If I could choose only one healthcare topic two months before the election, it would be…

…difficult to choose.

  1. The escalating cost of drugs is an election year favorite
  2. Then there are several reports this week that electronic health records are a PITA to doctors, and I don’t mean the kind wrapped in flatbread
  3. Let’s not forget the fact that the Affordable Care Act is anything but – for patients who have to pay the rates (as opposed to those who get government subsidies) and for the health insurance companies trying to provide them

I thought about posting a request for a vote and then expound on the most popular topic. Each one, however, is so rich with possibility. Let’s not let any of them lie fallow.

The Escalating Cost of Drugs

Pharmaceutical companies are under public scrutiny for raising prices. We’ve had the Shkreli scandal and now another company is in the news for increases from about $100 to $600 over the course of about 8 years, give or take. Ouch. If you are a patient paying full price out of pocket, or even some copay that amounts to about 25% of the full cost, you feel that. Not seen in this diagram, however, is that much of this product finds its way into schools for free to save the lives of children.

After the public outcry, this particular manufacturer immediately cut the cost of its drug by half, then introduced a generic version.

There is the potential for a trend here. If the manufacturer releases its own generic, it wins whether it’s playing on the swings or the sliding board. And I am sure that this manufacturer’s price hike will remain political fodder for the next few months because hating on the pharmaceutical industry is such an easy win for a politician pandering to public opinion.

Beware the legislation that arises from this controversy.

Electronic Health Records

I would say it myself, except this writer said it so much better:

Electronic health records slow doctors down and distract them from meaningful face time caring for patients.

That is the sad but unsurprising finding of a time and motion study published in Tuesday’s Annals of Internal Medicine. A team of researchers determined that physicians are spending almost half of their time in the office on electronic health records (EHRs) and desk work and just 27 percent on face time with patients — which is what the vast majority of doctors went into medicine to do. Once they get home, they average another one to two hours completing EHRs…

…This is a shared problem with more than enough culpability to go around. Vendors like my company, athenahealth, and others have been required to develop EHRs that satisfy government regulations rather than the needs of providers and patients.

With limited authority and the best of intentions to oversee EHR certification and adoption, the Office of the National Coordinator for Health Information Technology continues to inflict enormous pain on our nation’s providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating.

Motivated by more than $30 billion in incentives, vendors have lined up happily to ride the wave, building EHRs that satisfy government requirements but make it increasingly difficult and less rewarding to care for patients.

[end of excerpt]

I’ve been saying this for years, but writer Jonathan Bush just boiled it down so nicely. We’ve made progress on implementing electronic patient records throughout the system, certainly, and will continue to do so. However, so much greater progress will be made with physicians, patients and computer programmers working together in harmony rather than working against the constraints and deadlines of government regulations wending their way through a serpentine lawmaking process that can’t keep up with the pace of technological progress.

Technology should make our lives easier, don’t you think?

About the Cost of the ACA and Aetna’s Problem

I wrote about this when the ACA first passed, and it continues to be an obvious issue. The Affordable Care Act defies actuarial science. Under the ACA, rates are not set according to mortality charts, but are government-subsidized and the products are structured under regulations. In a rational health insurance scheme, healthy people pay into the plan and help fund sick people. Health insurance companies structure benefits considering the amount of risk they are willing to take on an individual given the amount of care the patient/member chooses to insure when they select a plan. Since the ACA, this concept is out the window. If someone shows up at the hospital without health insurance, the patient applies for health insurance and, at least in theory, the bill gets paid. Aetna is losing so much money on its ACA products that it is pulling out of most health exchanges.

If you are a provider, the ACA works because health insurance pays your invoice whether the patient was insured or not when they walked in the door. In fact, one hospital came up with the bright idea that they would even pay the premium of uninsured patients to make sure the bill got paid. That little scheme looks like it won’t pass court scrutiny.

Democrats need the ObamaCare plan to appear to work, even when the evidence is glaringly against it. Again, this New York Times writer was much more eloquent and succinct on this issue:

Premiums in many areas are expected to go up by double digits and some insurers are bailing out or scaling back after having lost hundreds of millions of dollars. Going into their fourth year, the law’s health insurance markets don’t seem to be on a stable footing yet. But they are also unlikely to implode, because subsidies will cushion the impact of premium increases for most customers.

[end of excerpt]

In election years, the cost and availability of healthcare have become perennially favorite scapegoats. If I were a politician, I’d promise free drugs, free health insurance, free exams, free everything because, after all, the government can just print more money and pay the bills.

What could possibly go wrong?

Nota bene: The opinions expressed are my own and reflect disillusionment with the politically-motivated solutions to our healthcare crisis. My opinions do not reflect lack of care for those who can’t afford to see a doctor or pay for a drug. Quite the opposite. My opinions reflect frustration, and I join with others looking for reasonable, rational, workable, affordable answers so people can get the healthcare they need, when they need it with the promise of technology providing part of the answer.








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