Healthcare Now Fully Politicized

Vox asked 8 Senate Republicans to explain what their health bill is trying to do and the answers are all political. Basically they're trying to fulfill their promise to repeal and replace Obamacare but they don't have any agreement (or seemingly knowledge of) the specifics of the healthcare issues that Americans are facing and what policies might actually improve them. When I hear Trump talk on some policy it's obvious to me that he has no understanding of any details of the issue. The replies by these Senators sounds almost as ignorant. The party's goal is to pass *something*, it doesn't really matter what, they can't agree because individually their members want different things, there's little if any shared knowledge no the specifics of the problems or the possible solutions. They know premiums are high but don't understand why or what would lower them, and they know that some counties have lost all insurers though it's not clear they know just how many or what would bring insurers back. Sarah Cliff is a bit more blunt, I’ve covered Obamacare since day one. I’ve never seen lying and obstruction like this.. Now I know Democrats understand the issues more fully. They know that some young and healthy people have chosen to not buy insurance and that getting them into the pool will lower premiums on average. There are ways to do that, raise the tax fee for not having insurance (that is enforcing the individual mandate) would accomplish that. They know that insurers have found that people are sicker than expected and with the threat of repeal and Trumps cut back on signup advertising there are fewer enrollees so insurers are dropping out of the markets. Stopping the repeal talk, advertising, and enforcing the individual mandate would help stabilize the markets. A public option would ensure an insurer and provide competition to lower premiums. A reinsurance program would help insurers deal with more expensive enrollees. A big portion of the premium expense is prescription drugs which all Obamacare plans must include. There are legislative options to lower drug costs (allow Medicare and Medicaid to negotiate prices) and perhaps they could offer plans to young people that don't include drugs to lower their costs. Sadly, rather than being loud and clear and on their plans, Democrats are playing politics too. The Atlantic explains How Democrats Would Fix Obamacare. > Exactly how Democrats would change the bill they enacted seven years ago is less clear. Lawmakers have floated a range of options, from tackling the cost of prescription drugs, to setting up a reinsurance program to shore up Obamacare’s flagging exchanges, to reviving the idea of a “public option” that would compete with private carriers and drive down prices. > But party leaders have chosen not to endorse a specific set of reforms, in part because Republicans have shown little interest in considering their ideas and in part to avoid distracting from their more urgent imperative to save Obamacare from destruction. “We’re not in the majority right now, and our whole focus right now is to keep them from sending us back to a time when insurance companies could sell plans that provided nothing and people found themselves just in a terrible bind,” Senator Patty Murray of Washington state, a member of the Democratic leadership, said in an interview.

Secrete Senate GOP Healthcare Plan

There was an episode of The West Wing where Josh was filling in for CJ and did such a horrible job that he said "the president had a secret plan to fight inflation".

[youtube https://www.youtube.com/watch?v=B_3kELe0M8A&w=560&h=315]

Well, now the for-real Senate has a secret plan to reform healthcare in America. Senate GOP won't release draft health care bill.

Senate Republicans are on track to finish writing their draft health care bill this evening, but have no plans to publicly release the bill, according to two senior Senate GOP aides.

"We aren't stupid," said one of the aides. One issue is that Senate Republicans plan to keep talking about it after the draft is done: "We are still in discussions about what will be in the final product so it is premature to release any draft absent further member conversations and consensus."

So the plan is to give the CBO two weeks to score it, that will be about June 26, and then vote by July 4th, and I assume their recess starts June 30 (certainly by July 3rd but I assume they'll take the weekend off). So that's a business week, where they might release their plan to the public and debate it before voting on something that affects one sixth of the US economy. Great job Republicans.

Democratic Ideas on How to Improve Health Care Are Complicated Too

I've been thinking that Democrats should be out there offering ways to fix Obamacare which they always just describe as "not perfect". If they're to learn anything from the election they can't just depend on the GOP ideas being bad, they have offer good ones themselves. Nancy LeTourneau explains in Washington Monthly Democratic Ideas on How to Improve Health Care Are Complicated Too

While Obamacare certainly wasn’t single payer and ultimately didn’t include a public option, most of it tackled the issue of how health insurance is provided. The expansion of Medicaid is a great example. And while many of the ideas being articulated now are important for Democrats to consider, it is also significant to remember that there are still 19 states that have refused to do so. Millions of Americans would have access to insurance and health care if that was tackled.

