with insurers and Medicare staff, which expensive to staff with specialized expertise due the idiosyncrasies of insurance policies.

Next Steps:

We clearly need to use computer systems and software to reduce the number of administrators and overhead in the system to the norm of per capita costs.  End the use of private insurers except as contractors to a single government agency, use a standard reimbursement procedure with no middle layers of pharmacy benefit managers and end go to middle managers for insurance companies.

In previous posts we have recommended:

The core need is to provide low cost effective health insurance for all people (like all developed countries do), so when illness strikes patients receive high quality care and become healthy again. Why do we need multiple insurance payers – private and the federal government?  If we were running a corporation we would not have two accounts payable departments?  We need to transition to individual health accounts that stay with the patient regardless of employment status beginning at birth.  Here are ideas on how this transition could work.

Complete Analysis of ACA – We need to learn from the public exchanges that work – California’s public exchange has been quite successful covering new patients, and keeping costs reasonable for low income patients.   Yet, we also need to look at why those exchanges like Oregon are not working well and expensive. Let’s summarize the analysis and publish the results so we can build a consensus around the solution, extending what works and recommendations for changes.

Priority One Cover the 9 Million Uninsured – those not covered by insurance need insurance now, we need to figure out how to cover 100 % of our citizens immediately. Offering a public option on the exchanges for basic health services and drug coverage would be a good start.

End State by State Coverage – state pools not large enough to make insurance work for all.  With 360 million people in the US we can make our health insurance pool work to reduce costs. Plus, legislation needs to be passed to reverse the Supreme Court decision to allow states to opt out of subsidies.  For example, Texas opted out on $10 billion subsidies leaving many low income families without insurance or very high premiums they cannot afford.  Interestingly, a few months ago I talked with a small business office manager in Texas, she complained that ACA was not working (her firm did not offer health insurance), for her hourly staff. Obviously, one reason is that Texas opted out of the subsidy program. Using a national pool would help to spread out the disparities between regions in terms of the rising cost of insurance versus stagnant wage increases.

Create Individual Health Accounts – funding can be setup via a payroll tax, accrued to a personal national health insurance account when working (if they don’t have employer options – to be transitioned later). For individuals or families below the regional poverty level they would pay no health payroll tax. For those individuals who are not contributing to their health account, the federal government would fund a basic health and drug account by progressive taxes on wealthy individuals over $250k and the increase taxes on corporate profits. Corporations can offset the increased tax, by offering lower cost insurance, medigap plans or encouraging their employees to move to the basic national health insurance program.

End COBRA – by setting up health accounts regardless of being employed, there is no need for COBRA plans.  Otherwise, for those unemployed to continue coverage often they have to pay soaring COBRA premiums up to 400 % of their employed premium rate.  For this author, two major illnesses occurred when I was unemployed, often with the stress of being unemployed is the time we need health insurance.  COBRA is another example where health insurers are charging outrageous rates to those who need the insurance badly but can least afford it. For the unemployed they could rely on basic health coverage in their individual health account.

Transition Employer Plans – convert employer plans over 4 years into a national personal health care account. Rollovers can be accomplished in a similar way to 401K to IRA rollovers (without the penalty for early withdrawal).  Ending employer programs will cut a layer of administration in benefits departments that more rightly belongs to the individual regardless of employment status.

End Penalties For No Insurance – we want to to tax behavior we don’t want and support or subsidize behavior we do want.  All Americans who have Social Security numbers should be able to enroll in a personal health insurance account, if they do not have a employer sponsored program.  Parents can apply for a SSN for their child to be covered.  A public insurance option should be offered to all those families not in employer sponsored programs. The public option run by Medicare is a basic health insurance program run similar to basic Medicare for seniors with medigap plans to cover the other 80 % of coverage needed.

Use the Medicare Drug Formulary – we don’t need multiple formularies and tiers of drug coverage. Medicare already provides one formulary which should be used as the industry formulary.  We need to empower Medicare to negotiate all drug prices and health procedures with providers with provision for regional differences on procedures.  A critical medication list can be created by Medicare for life threatening (Epipens) or serious chronic conditions (diabetes) capped at 5% profit for drug manufacturers.

End Stock Buybacks by Insurers – insurers need to end stock manipulation and the waste of stock buybacks. Companies like Aetna have spent billions of dollars on stock buybacks which would go a long way to reducing premiums and costs to patients.

Pricing needs to be transparent – similar to a mortgage disclosure statement. The explanation of benefits and drug claim form needs to be clear about the provider or drug price, any discounts and rebates, the price the insurer is paying, the price the provider is actually requiring, the price the pharmacy is paying and the exact out of pocket cost to the patient, with patient accruals in out of pocket and co pays toward insurance coverage.

