Independent Women's Forum RSS feedhttp://www.iwf.orgThe RSS feed for the IWF. News, Commentary and Blog posts from the Independent Women's Foundation.(...)IWF RSShttp://iwf.org/images/email-logo.pnghttp://www.iwf.org33968UK wait times a warning over 'right' to see the doc<div> <p> The&nbsp;<a href="https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7281" target="_blank">report from the House of Commons,</a>&nbsp;published Oct. 16, examined the &ldquo;demand, performance and capacity&rdquo; of medical services in England through its National Health Service, a single-payer system that has served the public for approximately 80 years.</p> <p> According to the report, the waiting list for hospital treatment has jumped 40 percent over five years to a record level of 4.5 million waiting for a hospital bed.</p> <p> &ldquo;Cancer waiting times have risen,&rdquo; the report admits, to the point that the goal of treating people within two months of a referral &ldquo;has not been met consistently since 2013.&rdquo;</p> <p> &quot;They have problems pretty frequently,&quot; <span style="color:#ffffff;"><span style="font-size:14px;"><strong><span style="background-color:#ea425b;">Hadley Heath Manning</span></strong></span></span> of the&nbsp;<a href="https://www.iwf.org/" target="_blank">Independent Women&#39;s Forum</a>&nbsp;says of the UK. &quot;They&#39;ve had problems related to women&#39;s health. They&#39;ve had problematic flu seasons where their hospital systems simply cannot accommodate surges in demand.&quot;</p> <p> The new NHS report hits at the same time Democratic presidential candidates are calling for &ldquo;free&rdquo; health care for Americans, vowing to crush insurance companies, and declaring the right to see a doctor without pay should be a legal right.</p> <p> &ldquo;Democrats believe that health care is a right, not a privilege<a href="https://democrats.org/where-we-stand/party-platform/ensure-the-health-and-safety-of-all-americans/" target="_blank">,&rdquo; the party website states,</a>&nbsp;&ldquo;and our health care system should put people before profits.&rdquo;</p> <p> The main face of the &ldquo;free healthcare&rdquo; push remains Sen. Bernie Sanders, who introduced his Medicare for All bill earlier this year and claims a majority of Americans, including Republicans, support it.</p> <p> \The UK and its NHS are&nbsp;<a href="https://feelthebern.org/bernie-sanders-on-healthcare/" target="_blank">mentioned on a Sanders&rsquo; campaign website</a>&nbsp;&ndash; but not favorably &ndash; because the senator claims he doesn&rsquo;t support government ownership of hospitals and employment of its doctors and nurses, the website claims.</p> <p> Manning tells OneNewsNow the UK&#39;s health care system is a bureaucratic system that is not &ldquo;well-suited&rdquo; to overseeing health care.</p> <p> &ldquo;Which has to be responsive to the individual needs of millions of patients,&quot; she adds.</p> <p> According&nbsp;<a href="https://fullfact.org/health/how-nhs-funded/" target="_blank">to its own website,</a>&nbsp;England&#39;s free health care is not free: 80 percent comes through taxes and 20 percent is funded through National Insurance payments that come from employers, employees, and the self-employed.&nbsp;</p> <p> &quot;The NHS in England is funded mostly through general taxation and National Insurance contributions,&quot; the website summarizes. &quot;A much smaller proportion is collected through patient charges, for things like prescriptions and dentistry.&quot;</p> <div id="storyEditorsNote"> &nbsp;</div> </div> <div> <div data-description="An eye-opening report from the United Kingdom shows hospital wait times have skyrocketed in recent years, fueling warnings in the U.S. that “free” health care will literally kill you." data-title="UK wait times a warning over 'right' to see the doc" data-url="https://onenewsnow.com/culture/2019/11/07/uk-wait-times-a-warning-over-right-to-see-the-doc" style="clear:both;"> <div aria-labelledby="at-19d7eb4c-715c-4f88-aa7a-0adaade87c5e" id="atstbx2" role="region"> &nbsp;</div> </div> </div> <p> &nbsp;</p> http://iwf.org/media/2811037/Hadley HeathThu, 7 Nov 2019 08:11:00 CSTen-usIndependent Women's ForumInsurance as a government program would jeopardize healthcare <p> <a href="https://berniesanders.com/issues/medicare-for-all/" target="_blank">Senators Bernie Sanders</a>&nbsp;(I-Vermont), Elizabeth Warren (D-Massachusetts) and other supporters of single-payer healthcare say it would level the playing field and provide everyone the same form of coverage.</p> <p> &quot;People who have healthcare under Medicare for All would have no premiums, no deductibles, no co-payments, no out-of-pocket expenses,&quot; Senator Sanders told NBC&#39;s Savannah Guthrie in a&nbsp;<a href="https://www.nbcnews.com/politics/2020-election/democratic-debate-transcript-july-31-2019-n1038016" target="_blank">July debate</a>&nbsp;featuring candidates for the Democratic Party&#39;s presidential nomination. &quot;They will pay more in taxes, but less in healthcare for what they get.&quot;</p> <p> &quot;The simplicity of Medicare for All is appealing,&quot; comments Hadley Heath Manning of the&nbsp;<a href="https://www.iwf.org/" target="_blank">Independent Women&#39;s Forum</a>&nbsp;(IWF). &quot;Everybody would have the same plan, and it&#39;s an easy way to make sure that everybody in the United States has health coverage. [But] I won&#39;t call it health insurance because at that point, it&#39;s not really insurance; it&#39;s a government program.&quot;</p> <p> Manning says it is important to bear in mind that having health coverage is not the same thing as having healthcare.</p> <p> &quot;People might be very unpleasantly surprised to learn that in other places that have tried a single-payer healthcare system like Medicare for All, people end up facing much more difficulty accessing doctors, accessing healthcare services,&quot; Manning warns. &quot;Waiting lists are very common, emergency rooms are more crowded, and people even in Canada use emergency rooms more than people in the United States.&quot;</p> <p> That is even for non-emergency care, Manning explains, as &quot;they simply have no other and better option.&quot;</p> <p> &quot;So while Medicare for All would reach its stated goal of universal coverage, and it would replace the myriad of private options that people have for insurance coverage today in the United States, it would not be an improvement when it comes to access to healthcare,&quot; Manning continues. &quot;In fact, in many cases it would put that access in jeopardy.&quot;</p> http://iwf.org/media/2810992/Hadley HeathMon, 4 Nov 2019 09:11:00 CSTen-usIndependent Women's ForumWarren Struggles to Answer How Americans Would Afford Medicare for All• After the Bellhttp://iwf.org/media/2810986/Hadley HeathThu, 31 Oct 2019 17:10:00 CSTen-usIndependent Women's ForumUnfair Trade Policies Artificially Forces Winners and Losers • Making Money with Charles Paynehttp://iwf.org/media/2810944/Hadley HeathFri, 25 Oct 2019 14:10:00 CSTen-usIndependent Women's ForumWhat to Look For in a New Energy Secretary • Coast to Coasthttp://iwf.org/media/2810878/Hadley HeathFri, 18 Oct 2019 19:10:00 CSTen-usIndependent Women's ForumBreakdown of Social Security Adjustment • Making Money http://iwf.org/media/2810845/Hadley HeathFri, 11 Oct 2019 15:10:00 CSTen-usIndependent Women's ForumTrump Executive Order On Medicare Draws A Contrast With Democratic Plans To Control Health Care<p> President Trump&rsquo;s new executive order on Medicare, the government health insurance program for seniors, will provide seniors with more options and more savings and help make the program fiscally solvent for future years.</p> <p> This direction is a stark contrast to the Democrats&rsquo; healthcare agenda of &ldquo;Medicare-for-all.&rdquo; While Democrats want to replace the private health insurance market with Medicare for everyone, President Trump wants to reserve Medicare for seniors only. In fact, he wants to make Medicare more like the private market, and, as demonstrated by his other actions on health care, he wants to make the private market more functional, competitive and affordable for patients of all ages.</p> <p> Medicare-for-all is packaged in the politically attractive concepts of equality and assurance for every person. No American wants to see a neighbor or friend face high medical bills or the uncertainty of going uninsured. Medicare-for-all falsely promises to protect people financially while giving equal access to healthcare services.</p> <p> But the U.S. has long had safety-net programs in health care designed to protect vulnerable populations. Since the 1965 Great Society agenda became law, Medicare has covered virtually all of the nation&rsquo;s seniors, and Medicaid has covered people with low-incomes. Even before these programs, the U.S. provided medical care for veterans.</p> <p> President Trump&rsquo;s approach to health care focuses on strengthening existing government healthcare programs. He seems to understand that expanding these programs beyond their original scope will only weaken them for the populations for whom they were designed.</p> <p> He&rsquo;s right. The Medicaid expansion in the Affordable Care Act (ACA), or Obamacare, shows what happens when a safety net program is stretched too thin. Both now and before the ACA, all 50 states offered coverage to low-income pregnant women, children, parents, people with disabilities, and the elderly (&ldquo;dual-eligible&rdquo; for Medicare). But the ACA offered states an incentive to expand coverage to able-bodied childless adults up to 138 percent of the federal poverty line. Thirty-five states opted in.</p> <p> The incentive was federal money. Specifically, the Medicaid expansion offered an enhanced federal matching rate for newly eligible enrollees. This amounted to the federal government paying states more to cover able-bodied childless people than to cover the traditional Medicaid population, which is generally more vulnerable. Talk about upside-down priorities.</p> <p> Medicaid already faced inferior health outcomes and access. More enrollees only worsened this problem.</p> <p> Any expansion of Medicare &mdash; whether it&rsquo;s Medicare-for-all or a slower-paced &ldquo;Medicare Buy-In&rdquo; &mdash; will have a similar effect, to the harm of Medicare&rsquo;s current population of senior citizens. Today we have a government program designed to serve seniors. If Medicare were open to all Americans, we would no longer have a program specifically designed to benefit seniors.</p> <p> And all of this is not even to mention the fiscal side of the equation. Medicare&rsquo;s Trustees presently project that the program will be solvent only until 2026. And it&rsquo;s a wonder Medicare has made it this far without going bankrupt, considering that the average senior takes out $3 in benefits for every $1 he paid in.</p> <p> This isn&rsquo;t sustainable for the 60 million seniors currently in Medicare, much less for the 327 million lives in the United States.</p> <p> By committing to preserve Medicare for seniors, President Trump is committing first and foremost to not expanding the program.</p> <p> He&rsquo;s also committing to improving Medicare: Consistent with his other actions on health care to expand choices for the general population (such as short-term and Association health plans, as well as the expansion of Health Reimbursement Accounts), President Trump is instructing his administration to expand plan options for Medicare patients, to expand choices for where and how they consume care, and to capitalize on the success of the Medicare Advantage model, wherein seniors use Medicare dollars to enroll in private health plans.