There is a publication called Aunt Minnie.com that is published by radiologists for radiologists. There is a very interesting article in today’s edition you may like to see.

AuntMinneLung Cancer Article

https://www.auntminnie.com/index.aspx?sec=sup&sub=cto&pag=dis&ItemID=120805. Check it out!

People ask Tim and I all the time why healthcare costs so much. It is situations like the ones highlighted in this article that are some of the causes for the high costs of healthcare.

On the one hand, we have developed great technologies, procedures and medications that can effectively treat lung cancer if caught early. On the other, early diagnosis, can save a life and perhaps save money – but it is also true that it can also cause the person that survives to have a lifetime of chronic conditions that are quite expensive. In many occasions, that cost is extremely significant across the person’s life. This can add a huge amount to our collective societal healthcare bill.

What is astounding is the incidence rate of the people who simply are not responsible enough to get any form of care until they develop the conditions, even if terminal, that will be very, very, expensive to them and, all of us as well.

This problem extends way beyond Lung Cancer to many other chronic conditions and diseases. One the one hand, we can save a life – always the best thing. Yet, on the other, we, or society under our current system, are now assuming the financial responsibility of the cost of many, many, years of care for most of these people.

For example, at the beginning of the HIV/AIDS crisis, the cost of medications and treatment was high typically $10-15,000 per month. With the effective care of that period, we could extend an afflicted patient’s lifespan about 8 years. Near the end of their lifespan, their quality of life was not very good. Total cost of life treatment would be about $1.4 million per patient.

Today, with modern care, medications and technologies, the patient can live almost a normal life span, and cost of treatment is still about $15-18,000 per month on average. They are now living another 40 – 60 years. Clearly this is a good thing. What is not so good a thing is the cost of the new lifetime of care is about $9 million.

This is not to say that we think we should let people die. Nor are we saying that we should restrict access to effective care. That is not our point. We are bringing this to the table to point out that early diagnosis and treatment often only lowers the cost of care for the short-term.  For the longer term, the chronic care that lingers, adds up.

These are just a few of the reasons healthcare costs are huge today. And, this is why we need to have open and honest discussions of why care is costing so much and, why we need to stop trying to blame the problems on Drug Manufacturers, Doctors, Insurance Companies, Hospitals, Government and every and anything else.  In the end, it is all of these issues and, frankly,  us that are causing the cost problems.  Our expectations are way beyond what modern medicine can deliver. When something doesn’t meet our unrealistic expectations, we want more care. And in the end we want to sue somebody.  Even if care does meet our expectations, particularly in later years, after 55, care costs begin to climb as our bodily systems age and begin to suffer the diseases of old age. and we need more and more care. Since Care is dangerous the care itself can trigger problems that will add-on more needed care costs.

The good news is there are answers. There is a way to have an effective healthcare system that will provide for us what we need effectively, efficiently and affordably, including a safety net for the helpless.  If we want to get there, WE, not the government, need to begin a dialog, a discussion; reset our expectations and understand why what we have is not working.  Join with us to make the changes WE (the people) need to make, dis-spell the myths and demand the changes that will bring us the care we need and make available the extra care we want.

Please comment below and let us know what you think! If you have a question ask it we will try to help get the answers.

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The ACA – ObamaCare is failing, and will surely fail, but not for the populist reasons being discussed so readily today!

False Costs!

Dan Munro states, in his article “Annual U.S. Healthcare Spending Hits $3.8 Trillion,” published in Forbes Magazine, February 2, 2014, that the nation’s true healthcare spend needs to be calculated to include both the National Healthcare Expenditure ($3.093 trillion) and the Sustainable Growth Rate ($0.116 trillion) deficit that is accumulating on our books.  He further is adds two numbers, recently calculated by Deloitte Center for Health Solutions, “The Hidden Costs of U.S. Health Care: Consumer Discretionary Health Care Spending,” Additional Direct Costs ($0.129 trillion) and Imputed Indirect Costs ($0.492 trillion).  This is how he gets to the staggering projection for 2014 of $3.8 trillion in total healthcare costs. He is correct and wrong!