I hadn't known about this detail (or have forgotten it):

But that battle obscured the one that happened over the public option in the House. There the disagreement was over what kind of public option would be included. This is where the issues of insurance and cost of care overlapped. Progressive Democrats tended to support what came to be known as a “robust” public option. It would tie payment to providers to the Medicare payment system. Conservative Democrats favored a public option that allowed HHS to negotiate payments with providers. In the end, Conservative Democrats won and it was their plan which was included in the House bill and later removed via reconciliation with the Senate. Interestingly enough, CBO said that premiums for that public option would be slightly higher than the private plans offered in the exchange. A later CBO report found that a “robust” public option would produce premiums that are 7-8% lower than private plans.

Any, now that Trump is off saying that the Democrats own Obamacare (which they always did) and it's going to both implode and explode (because those don't mean different things), I'd like to see the Democrats pushing for solutions they'd like to see. The Republicans clearly, at some point are going to have a conversation about it, we should be prepared for the argument.

The puzzling way Republicans want to replace the individual mandate, explained with a cartoon

Vox describes The puzzling way Republicans want to replace the individual mandate, explained with a cartoon

Today in Obamacare: the GOP’s Latest Plan Gives the Wealthy Extra Help to Buy Insurance

Sarah Kliff at Vox explains Today in Obamacare: the GOP’s latest plan gives the wealthy extra help to buy insurance.

Both Obamacare and the Republican replacement plans provide tax credits to help make insurance more affordable. But while Obamacare’s credits are based on income, meaning poorer people get more help, the Republican plan would base them on age. The result would be regressive: Wealthy people would get more help buying insurance, while poor people would likely get less assistance.

The Obamacare tax credits are income-adjusted, which means that people who earn less get more help. Under Obamacare, people who earn less than 200 percent of the poverty line (about $24,120 for an individual or $49,200 for a family of four) get the most generous help. They would get enough money so that a midlevel plan would cost no more than 6.4 percent of their income. People who earn more than 400 percent of the poverty line ($48,240 for an individual or $98,400 for a family of four) get nothing at all. There is no cap on what they have to pay for insurance.

The Republican plan is very different. It includes age-adjusted tax credits. Older people get more help, and younger people get less help. The idea is that older people need more support because they get charged higher premiums. But income does not matter at all. Under the Republican plan, it wouldn’t matter if a 30-year-old earned $15,000 or $150,000 — he would get the exact same tax credit.

Do high-deductible plans make the health care system better?

Do high-deductible plans make the health care system better?

High-deductible plans push people to shop around for health treatments, often without the benefit of information on quality and price. That worries Amitabh Chandra, an economist and health care researcher at Harvard University. 

'Simply calling the patient a consumer doesn’t make buying health care anything like buying cars and computers,' said Chandra.

In fact, Chandra’s research shows that even higher-income earners with more economic flexibility do not really shop for health care efficiently, even when they're given a state-of-the-art computer program to compare prices. People on these plans tend to forgo all sorts of care, regardless of their own need and health status. 

'Prevention, imaging, or drugs — consumers were cutting back on all those. And that’s a sign they don’t really know what care is valuable and what care isn’t valuable,' said Chandra.

In health care research, a new consensus is forming, in part because of Chandra’s work: high-deductible plans with cheaper premiums work well for people who are generally healthy. But for those who are chronically ill or live on lower incomes, these plans can be a disaster. At any income level, in fact, they incentivize the consumer to cut back on care they may need.

A Woman Was Killed By a Superbug Resistant to All 26 American Antibiotics

The Atlantic reports A Woman Was Killed By a Superbug Resistant to All 26 American Antibiotics

Funny—by which we all mean scary—because yesterday afternoon, the CDC also released a report about a Nevada woman who died after an infection resistant to 26 antibiotics, which is to say all available antibiotics in the U.S. The woman, who was in her 70s, had been previously hospitalized in India after fracturing her leg, which led to an infection of the bone. There was nothing to treat her infection—not colistin, not other last-line antibiotics. Scientists later tested the bacteria that killed her, and found it was somewhat susceptible to fosfomycin, but that antibiotic is not approved in the U.S. to treat her type of infection.