</p> <p> Importantly, this order would remove the near coercion into Medicare that seniors face: It unlinks Medicare from Social Security, providing seniors, for the first time, the ability to completely opt out of Medicare and keep their retirement benefits.</p> <p> Americans are rightly fed up with the status quo in healthcare, which represents neither a fully socialized system nor a free and competitive private marketplace. With this latest executive order, President Trump has demonstrated that he will advocate for the latter, even as his Democratic opponents move toward the former.</p> <p> At the very least, Americans now see two contrasting visions shaping up: Do we want Medicare-for-all, which would offer only one coverage option for all patients, or do we want a robust marketplace alongside a strong safety net reserved for only the truly vulnerable?</p> http://iwf.org/news/2810807/Hadley HeathWed, 9 Oct 2019 15:10:00 CSTen-usIndependent Women's ForumA Better Path Forward: Administration Outlines How Medicare Should Work • After the Bellhttp://iwf.org/media/2810757/Hadley HeathThu, 3 Oct 2019 08:10:00 CSTen-usIndependent Women's ForumWhy I Took a Concealed Carry Handgun Class<p> I was pregnant with our second child (a son) the day I went to my daughter&rsquo;s preschool for a tour. The kind head of school showed us the classrooms and talked about their philosophy on early childhood education. Then, she told us about school safety, including the preparations in place in the event of a school shooting.</p> <p> Maybe it was the pregnancy hormones, or just the thought of my then two-year-old daughter huddling with other toddlers in the corner of a classroom in a lockdown situation, but I lost it. I started crying. It was embarrassing!</p> <p> But it made an impression on me. As mass shootings cycle in and out of the news, I share the fears of many people &ndash; that I could be in the wrong place at the wrong time. God forbid my kids are with me.</p> <p> I&rsquo;ve had a gun for self-defense for about 10 years now. I even owned my handgun when I got mugged near Washington, D.C., in 2010, but I didn&rsquo;t have it with me as I was getting tackled by a stranger who jumped out from behind a bush. I practically pushed my purse at him, hoping he&rsquo;d be satisfied with that and just run away. Luckily, he did.</p> <p> I try to remind myself that overall, violence in the U.S. &ndash; including gun violence &ndash; is <a href="https://www.pewresearch.org/fact-tank/2019/01/03/5-facts-about-crime-in-the-u-s/">way, way down</a>. I don&rsquo;t want to have fears that are out of proportion with reality. But I do want to be prepared. So I decided to get my Concealed Carry Permit. Here&rsquo;s a video I took right after my handgun class that explains my motive a little more:</p> <p style="text-align: center;"> <iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/UmDrtKqYB3U" width="560"></iframe></p> <p> When I arrived at the class, offered by <a href="http://www.gunfightingintl.com/">Gunfighting International</a>, I met the instructor, Paul Gregory, and my 11 classmates for the day. Paul is a police sergeant with 20+ years experience, including about 15 years of SWAT team experience, and a father of three boys. He&rsquo;s passionate about helping law-abiding citizens learn about how to defend themselves and others. Here&rsquo;s a photo of Paul and me:</p> <p style="text-align: center;"> <img alt="" src="https://i1202.photobucket.com/albums/bb366/IWF11/2019%20blog%20photos/IMG_9269_zps2lhaftaa.jpg" style="width: 500px; height: 376px;" /></p> <p> Our class was half male, half female. That kind of surprised me, because I tend to associate shooting with men, but I also know that the biggest growth in CCW permits nationwide has been among <a href="https://www.foxnews.com/us/concealed-handgun-permits-surging-blacks-women-lead-growth">women and blacks</a>. Three of my classmates were not white.</p> <p> The guy sitting next to me came to the U.S. as a refugee from war-torn Kosovo. His perspective was interesting: He emphasized that he hoped never to shoot a person, because when you do that, &ldquo;you take their whole humanity.&rdquo; But he also deeply appreciated our freedom to defend our families and ourselves. He asked how many guns Americans were allowed to have, which got a good chuckle from the rest of the room. &ldquo;Yes,&rdquo; was Paul&rsquo;s answer.</p> <p> On the other hand, another classmate mentioned that he thought the whole idea of concealed carry permits turned our freedom upside down. &ldquo;Why should we have to get a permit from the government to exercise our Second Amendment right?&rdquo; he pondered. And yet he said he wanted to get the permit to follow the letter of the law.</p> <p> Interestingly, concealed carry permit holders are the most law-abiding segment of society, even more so than police. According to criminologist John Lott, CCW permit holders are convicted of misdemeanors and felonies at one-sixth the rate of police officers, who are themselves a more law-abiding group than the general population.</p> <p> Here are some of my law-abiding classmates practicing their shooting:</p> <p style="text-align: center;"> <img alt="" src="https://i1202.photobucket.com/albums/bb366/IWF11/2019%20blog%20photos/IMG_9267_zps5djwkuza.jpg" style="width: 500px; height: 375px;" /></p> <p> The first few hours of our class were in a classroom setting. We introduced ourselves and explained a little bit about our interest in the class. Most people cited personal safety, with a couple of people (professional drivers) citing their working conditions as less than perfectly safe. Several parents (including me) mentioned the desire to keep our homes safe for their children.</p> <p> First, we talked about what Paul called the &ldquo;awesome responsibility&rdquo; of owning and carrying a firearm. Safety is always the number one priority.</p> <p> Then we talked about what kind of gun and ammunition is best and how to clean, maintain, store and handle our guns. Here&rsquo;s my gun, after I took it apart (as I would if I were cleaning it, which I do after any training outing).</p> <p style="text-align: center;"> <img alt="" src="https://i1202.photobucket.com/albums/bb366/IWF11/2019%20blog%20photos/IMG_9246_zpsoj0y9pna.jpg" style="width: 500px; height: 375px;" /></p> <p> Then we spent a great deal of time talking about what the law says. Paul shared copies of the state laws in Colorado that pertain to use of physical force in defense of a person (others or oneself). We discussed a ton of &ldquo;what if&rdquo; situations, many of which pertained to what&rsquo;s legal and what&rsquo;s not, but also some that posed personal judgment calls, like when to get involved in a situation and when to simply flee.&nbsp; Paul provided us with a helpful framework for this kind of &ldquo;decisional shooting.&rdquo;</p> <p> We also talked about gun-free zones, like schools, and how to honor them. Ironically, the majority of mass public shootings (<a href="https://crimeresearch.org/2019/07/breaking-down-mass-public-shooting-data-from-1998-though-june-2019-info-on-weapons-used-gun-free-zones-racial-age-and-gender-demographics/">89 percent</a>) take place in gun-free zones.</p> <p> We reassembled our guns and did some handling of them (unloaded) in the classroom, just to get familiar with the moving parts and proper grip.&nbsp; Then it was time to hit the range, which was just outside. Here I am shooting at a target:</p> <p style="text-align: center;"> <img alt="" src="https://i1202.photobucket.com/albums/bb366/IWF11/2019%20blog%20photos/IMG_9251_zpsfmt0fdhp.jpg" style="width: 375px; height: 500px;" /></p> <p> We covered the basics of shooting and practiced several turns firing on our paper targets. Each turn, I grew more confident in quickly loading the magazine in my handgun, racking it, aiming it, and firing it. Paul was there to help us maintain good stance and grip, and most importantly to make sure we were being safe (pointing our guns downrange, keeping our fingers off the trigger until time to fire, etc.)</p> <p> At the end of the course, my classmates and I all received certificates of course completion. (Mine is pictured below.) The next step is to turn this certificate in, along with <a href="https://www.colorado.gov/pacific/sites/default/files/Concealed%20Handgun%20Permit%20Application.pdf">this form</a>, to my county sheriff&rsquo;s office. In Colorado, I also have to pay $152.50 in fees for my permit, which will be mailed to me.</p> <p style="text-align: center;"> <img alt="" src="https://i1202.photobucket.com/albums/bb366/IWF11/2019%20blog%20photos/IMG_9270_zpszldudscl.jpg" style="width: 500px; height: 375px;" /></p> <p> If you&rsquo;re interested in taking a CCW course, look for one in your state. If you plan to own a gun, I highly recommend it. I feel much better about having a gun in my home after this course; it helped me think through how I might use it in what I call a &ldquo;God forbid&rdquo; situation &ndash; if my children or my personal safety were in danger. And when my permit comes in the mail, I&rsquo;ll be able to carry a concealed gun with me if I choose.</p> <p> I&rsquo;m under no delusion that by carrying a gun I can lower the chance that my kids face a threat at their school (a gun-free zone) or that I will be some kind of hero in a violent situation. But I do feel, like my CCW classmate from Kosovo, that I am very blessed to live in a country where individuals are free to have guns, and I recognize that with any great freedom comes a great responsibility. I left my CCW training feeling empowered, supported, and proud of myself. And I feel safer now, too.</p> <p> That said, getting CCW training is only the beginning of training. Becoming a responsibly armed citizen is a life-long pursuit so that we re best prepared to protect our families and ourselves. And that&rsquo;s what I plan to do.</p> <p> &nbsp;</p> http://iwf.org/blog/2810714/Hadley HeathMon, 30 Sep 2019 12:09:00 CSTen-usIndependent Women's Forum10 Reasons Medicare For All is a Bad Idea Besides Financial Bankruptcy <p> Former vice president Joe Biden distinguished himself from other candidates in the most recent Democratic presidential debate by opposing Medicare-for-All, mainly by expressing concerns about cost. In doing so, Biden echoed Republicans&rsquo; favorite argument against single-payer health care: &ldquo;How will they pay for it?&rdquo;</p> <p> Still, Republicans and Joe Biden are making a huge mistake by focusing on cost. The implication is that government-run health care would be a good thing&mdash;a wonderful thing!&mdash;if only we could afford it. The important reality is that (in addition to runaway costs that would necessitate higher taxes,&nbsp;<a href="https://www.foxnews.com/opinion/medicare-for-all-middle-class-justin-haskins">even on middle-income people</a>) Medicare for All stinks for many other reasons. Here are just ten.</p> <h2 style="clear:both;"> 1. Ruinous to Health-Care Quality</h2> <div> <div> <div data-google-query-id="CKLSusKO8eQCFUgbhwodtgkIeg" id="div-gpt-ad-1379703300879-0"> <div id="google_ads_iframe_/1011927/TFC_300_by_250_top_0__container__"> &nbsp;</div> </div> </div> </div> <p> Medicare for All will hurt the quality of health care in America. Sen. Bernie Sanders and other M4A advocates rely on misleading international comparisons that make the quality of U.S. health care look bad. In reality, Americans have access to&nbsp;<a href="https://iwf.org/blog/2810381/VIDEO:-How-American-Health-Care-Stacks-Up">world-class health care</a>, especially the Americans with private insurance. But we can kiss that goodbye under M4A.