Do it Without Waiting – let’s get progressive investors to back drug manufacturers that adhere to drug cost reasonable, critical med list, transparent pricing innovative insurance, publicize get more investors on board. Work with Wall Street to setup an ETF stock to focus on companies adhering to the progressive national health programs demonstrating good returns.

Awareness of What Works – A media campaign with surrogates, leadership in Congress, interest groups like the AMA, and the insurers to bring the American people along on the solution journey and to put pressure on Congress to pass the necessary legislation.

Health insurers would focus on medigap plans, taking risk out of innovative drugs to help speed them to market, vision and integrative medicine, personalized medicine, telemedicine – taking their layer out with reduce costs dramatically. They can be contractors to Medicare for transition to health accts. Or insurers can be contract administrators to Medicare, keeping costs low and utilizing their expertise.

Lets establish a lifetime health insurance program that provides good quality care, and low cost medications for all Americans.”

EPA Relaxes Coal Burning Regulations Endangering People and Economies

 

Image: agriland.ie

The day after that EPA announces relaxation of coal burning regulations scientists announced the first time in all recorded history the ‘last ice sea’ north of Greenland has thawed twice!  ­This assumption that ‘last ice sea’ would not thaw due to climate warming is no longer proving to be true. One scientist described the iconic ice thawing discovery as ‘scary’.

Sources: The Polar Science Center, The Guardian – 8/21/18

At the same time, global warming is causing the seas to rise by 8 inches since 1900 of which 3 inches was since 1993.  Scientists predict the sea level will rise another 3 to 7 inches by 2030. Today, rising sea levels are sending property values in low tidal areas spiraling down. University of Colorado and Penn State University researchers found that homes within just one foot of being flooded from a sea level rise were selling at a 14.7 % discount compared to homes on higher ground. Analysts have totaled property price losses since 2005 for Charleston at $265 million and Miami- Dade County at $465 million. Of course this is just the tip of the iceberg when considering all the coastal properties in the U.S. – losses are in the billions of dollars.

California has experienced the highest number and most acreage of wildfires in its history. Japan sweltered under hot July summer temperatures making new records. During the summer large areas of heat pressure or heat domes scattered around the hemisphere led to the sweltering temperatures. The Canadian Broadcasting Corporation notes the heat is to blame for at least 54 deaths in southern Quebec, near Montreal, which sweated under record high temperatures. The worldwide list of new high temperatures goes on and on.  The chart below shows extremely hot temperatures worldwide in a model at 2 meters above ground.

Sources: University of Maine, The Washington Post – 7/5/18

The relaxation of Obama administration clean air restrictions would possibly kill from 470 to 1,400 people per year the EPA admits.  The policy shift would move enforcement responsibility to the states, and allow them to relax regulations on coal burning plants even when installing new equipment.  Utilities would be allowed to use old standards when installing new equipment without having to meet higher air quality regulations.  The Obama era policies were never enforced because the Supreme Court found in favor of the states who sued to overturn the tighter regulations.

Next Steps: 

Enough is enough, the federal government is here to protect American lives not kill more people as a result of policy.  The government’s position makes no sense, it’s time we as citizens take a stand.

As we have said in a previous post:

“we may need to look to how to make duty more of a core value in our culture and in particular business culture.  As we have observed our country is essentially run by Corporate Nation States, they must change their attitude, behavior and operating practices focused on their duty to all the people not just their executives and customers. Everything a corporation does in some way impacts the Common Good. We are the people these corporations serve, and we should expect nothing less than socially responsible behavior from the executives running these huge Corporate Nation States.”

We would like the executives of these coal companies to think about the people that will get ill or die because they wanted to make more money and be ‘efficient and affordable’.  What if their daughter died?  How would they feel.  It seems that we are back to the point we made in last week’s Common Good post we ‘use people, and love things (money)’. This policy is dead wrong, and should never be implemented.  Instead, these corporations should be coming to us with proposals on how to save people’s lives and speed up the process of reducing climate warming. Maybe, these executives need to look themselves in the mirror and ask ‘who am I serving?’.  Time is running out, people are being killed in the heat, economies are being destroyed.  All these forces will cause civil conflict unless we act now to reverse the course of climate warming, before it is too late. 

GOP Administration Panders to Infant Formula Companies

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab.)

Photo: elle

Last May, the U.S. attended a multi-lateral World Health Assembly meeting held in Ecuador to finalize the language for promotion of breast feeding to developing countries with poor regions.  The policy recommended mothers breast feed their babies to promote better health than using possibly contaminated water with dry formula.  The risks of mixing infant formula with polluted water outweighed the possibly less breast milk that some mothers give their infants.