The most worrisome kind of colistin resistance is caused by a single gene called mcr–1. The bacteria that killed this woman did not have mcr–1; it’s still unclear how they became resistant. Other cases of colistin resistance have emerged before though. What makes mcr–1 special is that sits on a loop of free-floating DNA called a plasmid, which bacteria of different species can pass back and forth. And there are many plasmids out there with genes that confer resistance to this or that class of antibiotics.

Why patients blame the weather for aching joints

Turns out, the weather doesn’t make your joint ache any more or less. Why patients blame the weather for aching joints

In the new study on knee osteoarthritis, the researchers asked 345 patients to log onto a website every time their pain flared up for eight hours or more — and then the team linked those episodes to the temperature, relative humidity, barometric pressure, and precipitation recorded in that patient’s neighborhood around that time by the Australian Bureau of Meteorology. The researchers also looked at the weather on days when the patients had no flare-ups. They found no significant relationship between pain and any kind of weather change. The same was true for the study on back pain.

Politics

Here are a few recent political stories that I found explained things in more depth than usual:

A Tale Of Two Foundations

While the reporting on the Clinton Foundation focuses on these kind of “conflicts,” there has been no evidence of actual misconduct. Charity watchdog groups rate the Clinton Foundation highly.

Meanwhile, on September 1, news broke that the Trump Foundation “violated tax laws by giving a political contribution to a campaign group connected to Florida’s attorney general.” It was required to pay a $2500 fine to the IRS.

The details of the case are even more unseemly. Florida’s Attorney General was considering opening an investigation into Trump University, which is accused of defrauding students. Bondi herself contacted Trump and asked for a political contribution. After a political committee associated with her campaign received the illegal $25,000 contribution, she decided not to pursue it.

The story has something that none of the Clinton Foundation stories have: Actual evidence of illegal conduct. In this case, not only is there concrete evidence that the Trump Foundation broke the law, but a formal finding of wrongdoing by the IRS.

In May digby wrote GOP suffering from Koch withdrawl.

Yesterday the world found out why when the National Review published a blockbuster scoop revealing that the Kochs have decided to withdraw from national politics. The 900 million dollars they'd planned to spend in this election cycle has been reduced to around 40 million on "educational" campaigns. They will continue their work at the state and local level (which is significant) but they are no longer much interested in electoral campaigns on the federal level.

Charles Koch provided a window into his own thinking in an interview last month with ABC’s Jonathan Karl.

“When you look back over the years, over the last several cycles, hundreds of millions of dollars in electoral politics, what have you gotten for that?” Karl asked. “What’s been the return on that investment?”

“Well, I’ve gotten a lot of abuse out of it,” Koch said. “What have we gotten for it? Well, I think there have been some good things, particularly at the state and local level.”

“At the federal level,” he added, shaking his head, “we haven’t in any way changed the trajectory of the country.”

Karl suggested it hasn’t been a very good investment. “No, no it hasn’t,” Koch replied. “It’s been disappointing.”

In June Vox explained, Paul Ryan's "why don't you get a job" approach to poverty is doomed to fail

He's right on one thing: It does appear that work requirements like the ones he's proposing get people to work more, increase their earnings, and reduce their reliance on government programs. But America's experience with welfare reform has taught us that this comes at a significant cost. While requirements boost work somewhat, they're not enough to get a job at a living wage for everyone who can work, and they do nothing for the elderly or disabled who can't work at all. The result is enduring poverty among those who can't work or can't find work.

Sarah Kliff says It sure looks like Aetna quit Obamacare because Obama opposed their merger

When one financial analyst asked Bertolini about it on the company’s last earnings call, he responded that the merger was a “separate conversation from our evaluation of how we think about the exchanges going forward.” But the July 5 letter paints an entirely different picture, one where Bertolini says that participating in the marketplaces would be too difficult and costly for the company if it also were in litigation over its merger proposal.

There will almost certainly be different interpretations of why Aetna tied together its marketplace participation and its merger approval. In this letter, Bertolini says it’s all about finances: that the company was losing money on the marketplaces and needed a financial boost from the marketplaces in order to continue to sustain those losses. And it certainly is true that Aetna has lost more than $400 million on the marketplaces since they launched in 2014.

I didn't find any of this surprising but apparently some do, What a liberal sociologist learned from spending five years in Trump's America.