</p> <h2 style="clear:both;"> 2. Medicare For All Will Not Help the Uninsured</h2> <p> Medicare for All will not help the uninsured. Just remember, the last expansion of government health insurance was the Affordable Care Act&rsquo;s expansion of Medicaid, the program for low-income people. As a study in the&nbsp;<a href="https://www.nejm.org/doi/full/10.1056/NEJMsa1212321">New England Journal of Medicine</a>&nbsp;said, &ldquo;Medicaid coverage generated no significant improvements [compared to being uninsured] in measured physical health outcomes in the first two years.&rdquo;</p> <h2 style="clear:both;"> 3. It Will Make Wait Times Worse</h2> <p> Medicare for All will make wait times for care longer. In other countries with socialized medical systems, patients must wait longer, on average, to see doctors and get procedures than Americans do. After four weeks,&nbsp;<a href="https://fee.org/articles/america-outperforms-canada-in-surgery-wait-times-and-its-not-even-close/">70 percent</a>&nbsp;of Americans have seen a specialist, while only 40 percent of Canadians have.</p> <h2 style="clear:both;"> 4. M4A Will Swamp Emergency Rooms</h2> <p> Medicare for All will swamp emergency rooms. Probably because they can&rsquo;t get timely doctor appointments, Canadians use hospital emergency departments much more than Americans do&mdash;and even there, they wait longer, according to the&nbsp;<a href="https://www.cihi.ca/sites/default/files/document/commonwealth-fund-2016-chartbook-en-web-rev.pptx">Commonwealth Fund</a>.</p> <h2 style="clear:both;"> 5. It Will End Private Health Insurance</h2> <div> <div> <div data-google-query-id="CKXSusKO8eQCFUgbhwodtgkIeg" id="div-gpt-ad-1463670073398-0"> <div id="google_ads_iframe_/1011927/TFC_300_by_250_2nd_0__container__"> &nbsp;</div> </div> </div> </div> <p> Medicare for All will end private insurance options, including employer-provided insurance plans. It says it right there in the name: Medicare &ldquo;for All.&rdquo; As Larry Levitt, a health policy expert at the left-leaning Kaiser Family Foundation,&nbsp;<a href="https://www.bloomberg.com/news/articles/2019-07-05/harris-keeps-tripping-up-on-her-medicare-for-all-fuzziness">has said</a>, &ldquo;As a practical matter, Senator Sanders&rsquo; Medicare for all bill would mean the end of private health insurance. Employer health benefits would no longer exist, and private insurance would be prohibited from duplicating the coverage under Medicare.&rdquo;</p> <h2 style="clear:both;"> 6. It Will Rob the Neediest People</h2> <p> Medicare for All will stretch Medicare and rob resources from those who truly need a safety net. Today the United States has health-care safety-net programs for veterans, seniors, and low-income people, particularly low-income pregnant women, children, and people with disabilities. Opening these programs to everyone would make it harder for vulnerable patients to see doctors. One-fifth of doctors already turn away new Medicare patients, and it&rsquo;s even worse in Medicaid,&nbsp;<a href="https://www.ajmc.com/focus-of-the-week/physicians-far-less-likely-to-take-new-medicaid-patients-cdc-finds">Centers for Disease Control data show</a>.</p> <h2 style="clear:both;"> 7. Medicare For All Will Reduce Medical Innovation</h2> <p> Medicare for All will reduce medical innovation. CMS Administrator&nbsp;<a href="https://www.mobihealthnews.com/content/cms-seema-verma-medicare-all-greatest-threat-innovation-healthcare">Seema Verma</a>&nbsp;calls M4A &ldquo;the greatest threat to innovation in health care&rdquo; probably because she&rsquo;s seen how Medicare, with all its good intentions, has&nbsp;<a href="https://reason.org/commentary/medicare-for-all-means-innovation-for-none/">slowed medical innovations</a>&nbsp;that could have helped the elderly.</p> <h2 style="clear:both;"> 8. It Will Worsen the Culture War</h2> <p> Medicare for All will worsen the culture war. If you like political debates about birth control, abortion, physician-assisted suicide, vaccines, or transgender surgery, you&rsquo;re going to love Medicare for All!</p> <h2 style="clear:both;"> 9. Gets Government Up In Your Grill</h2> <div> <div> <div data-google-query-id="CKbSusKO8eQCFUgbhwodtgkIeg" id="div-gpt-ad-1463670073398-1"> <div id="google_ads_iframe_/1011927/TFC_300_by_250_3rd_0__container__"> &nbsp;</div> </div> </div> </div> <p> Medicare for All will insert government into other personal choices. Even what we eat becomes government&rsquo;s business as soon as taxpayers are primarily responsible for our health-care bills. (Remember the &ldquo;Broccoli Mandate?&rdquo;) And that&rsquo;s not all. Just Google &ldquo;<a href="https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/">Social Determinants of Health</a>&rdquo; to learn how health care is really the bridge by which government could control, well, anything.</p> <h2 style="clear:both;"> 10. M4A Actually Devalues Lives</h2> <p> Medicare for All will devalue lives that aren&rsquo;t useful to the government. While it seems unthinkable that a society would put able-bodied workers (read: taxpayers) ahead of children and the elderly (budget liabilities), this is the incentive that socialized medicine creates. Just as water flows downhill, bad incentives eventually erode government policy to serve&hellip; government.</p> <p> Of course, policymakers should continue to talk about how expensive Medicare for All is. A&nbsp;<a href="https://www.mercatus.org/bridge/commentary/medicare-all-plan-would-cost-federal-government-32-trillion">$32-trillion price tag</a>&nbsp;is concerning. But they should take care to emphasize that, even if we had the tax dollars necessary to fund it, those dollars aren&rsquo;t the greatest cost of socialized medicine.</p> http://iwf.org/news/2810693/Hadley HeathFri, 27 Sep 2019 08:09:00 CSTen-usIndependent Women's ForumHow to Fix Health Care<p> Every fall, Americans find out how much their health insurance premiums will increase the following year. But this fall, they&rsquo;ll have one new resource to understand (and one day fix) our broken healthcare system: a new book by Dr. Marty Makary titled &ldquo;The Price We Pay.&rdquo;</p> <p> I had the chance to interview Dr. Makary in a special pop-up edition of IWF&rsquo;s She Thinks podcast. I also had the pleasure of reading an advance copy of the book. But, truth be told, at times I felt like throwing the book at a wall out of frustration. Reading stories about twisted incentives, predatory providers, and helpless patients made my heart ache. And it made me mad. But, as he says in the podcast, Dr. Makary doesn&rsquo;t diagnose any problem without offering his prescribed solution and examples of those solutions in action. So the book has bright spots, too.</p> <p> Dr. Makary paints a realistic picture of American health care today. He doesn&rsquo;t over-emphasize our problems, and he relates to the many doctors who entered their field to help and heal sick people. But he&rsquo;s no Pollyanna. He calls doctors out and encourages them to also become advocates for sound policy and help heal our systemic problems, mostly related to the appropriateness of medical care and how we pay for it.</p> <p> I talked with him about price transparency, restoring doctor/patient relationships, and reforming healthcare laws. I enjoyed our conversation and I hope you will too.</p> <p> <iframe allow="autoplay" frameborder="no" height="166" scrolling="no" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/685463260&amp;color=%23ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false&amp;show_teaser=true" width="100%"></iframe></p> <p> Beverly H:<br /> Hey everyone, it&#39;s Beverly Hallberg. Welcome to a special pop-up episode of She Thinks, your favorite podcast from the Independent Women&#39;s Forum where we talk with women and sometimes men about the policy issues that impact you and the people you care about most. Enjoy.<br /> <br /> Hadley HM:<br /> Hello, I&#39;m Hadley Heath Manning, director of policy for Independent Women&#39;s Forum, and your host for today&#39;s special pop-up edition of the She Thinks podcast. Today we have a very special guest. We have Dr. Marty Makary on the line. Dr Makary is a New York times bestselling author, and Johns Hopkins surgeon, and professor of health policy. His recent book, The Price We Pay, which I&#39;ve read and thoroughly enjoyed, takes on surprise medical bills and reveals how individuals and businesses can lower their healthcare costs. Isn&#39;t that something that we&#39;re all interested in? Steve Forbes, a friend of IWF, has described this new book as, &quot;a must read for every American.&quot; I second that endorsement. So thank you, Dr. Makary, for joining our podcast.<br /> <br /> Dr. Makary:<br /> Great to be with you, Hadley.<br /> <br /> Hadley HM:<br /> Well, the subtitle of your book I think is going to catch a lot of eyes. The subtitle of the book is, &quot;What Broke American Healthcare and How to Fix It.&quot; This is a very pertinent question. I think healthcare was the number one issue that voters cited in their 2018 exit polls and the midterm elections. So I don&#39;t want to ask you for a spoiler, but if you had to summarize what broke American healthcare ... let&#39;s say you had to do it in just one word ... what would you say? What would be that word?<br /> <br /> Dr. Makary:<br /> Well, can I use two words?<br /> <br /> Hadley HM:<br /> Sure, sure.<br /> <br /> Dr. Makary:<br /> Appropriateness and pricing. So in other words, we&#39;ve had a crisis of appropriateness in medicine. Too much medical care, over treatment, some under treatment, but the appropriateness of care has been a giant mismatch. That&#39;s issue number one.<br /> <br /> Dr. Makary:<br /> Root cause number two of our healthcare mess is pricing failures. These are embarrassingly simple to fix. The pricing failures, initiative calls for price transparency, honest billing practices, these are the issues that are resonating with everyday Americans. Right now people are getting hammered with their medical bills.<br /> <br /> Dr. Makary:<br /> Healthcare surprised everybody as being number one during the midterm elections as the number one issue. Healthcare will be number one in the presidential elections that are coming up. It&#39;s not the traditional back and forth Republican/Democrat issues, it is the fact that Americans are getting hammered with medical bills, businesses are getting hammered with our healthcare costs, and these are the fundamental issues of our era.<br /> <br /> Hadley HM:<br /> Yeah, it doesn&#39;t matter if you&#39;re a patient if you&#39;re a Republican or Democrat, we&#39;re all experiencing the same frustrations. I&#39;m curious about your experience writing The Price We Pay, because as I was reading it, I was overwhelmed at the amount of data and research and also personal stories that demonstrate what you&#39;re talking about, the lack of appropriateness, the lack of price transparency, just the difficulty that people have navigating American healthcare. But you also demonstrate that there are some glimmers of hope in our current system. So what was your experience writing a book? What was something that surprised you in your research?<br /> <br /> Dr. Makary:<br /> Well, I have I loved writing this book, doing the research, which involved traveling to 22 cities over two years. I talked to insurance CEOs, hospital executives, doctors, pharma middlemen, pharmacies, insurance brokers, and most importantly, patients who I still think are the real experts in healthcare.<br /> <br /> Dr. Makary:<br /> But I learned a ton. I really wanted to understand the business of medicine with a total command of the field to be able to explain every aspect of it and to encapsulate what&#39;s broken and how we fix it.