Source: Down to Earth – 3/22/18

About 11 % of the world’s population and 19 % of people in India alone do not have access to clean water.  For developing nations developing sources of clean water is crucial for their long term economic, and societal development. People drinking contaminated water suffer from multiple GI diseases, growth deformities and death.

U.S. representatives dropped long time support of over 40 years of research and other investigations in poor regions of the world noting the good health practice of breast feeding. Instead, the administration wanted all language recommending breast milk over infant formula deleted, including language focused on monitoring infant formula companies overly promoting their formula products.

Taking the corporate side is not new. In 1981, during the Reagan Administration  U.S. representatives at a WHO conference took the only position out of 118 countries against promoting the use of the breast milk over infant formula.

Breast milk provides anti-bodies, nutrients and other substances not available in infant formulas which are synthesized.  Obviously, when breast milk is not available infant formula maybe a good substitute temporarily when using clean water.

Next Steps:

The infant formula market is estimated to be $26 billion in 2017 growing to $66 billion by 2027. The industry is adding GMOs to its formula, offering organic versions and other approaches focused particularly on emerging countries where birth rates are much higher offering greater sales opportunities than in developed countries.  It is clear the infant formula industry has successfully lobbied the GOP Administration when it shifts policy that has been settled for decades promoting breast milk is best for babies to promote good health and longevity. Plus, other studies show the nurturing relationship of the mother with her baby during breast feeding is beneficial  to the social, and psychological health of the child.

The infant formula industry ought to understand their products depend on access to clean water to be effective as a compliment to breast feeding. The industry should shift  its resources from blind product promotion and lobbying efforts and instead help to increase access to clean water worldwide.  The infant formula industry needs to recognize their responsibility to support the common good promoting clean water and good health overall.

States Move Ahead of Fed To Reduce New Drug Prices

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab.)

Photo: healtheconomics.com

Several states including New York, Vermont, Massachusetts and California have begun initiatives to take on drug companies for the their exorbitant prices of new drugs.  New York is taking a price versus effectiveness approach with a new drug called Orkambi for cystic fibrosis.  The New York state Medicaid department is demanding a lower price as it is not clear the drug helps patients with the disease better than existing treatments. Vertex,  the manufacturer of Orkambi made $1.3 billion in sales from the drug which is a high sales level for a drug that is marketed to only 26,000 eligible patients.  Vertex prices Orkambi at $272,000 for one year of doses. The drug costs so much that some insurers pass on the high costs to patients in some cases $3000 per month.

Dr. Steven D. Pearson, President of the Institute for Clinical and Economic Review is working with New York officials on a state board case against Vertex to bring the price down.  The state board found that Orkambi did not meet the effectiveness claims by the manufacturer so New York should receive a 77 % discount.  Dr. Pearson said his evaluation of the costs indicated that the drug could be discounted by 77 %.

Major states like New York and California are taking on the drug companies with renewed interest as their Medicaid costs soar in part from new drugs where companies like Vertex price the medication at extreme multiples of a fair cost. While the GOP Administration has promoted some ideas to bring the cost of new drugs down, nothing to date has been done.

The U.S. is alone of all major developed countries in not directly regulating drug prices.  In Europe health services officials do not accept high prices for drug with marginal value and negotiate using their purchasing power to bring the price down.  Congress has consistently bowed to the drug lobby by not speeding generic drugs to the market and not including in any drug bill the power for Health and Human Services to directly negotiate the price of all the medications it covers for U.S. patients.

Source: Bloomberg – 5/11/18

In 2014, U.S. patients paid the most of ten developed countries at $1,100 per year out of pocket and for many patients with difficult treatment diseases the costs per year are significantly more.

Next Steps:

Time is up for the drug companies and insurers gouging patients with soaring prices while they make hefty profits and executives pocket huge compensation packages.  Drug companies need to stop buying back their stock, wasting the money that could be used to bring the price of their drugs by billions of dollars.  Congress needs to give HHS the power to negotiate prices and effectiveness limits on drugs of dubious value the way most developed countries in the world do today.  Over the past decade pharmaceutical companies have found that their exorbitant prices have not stuck in Europe or other developed country market, so they jack up the price of the medication in the U.S. where there is little regulatory constraint.

Federal Judge Strikes Down Medicaid Work Rule

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab.)