Do we really know how much America’s healthcare costs?

The short answer is, NO – we don’t. We just think we know what it costs because people produce a number that is nationally reported.

The real number is likely far less than what is reported; but getting to the real number is very difficult.  Here’s a few of the reasons:

  1. We do not collect consistent comparable data – it includes both prices invoiced in some cases and actual reimbursements in other cases.
  2. Much of the reimbursement data that is collected, is tainted by the false economic structures in place that both influences its price and affects the reporting.
  3. Some of the data reflects what is charged at invoice; but what is typically paid to providers is a significantly smaller number – averaging 22 cents on the dollar invoiced.
  4. The numbers that are calculated based on what is reimbursed to providers for the service – actually paid, not invoiced – are tainted by a number of hidden and, in some cases, arbitrary calculations and mechanisms that drive up the reported reimbursement price.

Circular Math Drives Inflated Costs

Let’s look at one program, in one state, California’s AIDS Drug Assistance Program (ADAP), they report that they paid $500 million for drugs delivered in 2009. Since CA “reimbursed” pharmacies for these drugs you would think the cost was accurate. Again, you would be wrong!

California, did report that is spent $500 million but that is not what the net cost really was. In this case, about one-half of the funding came from the federal government and about one-third of those funds came from a mandatory rebate program paid by pharmaceutical companies, who supplied the drugs, to the federal government who passed the funds back to California.  The other half of the funding came from two different sources in the California budget; about one-half is from the General Fund (taxes) and the other half is from a “Special” Fund (CA’s mandatory rebate from the same Pharmaceutical companies for the same drugs). So, even with government provided reimbursement cost data, the actual number spent is not correct – often, not even close.

Pharma created the funds to pay all these rebates by increasing prices. This is only one example of dozens throughout healthcare. The ACA has added many

similar taxes and fees creating the funding to pay subsidies. No one seems to see it continually drives prices up!

Employer Sponsored Insurance, Co-Pays and Deductibles = Price Obscurity

At first grouping numbers of employees together in an employer pool provided for group purchase discounts and, larger employers were able to offer better benefits. Soon, this advantage was consumed with rapidly expanding benefit offerings.  Employer A offered vision. Employer B responded with vision and dental. Next, benefits increased to include expanded dental coverage and more. Each year, employees demanded better coverage – more things covered – and each year employers responded by demanding more from their insurance plan to satisfy employees. Insurers responded by adding more covered items into the policies and raising premiums.

As policy costs grew, at first employers assimilated them and reduced salary increases.  The continual demand for more benefits moved beyond just good basic healthcare to items that were more weighted toward quality of life and desired additional care.

Along the way, employers needed a mechanism to offset the rising costs. Insurers responded with the idea of deductibles and co-pays.  As employees asked for more, or as the providers invented new more expensive ways to treat illness, accident and disease, costs were shifted to the employee and the provider payment was reduced by the insurance company. This was then predictably picked up by the patient in the form of co-pays.

The system now places an undue burden on the insured as routine deductibles, without subsidies – costing as much as $12,000 for a family of four – can alone bankrupt many families.  The concept of affordable care practically goes out the window. But it need not be this way.

We believe we can develop a system that will eliminate the need for copays and deductibles and replaces ESI with a tax incentivized stipend system coupled with lifetime health savings accounts. We believe we can do this while lowering premiums for everyone and creating an accessible, accountable, efficient and effective healthcare system, including a safety net for all, while preserving individual choice.

We have developed a dual market approach. A needs based LifeCare market on one side provides efficient, effective and affordable care to all with no networks. The choice based Quality of Life Care market provides easy access to all the additional care people want and provides portability, price transparency and certainty. We integrate both markets in a unique single point of access and administration that will lower cost of care in America by at least one-third.

If you would like to read additional information or the current draft of the whitepaper go to http://tloker.wordpress.com.