<br /> <br /> Dr. Makary:<br /> So for everything broken that I present in the book, there&#39;s a solution and disrupter who is already fixing healthcare in a small pocket somewhere. And that story needs to be told.<br /> <br /> Dr. Makary:<br /> I don&#39;t if you saw the movie The Big Short. Have you seen that film?<br /> <br /> Hadley HM:<br /> Yeah, it&#39;s good.<br /> <br /> Dr. Makary:<br /> It was a great film, wasn&#39;t it? It took a very complex subject, even a boring subject if you will, the same thing people ascribe to healthcare. Complex, wonky, boring, don&#39;t bother me with it. The Big Short took the banking industry and broke it down in very simple and easy to understand terms so anybody could understand. It&#39;s actually a lot simpler than we&#39;re told to believe. It&#39;s as simple as banks spending money they don&#39;t have, they&#39;re spending borrowed money, they&#39;re selling toxic assets, they&#39;re trading things that they&#39;re sort of betting on their competitors, and they&#39;re paying ratings agencies to give them inflated ratings. So I was so impressed at how this film took a very complex industry and broke it down for the everyday American where you could leave that film and understand, &quot;Now I understand exactly how the banking industry worked.&quot;<br /> <br /> Dr. Makary:<br /> I wanted to do the same for healthcare. So that was this awesome trip for two years across America talking to folks. I think what I left with was an incredible sense of optimism that people are fed up, that there are great solutions being used in the market that experiments with price transparency. With direct employer purchasing of healthcare, with cutting through the middlemen, cutting out the money games, making healthcare simple, making it more accessible, lowering drug pricing.<br /> <br /> Dr. Makary:<br /> These were things that we&#39;ve already fixed in small pockets in little experiments around the country, we just need to get the story out. After all, that&#39;s why somebody should write a book. There&#39;s a story that needs to be told that is not currently being told.<br /> <br /> Hadley HM:<br /> Right. I&#39;m so encouraged to hear that, because I think in my conversations with a lot of my friends, there&#39;s just a lot of heavy hearts and head shaking like, &quot;Oh, healthcare, it&#39;s so broken.&quot; It&#39;s almost overwhelmingly broken. So it&#39;s nice to hear that there are reasons for optimism.<br /> <br /> Hadley HM:<br /> I mentioned my friend group, because ironically, I have a lot of doctors as friends. I&#39;m married to an MD and a lot of our friends are completing residency or have just recently completed residency. I appreciate that you acknowledge the role of physicians in this book in caring not just for their patient&#39;s health, but also generally for the health of our healthcare system. So I&#39;m curious what you think doctors specifically can do or should do to help fix healthcare in the U.S.?<br /> <br /> Dr. Makary:<br /> Well, you&#39;re absolutely right. Doctors and nurses, medical professionals at every level, especially the millennials who as a part of their generation believe in social justice, they are rising up and they are saying the solution is as simple as getting back to our mission. We need to just restore that great heritage.<br /> <br /> Dr. Makary:<br /> You know, Hadley, when most U.S. hospitals were founded, they were founded with a charter to take care of the sick and injured in their community regardless of, quote unquote, &quot;race, ethnicity, creed, or one&#39;s ability to pay.&quot; That&#39;s our incredible heritage. Most hospitals were started by churches. Most hospitals took care of anybody. It didn&#39;t matter who you were, they were there to serve.<br /> <br /> Dr. Makary:<br /> Hospitals today still hold these incredible mission statements, but when you go to the hospital, you can have a simple treatment and get your life financially ruined by these crazy surprise and overinflated bills. We&#39;ve even discovered a pattern where some hospitals will aggressively sue patients in court and garnish their wages. That is not who we are. That is not our heritage, and the doctors and nurses are right to just absolutely stand against that, to talk to their own hospital leaders, to dispel the myths out there that bills are overpriced in order to compensate for charity care. That&#39;s one of the great myths out there.<br /> <br /> Dr. Makary:<br /> So in medicine, we&#39;re taught medical literacy, but we&#39;re not taught healthcare literacy, and that&#39;s why I wanted to write the book, The Price We Pay.<br /> <br /> Hadley HM:<br /> Yeah, yeah. It&#39;s interesting you mentioned the foundational mission that so many hospitals had long ago. I think there&#39;s a lot of cynicism today towards the healthcare system and distrust even, especially because of the problem you mentioned.<br /> <br /> Hadley HM:<br /> It has to do with with billing, and the lack of price transparency, the way that those bills can wreck us financially, as well as the extreme price variation. You offer several examples of this in the book where patients might have a procedure and they look at two different hospitals, or you go look at two different hospitals and you find two extremely different prices for this same thing.<br /> <br /> Hadley HM:<br /> So why is this, Dr. Makary? Why do we have such price variation in healthcare? Because it doesn&#39;t seem like we have this in other markets. Why the lack of price transparency and the extreme price variation?<br /> <br /> Dr. Makary:<br /> Well, Hadley, I honestly believe, as I met with so many people who work in the business of medicine, that we don&#39;t have bad people. Actually, everybody who&#39;s in healthcare at every level, from administration to being a physical therapist to office assistant, they go into medicine for one central unified reason, and it&#39;s a sense of compassion. They want to dedicate their lives to helping people. The soul yearns for a sense of purpose in life. You see that all over healthcare.<br /> <br /> Dr. Makary:<br /> We have great people, but they&#39;re working in a bad system where the incentives now are so perverse. They&#39;re doing things that medical professionals themselves find despicable and oftentimes internalize rather than having a vehicle to speak openly about. I think if you look at the workload on American hospitals, they&#39;ve been pounded with regulatory requirements and other burdens. They have not had the time or the need to produce an honest and fair price itemized to the service that&#39;s being provided.<br /> <br /> Dr. Makary:<br /> Now, we&#39;re not talking about getting shot and being in the ICU. You&#39;re never going to get a bill or an estimate ahead of time for that. We&#39;re talking about the 60% of healthcare that is shoppable.<br /> <br /> Dr. Makary:<br /> We&#39;re talking about the researcher that called 100 U.S. hospitals that do heart surgery and asked, &quot;How much is a heart bypass CABG procedure?&quot; Only half the hospitals could give him an answer after he called back and called back and fought. Of those who gave them an answer, the price range from 44,000 to almost half a million for the same procedure. All the outcomes are publicly available, and he found there was no association between quality and price. It&#39;s been haphazard, it&#39;s random, and we can do better.<br /> <br /> Hadley HM:<br /> Yeah, that&#39;s ... So how can we do better? Because this is sort of my next question for you. When it comes to price transparency ... because when you mentioned calling back and calling back, I think everybody&#39;s had this experience at one point or another where your insurance coverage, the hospital or the doctor didn&#39;t have the right one, or the hospital had it, but the doctor&#39;s group didn&#39;t, or there was a doctor who treated you while you were in the hospital that happened to be out of network, and then you get a surprise bill for that.<br /> <br /> Hadley HM:<br /> So what can we do to address some of these problems? How can we give patients better tools so that when they are consuming that 60% of services that are shoppable, if they want to comparison shop to save money or if they just want to plan ahead so they know what to expect to pay out of pocket, how can we give them better tools? How can we solve this problem of getting that better pricing information?<br /> <br /> Dr. Makary:<br /> Well, good things are happening right now, Hadley. As of earlier this year, Medicare announced that every hospital has to disclose their sticker prices. Now we know those are not the real prices, but it&#39;s a first step.<br /> <br /> Dr. Makary:<br /> I&#39;ve been encouraging Google and other patient navigation sites to provide an average markup for a hospital when somebody goes to look up a hospital. That increases accountability and creates more transparency.<br /> <br /> Dr. Makary:<br /> I&#39;ve encouraged U.S. News World Report And Medicare when they rank hospitals in the United States to use the billing quality. Does the hospital use predatory billing practices? Do they sue patients? Or do they have good, honest, forgiving, merciful policies with low income patients?<br /> <br /> Dr. Makary:<br /> So we&#39;re seeing more transparency, we&#39;re seeing more accountability. And although only some patients will use real prices to shop ... not everybody, but some will ... they they serve as proxy shoppers and drive the entire marketplace.<br /> <br /> Dr. Makary:<br /> Also, employers that sponsor health plans for their employees, they are proxy shoppers of healthcare. For example, one guy who has a business in Boston saw that the price of delivering a baby, that is a standard uncomplicated vaginal delivery, ranges from $8,000 to $40,000 in Boston for the identical service with the same quality. Of course, he wants his employees to go to the $8,000 hospitals, but he doesn&#39;t want to have to tell them where they can and can&#39;t go. So he says, &quot;If you go to the $8,000 hospitals, you will get free diapers and wipes for a year.&quot;<br /> <br /> Hadley HM:<br /> There you go.<br /> <br /> Dr. Makary:<br /> That&#39;s where everybody went.<br /> <br /> Hadley HM:<br /> Yeah, I think I would, too.<br /> <br /> Dr. Makary:<br /> So we&#39;re seeing proxy shoppers, we&#39;re seeing employers do really creative things, we&#39;re seeing Medicare make chargemaster pricing available, we&#39;re seeing more accountability with the markup. And soon we&#39;re going to see patient navigation apps, and tools, and search engines show what a hospital&#39;s average markup is when you consider going there for your care.<br /> <br /> Hadley HM:<br /> Yeah. Gosh, we live in the information age, and there&#39;s an app for everything. There&#39;s just so much information available to us at our fingertips. Imagine what some really innovative entrepreneurs could do with better pricing information, and that they&#39;re already doing with some pricing information that we have available.<br /> <br /> Hadley HM:<br /> I&#39;m glad you mentioned the proxy shopper point, because one piece of pushback I often get when I advocate for greater price transparency in healthcare ... aside from this idea that patients aren&#39;t smart enough to shop around or that people are going to be unconscious in the back of an ambulance unable to shop around. I can see that we&#39;re not going to be shopping when we&#39;re unconscious, but for the pieces that are shoppable, we&#39;re seeing this trend towards higher and higher deductibles in health insurance. Certainly there&#39;s this segment of the market where out-of-pocket costs, people are very sensitive to that, and those people will be proxy shoppers. So I think that&#39;s an important point.