Photo: gcgi.com

Last Friday, a federal judge struck down a policy shift by the state of Kentucky approved by the GOP Administration to require all Medicaid patients to work, or volunteer to receive benefits.  Judge James E. Boasberg of Federal District Court for the District of Columbia, an appointee of President Obama, handed down a ruling that the Trump administration’s approval of the plan had been “arbitrary and capricious” because the plan had not provided for state support of medical insurance for all citizens “ a central objective of Medicaid.

We noted in our blog on the topic last January:

“The White House announced approval of a work requirement for Medicaid  recipients, yet most already work.  Why?  The Kaiser Family Family found in 2016 that 59 % of  Medicaid patients already work:

Source: The Kaiser Family Foundation – 2016

So of the 41 % not working who is going to work?  The Administration said those that are disabled, ill, in school or caregiving will not be required to work or provide community service. Does that mean that those that are retired will be required to find work? Only 8 % said they could not find work.  We view this as the beginning  of an effort to cut down the rolls and thus the costs of Medicaid.  Instead of being viewed as a welfare program, Medicaid should be viewed as medical insurance.  We don’t ask Medicare enrollees to work, and private insurers don’t ask for patients to work.”

We are pleased to see that Judge Boasberg agreed with us that Medicaid should be viewed as medical insurance not a benefit for work program.

The view that if people don’t work they don’t need health insurance is patently false. People need health insurance from the day they are born, whether they are working or not, married or not, being a volunteer or caregiver or not. What happens today is we all pay in increased premiums and health provider pricing for those that do not have insurance when health they use medical services.  Often, these uninsured patients are charged an exorbitant price which is not usually what the cost is of he service or test, they patient can’t pay it because they have no insurance, then the hospital writes off the loss.  Finally, to recover these unfunded losses the hospital charges more to other patients because the uninsured patient is an overhead cost.

Next Steps 

Our recommendation is for a national medical insurance program for all which is inclusive of employer based plans for those that are working.  We detailed our plan in our blog – The Free Ride Is Over: Time for Single Payer Insurance. As we noted in our call for a single payer plan:

The idea of insurance is that we establish a large pool of 360 million people, to spread the costs of the sick along with the well, so that when the well get sick they will have services that don’t cost an unreasonable amount.  The health insurers have somehow talked the American public into the idea that they get to cream off the well pool from the sick one (which is more expensive) and then sock it to people that are sick.  That is just plan wrong.”

EPA Abdicates Common Good Responsibility to Ensure Clean Water

 

Photo: commonfloor.com

The Wall Street Journal yesterday disclosed that Scott Pruitt, EPA Director, is working to limit the veto power of the agency over large projects impacting water quality. The agency has used the veto power sparingly – only 13 times since it was given the authority in the Clean Water Act of 1972.

Pruit believes the veto authority has gone too far impeding economic development, “I am concerned that the mere potential of EPA’s use of its… authority before or after the permitting process could influence investment decisions and chill economic growth by short-circuiting the permitting process,”, in a 4 page memo to regional staff.

Why is this clean water common good responsibility so hard to execute?   If a person dumped all his waste water and sewage in the street in front of his neighbors’  house, the neighbor would be upset and rightfully so. So, why do we treat mines, real estate developments, or port development any differently?  Is it because they are trying to make a profit while desecrating the land so it is ok?

Chromium-6 a known carcinogen made famous in the movie ‘Erin Brockovich’ has been found in the drinking water of millions of Americans. The non-profit Environmental Working Group has been monitoring the status of chromium-6  found in 2017 the substance in the drinking water of over 200 million people.  So, there are dangerous substances that still need to be monitoring in our drinking water.

The EPA has not taken in its public stewardship responsibility to the level of other countries, there are thousands of chemicals that can cause pollution and possible health hazards – none have been added to the pollutants list since 2000.  The list is small only 90 are covered in the Clean Water Act out of about ten thousand.  In the European Union they closely track over 2,500 different chemicals.

While the EPA is not as diligent as it needs to be, President Trump a year ago weakened the Clean Water Act requirement that mining companies ensure that water dumped into streams be cleaned to safe water standards.  The policy shift impacts the drinking water of over 117 million people.

Source: Scientific American, – 3/10/17

The GOP Administration continues to undermine protections in place for 40 years to ensure clean water is available to all citizens.  The lead levels found in Flint, Michigan water show that in some areas around the country the job is not getting done. Weakening the Clean Water Act in regard to mining dross and limiting the use of EPA veto on projects are just two examples of an indifferent and dangerous attitude by the agency.

Next steps:

In a Gallup poll 57 %  of the people said they favor ensuring environmental quality over economic growth when a decision needs to be made.