<br /> <br /> Hadley HM:<br /> But I wanted to mention a couple of the lines that I read in your book that just stopped me in my tracks. For example, you wrote that, &quot;Half of stage four breast cancer patients have bills in collections.&quot; Whoa. As a woman and as someone ... all of us have a friend or family member who has been touched by breast cancer, or any type of cancer really. To imagine someone who&#39;s going through chemotherapy or going through these incredibly difficult treatments where their lives are literally on the line, and then to think that they&#39;re getting calls from debt collectors on top of that.<br /> <br /> Hadley HM:<br /> And you highlight the predatory practices of several hospitals. Can you talk about the air ambulance services? This stuff in the book, everybody needs to go buy the book and read it, but be prepared to have your blood pressure go up while you&#39;re reading this book. I told my husband to read the book, because as I mentioned, he&#39;s a hospitalist. I said, &quot;But you&#39;ve got be careful reading this, because you&#39;ll become angry on behalf of your patients, just at what patients are up against.&quot;<br /> <br /> Hadley HM:<br /> So I appreciate that you mentioned the progress that we&#39;re making, but some of the problems are just so infuriating. What efforts have been made to help patients, especially these patients that are in just terrible circumstances? How can we help those vulnerable segments of society and those patients? How can we help them navigate this landmine field of medical billing?<br /> <br /> Dr. Makary:<br /> Well, Hadley, I did try, as you said in the book The Price We Pay to put bright spots throughout the book. It&#39;s in part to show how good things are happening, but in part to manage the outrage, because it is outrageous. Talk to doctors and nurses across America. They are outraged right now. People trust us to the point of putting a knife to their skin within a second of meeting us sometimes, or they&#39;ll tell a nurse in the emergency room secrets they&#39;ve never told their spouse of 50 years within a minute of meeting them. Why? Because of the incredible heritage of trust in the medical profession. Hospitals have historically been a safe haven.<br /> <br /> Dr. Makary:<br /> What we&#39;re seeing right now is that these crazy, and outrageous, unconscionable billing practices where medicine has adopted a business model of price gouging in some places is eroding that public trust. People are getting crushed out there. People are getting hammered by these bills.<br /> <br /> Dr. Makary:<br /> I&#39;m a cancer surgeon. I&#39;m constantly reminded how short life is. People have asked me, &quot;Why are you working on this issue of the public trust, and restoring medicine to its mission, and addressing burnout in the medical community?&quot;<br /> <br /> Dr. Makary:<br /> You know what? A quarter of all patients out there don&#39;t trust us anymore, and it&#39;s because of drug prices, and medical bills, and surprise bills, and price gouging, and [inaudible 00:18:56] statements by preauthorization contracts. These are the money games of medicine, and enough is enough. People are saying, &quot;Can we get back to the bedside art of taking care of patients?&quot; Modern business medicine has created tens of thousands of millionaires who are not patient facing. We&#39;re seeing money go into the system that is so wasteful. Administrative waste, and I would even suggest clinical waste. We already spend enough money to provide every American with gold plated healthcare, we just need to cut the waste.<br /> <br /> Dr. Makary:<br /> I think that&#39;s a bipartisan message that we&#39;re seeing senators resonate. I&#39;ve taken patients that have gotten crazy bills and been sued, and I&#39;ve taken them right to the White House and I had them tell their story directly to our political leaders. Because these are not partisan issues, these are common sense issues.<br /> <br /> Hadley HM:<br /> I want to ask you a sort of political question. But first of all, I want to give people a pick me up, because as in your book, there&#39;s some dark spots, but there&#39;s also some bright spots. You highlighted an innovative model in the book in the solutions section. I hope I say this right, is it Iora Health?<br /> <br /> Dr. Makary:<br /> Yeah, Iora Health.<br /> <br /> Hadley HM:<br /> Okay. Tell us about Iora Health and why their model is a reason for hope. It sounds great. I would be curious ... once you explained the model, my question would be how do we make it so that more Americans can use a model like this? What changes would be necessary to expand these bright spots of hope that are in pockets. Pockets where you say we&#39;re solving some of these problems, but how do we scale these things up so that more Americans can have the benefit of those bright spots?<br /> <br /> Dr. Makary:<br /> Well, Hadley, I loved my time visiting the Iora clinics and the ChenMed clinics alike. These are refreshing, bright spots in healthcare that are on the brink of going national, and they need support, they need people to know about what they&#39;re doing. That&#39;s why I wrote the book the Price We Pay.<br /> <br /> Dr. Makary:<br /> Iora and ChenMed, the same, they take in patients and forget about all billing. They are paid on a global capitation level. That means they&#39;re paid lump sum for a group of patients, large groups, sometimes a group of Medicare beneficiaries on a Medicare advantage plan.<br /> <br /> Dr. Makary:<br /> But that clinic or that group of clinics is responsible for a population of people, say 4,000 people that live in the community, and they can do whatever they believe in their own medical judgment is best for their longterm health. They&#39;ll visit their home if they need to. They will review all their medications and do what we call a deep prescribing review. They&#39;ve got bags of medications where they realize people don&#39;t need to be on these things. People bring in their meds and they take them off, because they switch them to lifestyle based therapies, and food is medicine, and exercise, and diabetes cooking classes.<br /> <br /> Dr. Makary:<br /> And they don&#39;t have any billing. Their doctors are not burdened by it. The doctors are sort of relieved. They come from billing practices and they realize, &quot;Hey, I can just do what&#39;s in the best interest of the patient.&quot; If you look at the ChenMed example, they take all the downstream financial risk of the patient. That is, they&#39;re paid this lump sum amount electronically, it&#39;s not an exchange.<br /> <br /> Dr. Makary:<br /> Basically, over a short period of time, they assume the long term downstream consequences of whatever happens to that patient. So if you need an open heart surgery, you need a colonoscopy, you name it, they are picking the high value doctors in the area. After all, who knows best about quality than the primary care doctors in that location? So they&#39;re not referring you to their golf buddy, they&#39;re referring you to the doctor with the best outcomes that has a fair price. Not necessarily a low price, but a fair price. They assume those downstream financial costs of the patients.<br /> <br /> Dr. Makary:<br /> So they are a true medical home. They&#39;re a true gatekeeper. They&#39;re practicing the art of medicine. They&#39;ve converted their billing room in the clinic to a lifestyle medicine room where they&#39;re teaching them things they can do better. It&#39;s awesome. Iora, ChenMed, they&#39;re awesome.<br /> <br /> Hadley HM:<br /> Yeah, that&#39;s so refreshing to hear that there are potential paths forward for healthier lives, but also just a healthier healthcare system.<br /> <br /> Hadley HM:<br /> But the way things stand today ... and I promised our listeners a political question ... people are so frustrated that they&#39;re ready to just throw in the towel. They&#39;re ready to say, &quot;We need something completely different. Just scrap the current healthcare system that we have.&quot; And this is sort of a hot topic, but they say, &quot;We just need Medicare For All.&quot; You mentioned Medicare rates throughout the book as a comparison or contrast with other prices that other hospitals charge.<br /> <br /> Hadley HM:<br /> The nonpartisan Congressional Budget Office just issued a report on Medicare For All. They said that if we moved to a system like this, it might expand coverage for preventive care and other benefits that may ultimately improve people&#39;s health, but the CBO also said that extending coverage to more Americans could produce longer wait times or reduce access to care if there weren&#39;t enough health workers. So I&#39;m curious if you agree with the CBO&#39;s analysis, why or why not, and just sort of a general take on Medicare For All.<br /> <br /> Dr. Makary:<br /> Well, I understand how people are attracted to the concept of Medicare For All because they&#39;re sick of the current system, and they&#39;re sick of the middlemen and the pricing failures. But you look at any country that has adopted that type of model, over the long term, they massively underfunded over time, tightening the belt year after year. It&#39;s irresistible, all governments do it. Everywhere in the world where it&#39;s been used, you have in 10 or 20 years a massively dilapidated healthcare system. I think we can do better. We&#39;re the United States, we&#39;ve been the leaders in medicine and innovation in doing things, putting patients at the center, and adopting what is really a democratic model for medicine. So I think we can do a lot better.<br /> <br /> Hadley HM:<br /> Listen, Dr. Makary, I know you&#39;re a doctor, you&#39;ve got to go see patients, you&#39;ve got to continue researching how to restore the public trust in healthcare providers, and the art of practicing medicine, as you mentioned. But as we close, I want to ask you where can people go to learn more about your work, and your books, and specifically this new book The Price We Pay.<br /> <br /> Dr. Makary:<br /> Well, thank you, Hadley. The Price We Pay is available online momentarily everywhere books are sold.<br /> <br /> Dr. Makary:<br /> Our work is really to help people who cannot afford their medical bills. We do that by defending them, either to the hospitals or sometimes in court to explain that the hospital shaking down people for overpriced bills, it violates their mission and the charter of many of these hospitals. So we want to remind them of why we&#39;re all in healthcare.<br /> <br /> Dr. Makary:<br /> Our group is called Restoring Medicine. It&#39;s at restoringmedicine.org, and we&#39;re on Facebook. We, of course, love all the tremendous support out there. It&#39;s been awesome. So thank you so much for having me on this. You&#39;re doing great work, and really a pleasure to finally meet you here.<br /> <br /> Hadley HM:<br /> Yeah, well, thank you, Dr. Makary. I appreciate knowing a physician who&#39;s not just in the the business of medicine, but really in the art of practicing medicine, caring for patients, and caring for American healthcare. And like I said, I really enjoyed the book, I appreciate the work you&#39;re doing.<br /> <br /> Hadley HM:<br /> I think we need to get more physicians and more patients aware and involved in this effort to put doctors and patients back at the center of American healthcare. Because I think the frustrations today come from maybe there&#39;s too much corporate control or maybe there&#39;s too much involvement, as you mentioned, from those regulations and the bureaucratic demands on hospitals and so forth. But it really shouldn&#39;t be either way, it shouldn&#39;t be a big government model and it shouldn&#39;t be a big business model, it should be about doctors and patients.<br /> <br /> Hadley HM:<br /> So I appreciate your efforts to move us in that right direction. We really appreciate your time today. Again, our guest has been Dr. Marty Makary. His book is The Price We Pay. I encourage you all to to go get a copy and read it. This has been another edition of Independent Women&#39;s Forum&#39;s She Thinks podcast. If you liked it, please share it, and subscribe, and become a follower of our work at iwf.org.</p> http://iwf.org/blog/2810647/Hadley HeathMon, 23 Sep 2019 06:09:00 CSTen-usIndependent Women's ForumHow to Fix Health Care<p> Every fall, Americans find out how much their health insurance premiums will increase the following year. But this fall, they&rsquo;ll have one new resource to understand (and one day fix) our broken healthcare system: a new book by Dr. Marty Makary titled &ldquo;The Price We Pay.&rdquo;</p> <p> I had the chance to interview Dr. Makary in a special pop-up edition of IWF&rsquo;s She Thinks podcast. I also had the pleasure of reading an advance copy of the book. But, truth be told, at times I felt like throwing the book at a wall out of frustration. Reading stories about twisted incentives, predatory providers, and helpless patients made my heart ache. And it made me mad. But, as he says in the podcast, Dr. Makary doesn&rsquo;t diagnose any problem without offering his prescribed solution and examples of those solutions in action. So the book has bright spots, too.</p> <p> Dr. Makary paints a realistic picture of American health care today. He doesn&rsquo;t over-emphasize our problems, and he relates to the many doctors who entered their field to help and heal sick people. But he&rsquo;s no Pollyanna. He calls doctors out and encourages them to also become advocates for sound policy and help heal our systemic problems, mostly related to the appropriateness of medical care and how we pay for it.</p> <p> I talked with him about price transparency, restoring doctor/patient relationships, and reforming healthcare laws. I enjoyed our conversation and I hope you will too.</p> <p> <iframe allow="autoplay" frameborder="no" height="166" scrolling="no" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/685463260&amp;color=%23ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false&amp;show_teaser=true" width="100%"></iframe></p> <p> Beverly H:<br /> Hey everyone, it&#39;s Beverly Hallberg. Welcome to a special pop-up episode of She Thinks, your favorite podcast from the Independent Women&#39;s Forum where we talk with women and sometimes men about the policy issues that impact you and the people you care about most. Enjoy.<br /> <br /> Hadley HM:<br /> Hello, I&#39;m Hadley Heath Manning, director of policy for Independent Women&#39;s Forum, and your host for today&#39;s special pop-up edition of the She Thinks podcast. Today we have a very special guest. We have Dr. Marty Makary on the line. Dr Makary is a New York times bestselling author, and Johns Hopkins surgeon, and professor of health policy. His recent book, The Price We Pay, which I&#39;ve read and thoroughly enjoyed, takes on surprise medical bills and reveals how individuals and businesses can lower their healthcare costs. Isn&#39;t that something that we&#39;re all interested in? Steve Forbes, a friend of IWF, has described this new book as, &quot;a must read for every American.&quot; I second that endorsement. So thank you, Dr. Makary, for joining our podcast.<br /> <br /> Dr. Makary:<br /> Great to be with you, Hadley.<br /> <br /> Hadley HM:<br /> Well, the subtitle of your book I think is going to catch a lot of eyes. The subtitle of the book is, &quot;What Broke American Healthcare and How to Fix It.&quot; This is a very pertinent question. I think healthcare was the number one issue that voters cited in their 2018 exit polls and the midterm elections. So I don&#39;t want to ask you for a spoiler, but if you had to summarize what broke American healthcare ... let&#39;s say you had to do it in just one word ... what would you say? What would be that word?<br /> <br /> Dr. Makary:<br /> Well, can I use two words?<br /> <br /> Hadley HM:<br /> Sure, sure.<br /> <br /> Dr. Makary:<br /> Appropriateness and pricing. So in other words, we&#39;ve had a crisis of appropriateness in medicine. Too much medical care, over treatment, some under treatment, but the appropriateness of care has been a giant mismatch. That&#39;s issue number one.<br /> <br /> Dr. Makary:<br /> Root cause number two of our healthcare mess is pricing failures. These are embarrassingly simple to fix. The pricing failures, initiative calls for price transparency, honest billing practices, these are the issues that are resonating with everyday Americans. Right now people are getting hammered with their medical bills.<br /> <br /> Dr. Makary:<br /> Healthcare surprised everybody as being number one during the midterm elections as the number one issue. Healthcare will be number one in the presidential elections that are coming up. It&#39;s not the traditional back and forth Republican/Democrat issues, it is the fact that Americans are getting hammered with medical bills, businesses are getting hammered with our healthcare costs, and these are the fundamental issues of our era.<br /> <br /> Hadley HM:<br /> Yeah, it doesn&#39;t matter if you&#39;re a patient if you&#39;re a Republican or Democrat, we&#39;re all experiencing the same frustrations. I&#39;m curious about your experience writing The Price We Pay, because as I was reading it, I was overwhelmed at the amount of data and research and also personal stories that demonstrate what you&#39;re talking about, the lack of appropriateness, the lack of price transparency, just the difficulty that people have navigating American healthcare. But you also demonstrate that there are some glimmers of hope in our current system. So what was your experience writing a book? What was something that surprised you in your research?<br /> <br /> Dr. Makary:<br /> Well, I have I loved writing this book, doing the research, which involved traveling to 22 cities over two years. I talked to insurance CEOs, hospital executives, doctors, pharma middlemen, pharmacies, insurance brokers, and most importantly, patients who I still think are the real experts in healthcare.<br /> <br /> Dr. Makary:<br /> But I learned a ton. I really wanted to understand the business of medicine with a total command of the field to be able to explain every aspect of it and to encapsulate what&#39;s broken and how we fix it.<br /> <br /> Dr. Makary:<br /> So for everything broken that I present in the book, there&#39;s a solution and disrupter who is already fixing healthcare in a small pocket somewhere. And that story needs to be told.<br /> <br /> Dr. Makary:<br /> I don&#39;t if you saw the movie The Big Short. Have you seen that film?<br /> <br /> Hadley HM:<br /> Yeah, it&#39;s good.<br /> <br /> Dr. Makary:<br /> It was a great film, wasn&#39;t it? It took a very complex subject, even a boring subject if you will, the same thing people ascribe to healthcare. Complex, wonky, boring, don&#39;t bother me with it. The Big Short took the banking industry and broke it down in very simple and easy to understand terms so anybody could understand. It&#39;s actually a lot simpler than we&#39;re told to believe. It&#39;s as simple as banks spending money they don&#39;t have, they&#39;re spending borrowed money, they&#39;re selling toxic assets, they&#39;re trading things that they&#39;re sort of betting on their competitors, and they&#39;re paying ratings agencies to give them inflated ratings. So I was so impressed at how this film took a very complex industry and broke it down for the everyday American where you could leave that film and understand, &quot;Now I understand exactly how the banking industry worked.&quot;<br /> <br /> Dr. Makary:<br /> I wanted to do the same for healthcare. So that was this awesome trip for two years across America talking to folks. I think what I left with was an incredible sense of optimism that people are fed up, that there are great solutions being used in the market that experiments with price transparency. With direct employer purchasing of healthcare, with cutting through the middlemen, cutting out the money games, making healthcare simple, making it more accessible, lowering drug pricing.<br /> <br /> Dr. Makary:<br /> These were things that we&#39;ve already fixed in small pockets in little experiments around the country, we just need to get the story out. After all, that&#39;s why somebody should write a book. There&#39;s a story that needs to be told that is not currently being told.<br /> <br /> Hadley HM:<br /> Right. I&#39;m so encouraged to hear that, because I think in my conversations with a lot of my friends, there&#39;s just a lot of heavy hearts and head shaking like, &quot;Oh, healthcare, it&#39;s so broken.&quot; It&#39;s almost overwhelmingly broken. So it&#39;s nice to hear that there are reasons for optimism.<br /> <br /> Hadley HM:<br /> I mentioned my friend group, because ironically, I have a lot of doctors as friends. I&#39;m married to an MD and a lot of our friends are completing residency or have just recently completed residency. I appreciate that you acknowledge the role of physicians in this book in caring not just for their patient&#39;s health, but also generally for the health of our healthcare system. So I&#39;m curious what you think doctors specifically can do or should do to help fix healthcare in the U.S.?<br /> <br /> Dr. Makary:<br /> Well, you&#39;re absolutely right. Doctors and nurses, medical professionals at every level, especially the millennials who as a part of their generation believe in social justice, they are rising up and they are saying the solution is as simple as getting back to our mission. We need to just restore that great heritage.<br /> <br /> Dr. Makary:<br /> You know, Hadley, when most U.S. hospitals were founded, they were founded with a charter to take care of the sick and injured in their community regardless of, quote unquote, &quot;race, ethnicity, creed, or one&#39;s ability to pay.&quot; That&#39;s our incredible heritage. Most hospitals were started by churches. Most hospitals took care of anybody. It didn&#39;t matter who you were, they were there to serve.<br /> <br /> Dr. Makary:<br /> Hospitals today still hold these incredible mission statements, but when you go to the hospital, you can have a simple treatment and get your life financially ruined by these crazy surprise and overinflated bills. We&#39;ve even discovered a pattern where some hospitals will aggressively sue patients in court and garnish their wages. That is not who we are. That is not our heritage, and the doctors and nurses are right to just absolutely stand against that, to talk to their own hospital leaders, to dispel the myths out there that bills are overpriced in order to compensate for charity care. That&#39;s one of the great myths out there.<br /> <br /> Dr. Makary:<br /> So in medicine, we&#39;re taught medical literacy, but we&#39;re not taught healthcare literacy, and that&#39;s why I wanted to write the book, The Price We Pay.