Source: Gallup – 4/2/18

When are we going to get a government that represents the will of the people on issues of our very survival like the environment?  The EPA Director worked as attorney general in Oklahoma relaxing environmental laws and now he is plowing ahead not protecting the public and not steadfastly defending the common good. Congress needs to act to update the Clean Water Act from updates in the 1980s, give the EPA a clear message that protecting the public is the first priority over economic costs.

Mississippi Life Expectancy Same as Libya – Why?

Photo: newsok.com

An insightful analysis in the Journal of the American Medical Association and the World Health Organization shows how far we are behind in Heartland medical care. A comparison of life expectancies in many of our Heartland states are as poor as many war torn or developing countries in pairings like, Mississippi – Libya, Tennessee – Gaza Strip, in a similar range as Libya and Gaza fall Kentucky, West Virginia, Arkansas, Louisiana, and Alabama.

Sources: JAMA, WHO, Signal The Wall Street Journal, The Daily Shot – 6/18/18

Many of these states in the South and Midwest have the highest rates of cancer, diabetes, and opioid use in the U.S. As globalization took many factory jobs away from the Heartland, medical service providers, doctors and other health professionals left for cities or the coasts where they had transferable skills and could make a better income. Plus, the number of rural hospital closures has been accelerating in the past 8 years with 120 going out of business since 2005. Researchers at the University of North Carolina who led the study believe the trend in more closings will continue to accelerate as costs go up, people move out and businesses are financially challenged.  Good health is often found where there are good incomes and healthy businesses.

We noted in our blog of March 25th that:

“Personal Income growth rates in heartland regions continue to lag the coasts by 3.8 to 2.0 % comparing income growth from 2016 to 2017.  The following chart from the US Bureau of Economic Analysis shows how large the gap is:”

Source: US Bureau of Economic Analysis, The Wall Street Journal, The Daily Shot – 3/26/18

“Core issues for the lack of growth are young people moving out, industrial companies leaving for non-union states or moving factories overseas, automation, poor health, slow Internet speeds and fewer education opportunities.  Added to these issues which have trended in these ways over the past 20 years are now tariffs on imports with soybean farmers threatened in the Midwest with a possible loss of $624 million where they already are competing with lower price soybean products from Brazil.”

As the Trump Trade War heats up prices of many Heartland agriculture crops have been falling such as soybeans by 2.20 % and corn by .62 % today alone.  As prices and foreign customers find other suppliers Midwest and South farmers will find their customers have moved onto other countries hurting sales.

Other tariffs in steel and aluminum are squeezing Midwest businesses.

“In the advanced manufacturing sector which is based in the Midwest and South will likely see increases in imported aluminum and steel prices of between 10 – 25 % used in their products they resell. These price increases threaten their ability to compete and may have to lay off workers.”

The situation is in a downward spiral, as federal tariff and trade policies don’t help in turning around the economic, health and educational opportunities for these mostly rural regions.

Next Steps:

Our heartland neighbors continue to feel under siege from many different directions.  We discuss these issues in our blog – The Hallowing Out of America’s Heartland.  We recommend that a major set of investments be made with the federal government providing seed funding for a partnership between non-government organizations, health services providers, universities, corporations and state and local government.  To bring focus to the development process we propose that Heartland Development Centers (HDCs) be located in key regions maybe near a major university – land grant universities are good candidates located in rural communities. Experts from across the country in HDCs would join together with local leaders in customizing solutions to build entrepreneurship centers, high quality health services, high speed Internet services, job and career training and other services necessary to renew the economic vitality of these regions.

GOP Administration Announces Work Requirement for Medicaid To Reduce Rolls

Photo: ahrq.gov

The White House announced approval of a work requirement for Medicaid  recipients, yet most already work.  Why?  The Kaiser Family Family found in 2016 that 59 % of  Medicaid patients already work:

Source: The Kaiser Family Foundation – 2016

So of the 41 % not working who is going to work?  The Administration said those that are disabled, ill, in school or caregiving will not be required to work or provide community service. Does that mean that those that are retired will be required to find work? Only 8 % said they could not find work.  We view this as the beginning  of an effort to cut down the rolls and thus the costs of Medicaid.  Instead of being viewed as a welfare program, Medicaid should be viewed as medical insurance.  We don’t ask Medicare enrollees to work, and private insurers don’t ask for patients to work.

Next Steps:

Enroll US citizens into healthcare insurance at the time of birth (our blog in depth),  establishing a healthcare account with Medicare for all.  The idea of insurance is that we establish a large pool of 360 million people, to spread the costs of the sick along with the well, so that when the well get sick they will have services that don’t cost an unreasonable amount.  The health insurers have somehow talked the American public into the idea that they get to cream off the well pool from the sick one (which is more expensive) and then sock it to people that are sick.  That is just plan wrong.

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