<br /> <br /> Hadley HM:<br /> Yeah, yeah. It&#39;s interesting you mentioned the foundational mission that so many hospitals had long ago. I think there&#39;s a lot of cynicism today towards the healthcare system and distrust even, especially because of the problem you mentioned.<br /> <br /> Hadley HM:<br /> It has to do with with billing, and the lack of price transparency, the way that those bills can wreck us financially, as well as the extreme price variation. You offer several examples of this in the book where patients might have a procedure and they look at two different hospitals, or you go look at two different hospitals and you find two extremely different prices for this same thing.<br /> <br /> Hadley HM:<br /> So why is this, Dr. Makary? Why do we have such price variation in healthcare? Because it doesn&#39;t seem like we have this in other markets. Why the lack of price transparency and the extreme price variation?<br /> <br /> Dr. Makary:<br /> Well, Hadley, I honestly believe, as I met with so many people who work in the business of medicine, that we don&#39;t have bad people. Actually, everybody who&#39;s in healthcare at every level, from administration to being a physical therapist to office assistant, they go into medicine for one central unified reason, and it&#39;s a sense of compassion. They want to dedicate their lives to helping people. The soul yearns for a sense of purpose in life. You see that all over healthcare.<br /> <br /> Dr. Makary:<br /> We have great people, but they&#39;re working in a bad system where the incentives now are so perverse. They&#39;re doing things that medical professionals themselves find despicable and oftentimes internalize rather than having a vehicle to speak openly about. I think if you look at the workload on American hospitals, they&#39;ve been pounded with regulatory requirements and other burdens. They have not had the time or the need to produce an honest and fair price itemized to the service that&#39;s being provided.<br /> <br /> Dr. Makary:<br /> Now, we&#39;re not talking about getting shot and being in the ICU. You&#39;re never going to get a bill or an estimate ahead of time for that. We&#39;re talking about the 60% of healthcare that is shoppable.<br /> <br /> Dr. Makary:<br /> We&#39;re talking about the researcher that called 100 U.S. hospitals that do heart surgery and asked, &quot;How much is a heart bypass CABG procedure?&quot; Only half the hospitals could give him an answer after he called back and called back and fought. Of those who gave them an answer, the price range from 44,000 to almost half a million for the same procedure. All the outcomes are publicly available, and he found there was no association between quality and price. It&#39;s been haphazard, it&#39;s random, and we can do better.<br /> <br /> Hadley HM:<br /> Yeah, that&#39;s ... So how can we do better? Because this is sort of my next question for you. When it comes to price transparency ... because when you mentioned calling back and calling back, I think everybody&#39;s had this experience at one point or another where your insurance coverage, the hospital or the doctor didn&#39;t have the right one, or the hospital had it, but the doctor&#39;s group didn&#39;t, or there was a doctor who treated you while you were in the hospital that happened to be out of network, and then you get a surprise bill for that.<br /> <br /> Hadley HM:<br /> So what can we do to address some of these problems? How can we give patients better tools so that when they are consuming that 60% of services that are shoppable, if they want to comparison shop to save money or if they just want to plan ahead so they know what to expect to pay out of pocket, how can we give them better tools? How can we solve this problem of getting that better pricing information?<br /> <br /> Dr. Makary:<br /> Well, good things are happening right now, Hadley. As of earlier this year, Medicare announced that every hospital has to disclose their sticker prices. Now we know those are not the real prices, but it&#39;s a first step.<br /> <br /> Dr. Makary:<br /> I&#39;ve been encouraging Google and other patient navigation sites to provide an average markup for a hospital when somebody goes to look up a hospital. That increases accountability and creates more transparency.<br /> <br /> Dr. Makary:<br /> I&#39;ve encouraged U.S. News World Report And Medicare when they rank hospitals in the United States to use the billing quality. Does the hospital use predatory billing practices? Do they sue patients? Or do they have good, honest, forgiving, merciful policies with low income patients?<br /> <br /> Dr. Makary:<br /> So we&#39;re seeing more transparency, we&#39;re seeing more accountability. And although only some patients will use real prices to shop ... not everybody, but some will ... they they serve as proxy shoppers and drive the entire marketplace.<br /> <br /> Dr. Makary:<br /> Also, employers that sponsor health plans for their employees, they are proxy shoppers of healthcare. For example, one guy who has a business in Boston saw that the price of delivering a baby, that is a standard uncomplicated vaginal delivery, ranges from $8,000 to $40,000 in Boston for the identical service with the same quality. Of course, he wants his employees to go to the $8,000 hospitals, but he doesn&#39;t want to have to tell them where they can and can&#39;t go. So he says, &quot;If you go to the $8,000 hospitals, you will get free diapers and wipes for a year.&quot;<br /> <br /> Hadley HM:<br /> There you go.<br /> <br /> Dr. Makary:<br /> That&#39;s where everybody went.<br /> <br /> Hadley HM:<br /> Yeah, I think I would, too.<br /> <br /> Dr. Makary:<br /> So we&#39;re seeing proxy shoppers, we&#39;re seeing employers do really creative things, we&#39;re seeing Medicare make chargemaster pricing available, we&#39;re seeing more accountability with the markup. And soon we&#39;re going to see patient navigation apps, and tools, and search engines show what a hospital&#39;s average markup is when you consider going there for your care.<br /> <br /> Hadley HM:<br /> Yeah. Gosh, we live in the information age, and there&#39;s an app for everything. There&#39;s just so much information available to us at our fingertips. Imagine what some really innovative entrepreneurs could do with better pricing information, and that they&#39;re already doing with some pricing information that we have available.<br /> <br /> Hadley HM:<br /> I&#39;m glad you mentioned the proxy shopper point, because one piece of pushback I often get when I advocate for greater price transparency in healthcare ... aside from this idea that patients aren&#39;t smart enough to shop around or that people are going to be unconscious in the back of an ambulance unable to shop around. I can see that we&#39;re not going to be shopping when we&#39;re unconscious, but for the pieces that are shoppable, we&#39;re seeing this trend towards higher and higher deductibles in health insurance. Certainly there&#39;s this segment of the market where out-of-pocket costs, people are very sensitive to that, and those people will be proxy shoppers. So I think that&#39;s an important point.<br /> <br /> Hadley HM:<br /> But I wanted to mention a couple of the lines that I read in your book that just stopped me in my tracks. For example, you wrote that, &quot;Half of stage four breast cancer patients have bills in collections.&quot; Whoa. As a woman and as someone ... all of us have a friend or family member who has been touched by breast cancer, or any type of cancer really. To imagine someone who&#39;s going through chemotherapy or going through these incredibly difficult treatments where their lives are literally on the line, and then to think that they&#39;re getting calls from debt collectors on top of that.<br /> <br /> Hadley HM:<br /> And you highlight the predatory practices of several hospitals. Can you talk about the air ambulance services? This stuff in the book, everybody needs to go buy the book and read it, but be prepared to have your blood pressure go up while you&#39;re reading this book. I told my husband to read the book, because as I mentioned, he&#39;s a hospitalist. I said, &quot;But you&#39;ve got be careful reading this, because you&#39;ll become angry on behalf of your patients, just at what patients are up against.&quot;<br /> <br /> Hadley HM:<br /> So I appreciate that you mentioned the progress that we&#39;re making, but some of the problems are just so infuriating. What efforts have been made to help patients, especially these patients that are in just terrible circumstances? How can we help those vulnerable segments of society and those patients? How can we help them navigate this landmine field of medical billing?<br /> <br /> Dr. Makary:<br /> Well, Hadley, I did try, as you said in the book The Price We Pay to put bright spots throughout the book. It&#39;s in part to show how good things are happening, but in part to manage the outrage, because it is outrageous. Talk to doctors and nurses across America. They are outraged right now. People trust us to the point of putting a knife to their skin within a second of meeting us sometimes, or they&#39;ll tell a nurse in the emergency room secrets they&#39;ve never told their spouse of 50 years within a minute of meeting them. Why? Because of the incredible heritage of trust in the medical profession. Hospitals have historically been a safe haven.<br /> <br /> Dr. Makary:<br /> What we&#39;re seeing right now is that these crazy, and outrageous, unconscionable billing practices where medicine has adopted a business model of price gouging in some places is eroding that public trust. People are getting crushed out there. People are getting hammered by these bills.<br /> <br /> Dr. Makary:<br /> I&#39;m a cancer surgeon. I&#39;m constantly reminded how short life is. People have asked me, &quot;Why are you working on this issue of the public trust, and restoring medicine to its mission, and addressing burnout in the medical community?&quot;<br /> <br /> Dr. Makary:<br /> You know what? A quarter of all patients out there don&#39;t trust us anymore, and it&#39;s because of drug prices, and medical bills, and surprise bills, and price gouging, and [inaudible 00:18:56] statements by preauthorization contracts. These are the money games of medicine, and enough is enough. People are saying, &quot;Can we get back to the bedside art of taking care of patients?&quot; Modern business medicine has created tens of thousands of millionaires who are not patient facing. We&#39;re seeing money go into the system that is so wasteful. Administrative waste, and I would even suggest clinical waste. We already spend enough money to provide every American with gold plated healthcare, we just need to cut the waste.<br /> <br /> Dr. Makary:<br /> I think that&#39;s a bipartisan message that we&#39;re seeing senators resonate. I&#39;ve taken patients that have gotten crazy bills and been sued, and I&#39;ve taken them right to the White House and I had them tell their story directly to our political leaders. Because these are not partisan issues, these are common sense issues.<br /> <br /> Hadley HM:<br /> I want to ask you a sort of political question. But first of all, I want to give people a pick me up, because as in your book, there&#39;s some dark spots, but there&#39;s also some bright spots. You highlighted an innovative model in the book in the solutions section. I hope I say this right, is it Iora Health?<br /> <br /> Dr. Makary:<br /> Yeah, Iora Health.<br /> <br /> Hadley HM:<br /> Okay. Tell us about Iora Health and why their model is a reason for hope. It sounds great. I would be curious ... once you explained the model, my question would be how do we make it so that more Americans can use a model like this? What changes would be necessary to expand these bright spots of hope that are in pockets. Pockets where you say we&#39;re solving some of these problems, but how do we scale these things up so that more Americans can have the benefit of those bright spots?<br /> <br /> Dr. Makary:<br /> Well, Hadley, I loved my time visiting the Iora clinics and the ChenMed clinics alike. These are refreshing, bright spots in healthcare that are on the brink of going national, and they need support, they need people to know about what they&#39;re doing. That&#39;s why I wrote the book the Price We Pay.<br /> <br /> Dr. Makary:<br /> Iora and ChenMed, the same, they take in patients and forget about all billing. They are paid on a global capitation level. That means they&#39;re paid lump sum for a group of patients, large groups, sometimes a group of Medicare beneficiaries on a Medicare advantage plan.<br /> <br /> Dr. Makary:<br /> But that clinic or that group of clinics is responsible for a population of people, say 4,000 people that live in the community, and they can do whatever they believe in their own medical judgment is best for their longterm health. They&#39;ll visit their home if they need to. They will review all their medications and do what we call a deep prescribing review. They&#39;ve got bags of medications where they realize people don&#39;t need to be on these things. People bring in their meds and they take them off, because they switch them to lifestyle based therapies, and food is medicine, and exercise, and diabetes cooking classes.<br /> <br /> Dr. Makary:<br /> And they don&#39;t have any billing. Their doctors are not burdened by it. The doctors are sort of relieved. They come from billing practices and they realize, &quot;Hey, I can just do what&#39;s in the best interest of the patient.&quot; If you look at the ChenMed example, they take all the downstream financial risk of the patient. That is, they&#39;re paid this lump sum amount electronically, it&#39;s not an exchange.<br /> <br /> Dr. Makary:<br /> Basically, over a short period of time, they assume the long term downstream consequences of whatever happens to that patient. So if you need an open heart surgery, you need a colonoscopy, you name it, they are picking the high value doctors in the area. After all, who knows best about quality than the primary care doctors in that location? So they&#39;re not referring you to their golf buddy, they&#39;re referring you to the doctor with the best outcomes that has a fair price. Not necessarily a low price, but a fair price. They assume those downstream financial costs of the patients.<br /> <br /> Dr. Makary:<br /> So they are a true medical home. They&#39;re a true gatekeeper. They&#39;re practicing the art of medicine. They&#39;ve converted their billing room in the clinic to a lifestyle medicine room where they&#39;re teaching them things they can do better. It&#39;s awesome. Iora, ChenMed, they&#39;re awesome.<br /> <br /> Hadley HM:<br /> Yeah, that&#39;s so refreshing to hear that there are potential paths forward for healthier lives, but also just a healthier healthcare system.<br /> <br /> Hadley HM:<br /> But the way things stand today ... and I promised our listeners a political question ... people are so frustrated that they&#39;re ready to just throw in the towel. They&#39;re ready to say, &quot;We need something completely different. Just scrap the current healthcare system that we have.&quot; And this is sort of a hot topic, but they say, &quot;We just need Medicare For All.&quot; You mentioned Medicare rates throughout the book as a comparison or contrast with other prices that other hospitals charge.<br /> <br /> Hadley HM:<br /> The nonpartisan Congressional Budget Office just issued a report on Medicare For All. They said that if we moved to a system like this, it might expand coverage for preventive care and other benefits that may ultimately improve people&#39;s health, but the CBO also said that extending coverage to more Americans could produce longer wait times or reduce access to care if there weren&#39;t enough health workers. So I&#39;m curious if you agree with the CBO&#39;s analysis, why or why not, and just sort of a general take on Medicare For All.<br /> <br /> Dr. Makary:<br /> Well, I understand how people are attracted to the concept of Medicare For All because they&#39;re sick of the current system, and they&#39;re sick of the middlemen and the pricing failures. But you look at any country that has adopted that type of model, over the long term, they massively underfunded over time, tightening the belt year after year. It&#39;s irresistible, all governments do it. Everywhere in the world where it&#39;s been used, you have in 10 or 20 years a massively dilapidated healthcare system. I think we can do better. We&#39;re the United States, we&#39;ve been the leaders in medicine and innovation in doing things, putting patients at the center, and adopting what is really a democratic model for medicine. So I think we can do a lot better.<br /> <br /> Hadley HM:<br /> Listen, Dr. Makary, I know you&#39;re a doctor, you&#39;ve got to go see patients, you&#39;ve got to continue researching how to restore the public trust in healthcare providers, and the art of practicing medicine, as you mentioned. But as we close, I want to ask you where can people go to learn more about your work, and your books, and specifically this new book The Price We Pay.<br /> <br /> Dr. Makary:<br /> Well, thank you, Hadley. The Price We Pay is available online momentarily everywhere books are sold.<br /> <br /> Dr. Makary:<br /> Our work is really to help people who cannot afford their medical bills. We do that by defending them, either to the hospitals or sometimes in court to explain that the hospital shaking down people for overpriced bills, it violates their mission and the charter of many of these hospitals. So we want to remind them of why we&#39;re all in healthcare.<br /> <br /> Dr. Makary:<br /> Our group is called Restoring Medicine. It&#39;s at restoringmedicine.org, and we&#39;re on Facebook. We, of course, love all the tremendous support out there. It&#39;s been awesome. So thank you so much for having me on this. You&#39;re doing great work, and really a pleasure to finally meet you here.<br /> <br /> Hadley HM:<br /> Yeah, well, thank you, Dr. Makary. I appreciate knowing a physician who&#39;s not just in the the business of medicine, but really in the art of practicing medicine, caring for patients, and caring for American healthcare. And like I said, I really enjoyed the book, I appreciate the work you&#39;re doing.<br /> <br /> Hadley HM:<br /> I think we need to get more physicians and more patients aware and involved in this effort to put doctors and patients back at the center of American healthcare. Because I think the frustrations today come from maybe there&#39;s too much corporate control or maybe there&#39;s too much involvement, as you mentioned, from those regulations and the bureaucratic demands on hospitals and so forth. But it really shouldn&#39;t be either way, it shouldn&#39;t be a big government model and it shouldn&#39;t be a big business model, it should be about doctors and patients.<br /> <br /> Hadley HM:<br /> So I appreciate your efforts to move us in that right direction. We really appreciate your time today. Again, our guest has been Dr. Marty Makary. His book is The Price We Pay. I encourage you all to to go get a copy and read it. This has been another edition of Independent Women&#39;s Forum&#39;s She Thinks podcast. If you liked it, please share it, and subscribe, and become a follower of our work at iwf.org.</p> http://iwf.org/media/2810646/Hadley HeathMon, 23 Sep 2019 06:09:00 CSTen-usIndependent Women's ForumUAW Strike Signals Uncertainty in Auto Industry • Making Moneyhttp://iwf.org/media/2810617/Hadley HeathMon, 16 Sep 2019 15:09:00 CSTen-usIndependent Women's ForumFewer Americans Have Health Insurance - Why?<p> New federal data show that the number of Americans without insurance increased in 2018 to <a href="https://www.wsj.com/articles/number-of-americans-without-insurance-shows-first-increase-since2008-11568128381">27.5 million</a>. This is the first increase since 2009. Why is this happening?&nbsp;</p> <p> Let&#39;s take a look at recent history: In 2010, the Affordable Care Act (ACA) became law. Most of its major provisions didn&#39;t take effect until 2014. The law created new rules for insurance companies, provided income-based subsidies and tax credits for people who buy their own insurance, and expanded Medicaid, the government insurance program for low-income people.&nbsp;</p> <p> Most of the present decrease in the number of people with insurance is attributable to Medicaid. Some states have recently put more stringest eligibility rules in place. But there&#39;s another phenomenon at work: The strong economy has lifted the incomes of many low-income people to the point they are no longer eligibile. In the grand scheme of things, a good economy is, well, good. But for people who lose access to Medicaid, it doesn&#39;t feel good. While many public programs phase out benefits as income increases, Medicaid faces what we call a &quot;benefit cliff.&quot; Either you&#39;re eligible or you&#39;re not. And if you&#39;re not, private insurnace can be hard to afford.</p> <p> Because of the well-intended changes the ACA made to private insurance (an effort to make coverage more robust), premiums have soared. Most recently, they went up 34 percent just from 2018 to 2019. And in spite of the current Administration&#39;s efforts to expand access to more affordable insurnace options (like short-term or Association Health Plans), many people still face a very limited set of health insurance options at very high prices.&nbsp;</p> <p> Another one of the unintended consequences of the ACA was that, although the subsidies for private insurance plans *start* at 100 percent of the federal poverty line, not all Medicaid eligibility goes *up* to 100 percent FPL. For example, 100 percent of the federal poverty level for a single person is about $12,000 annual wages. Some states don&#39;t offer Medicaid to able-bodied childless adults, so a person who makes less than $12,000 per year would face a HIGHER premium than someone making $15,000 per year (who is eligible for a subsidy).&nbsp; Importantly, all 50 states offer Medicaid to children, pregnant women, and parents (at varying income eligibility thresholds). You can see a <a href="https://www.kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-and-chip/">state-by-state breakdown here</a>.&nbsp;</p> <p> So changes to Medicaid eligibility, whether the result of public policy changes or increases in income, are mostly to blame for the uptick in uninsured people. Although exiting dependency on government is good, we don&#39;t want to see Americans lose public benefits if they lack other good options. This news is another reminder that policymakers should be working to improve the affordability of private health insurance, which will require rolling back some of the most counterproductive regulations in the ACA. It&#39;s a difficult political battle, but one worth fighting on behalf of the many Americans who are working hard to provide for themselves and their loved ones.&nbsp;</p> http://iwf.org/blog/2810574/Hadley HeathWed, 11 Sep 2019 11:09:00 CSTen-usIndependent Women's ForumCA Putting More Restrictions on the Gig Economy • Making Money with Charles Paynehttp://iwf.org/media/2810586/Hadley HeathWed, 11 Sep 2019 08:09:00 CSTen-usIndependent Women's Forum