The result is Hochschild’s new book Strangers In Their Own Land: Anger and Mourning on the American Right — the result of five years and hundreds of in-depth interviews. The book fixates on a paradox: Calcasieu Parish in Louisiana, where she spends much of her time, is one of the most polluted regions of the country, ravaged by the oil and petrochemical industries. Residents mourned the loss of the pristine bayous of their youth, of their favorite fishing and hunting spots. Yet to her surprise, they remained deeply hostile to the Environmental Protection Agency and environmental regulation. Why was that?

There was no one simple explanation. Some of the people she met were worried about regulations killing jobs. Others saw toxic pollution and environmental disasters as the sort of risk essential to a vibrant economy, something to be stoically endured. Still others had become disillusioned with corrupt and ineffective local regulators.

As Hochschild probed deeper, what she found most common was a "deep story" the conservative white residents were telling themselves. They felt left behind or even kept down by a federal government that no longer looked out for them — that was against their interests at every turn. When Donald Trump enters the scene midway through the story, she’s none too shocked that he finds fertile territory here.

In the interview Hochschild says:

So the deep story I felt operating in Louisiana was this: Think of people waiting in a long line that stretches up a hill. And at the top of that is the American dream. And the people waiting in line felt like they’d worked extremely hard, sacrificed a lot, tried their best, and were waiting for something they deserved. And this line is increasingly not moving, or moving more slowly [i.e., as the economy stalls].

Then they see people cutting ahead of them in line. Immigrants, blacks, women, refugees, public sector workers. And even an oil-drenched brown pelican getting priority. In their view, people are cutting ahead unfairly. And then in this narrative, there is Barack Obama, to the side, the line supervisor who seems to be waving these people (and the pelican) ahead. So the government seemed to be on the side of the people who were cutting in line and pushing the people in line back.

I went back with this story to a lot of the people that I’d talked to. I asked, is this the way you feel? And they said, "Yeah, you read my mind!" or, "Yeah, I live your narrative!" And this all becomes more acute as their place in line feels more vulnerable. There’s the offshoring of American jobs, automation that is now making even skilled jobs feel vulnerable. So when you add a cultural and demographic sense of loss and decline to a real economic threat, it becomes alarming. And the government doesn’t seem like it’s heard your distress call.

Vox explains, The US paid Iran $1.3 billion in secret. It’s not a scandal.

Obamacare Hits a Bump

Paul Krugman in Obamacare Hits a Bump does a nice job explaining the current issues the program is facing, most notably about Aetna dropping out of many of the exchanges.

The story so far: Since Obamacare took full effect in January 2014, two things have happened. First, the percentage of Americans who are uninsured has dropped sharply. Second, the growth of health costs has slowed sharply, so that the law is costing both consumers and taxpayers less than expected.

Meanwhile, the bad things that were supposed to happen didn’t. Health reform didn’t cause the budget deficit to soar; it didn’t kill private-sector jobs, which have actually grown more rapidly since Obamacare went into effect than at any time since the 1990s. Evidence also is growing that the law has meant a significant improvement in both health and financial security for millions, probably tens of millions, of Americans.

Much of the new system is doing pretty well — not just the Medicaid expansion, but also private insurer-based exchanges in big states that are trying to make the law work, California in particular. The bad news mainly hits states that have small populations and/or have governments hostile to reform, where the exit of insurers may leave markets without adequate competition. That’s not the whole country, but it would be a significant setback.

But it would be quite easy to fix the system. It seems clear that subsidies for purchasing insurance, and in some cases for insurers themselves, should be somewhat bigger — an affordable proposition given that the program so far has come in under budget, and easily justified now that we know just how badly many of our fellow citizens needed coverage. There should also be a reinforced effort to ensure that healthy Americans buy insurance, as the law requires, rather than them waiting until they get sick. Such measures would go a long way toward getting things back on track.

But of course Congress is broken and Republicans are hostile to any fixes to Obamacare.

The Gel That's Revolutionizing Pain Treatment - The Atlantic

The Atlantic reports on The Gel That's Revolutionizing Pain Treatment

Researchers have created a gel that can attach to inflammation sites and slowly deliver drugs to combat a wide variety of ailments—ulcerative colitis, arthritis and mucositis, to name a few. Inflammation is part of the body’s immune response, bringing extra blood to an injured area, but in cases of chronic inflammation, the heat, pain, and swelling become a problem. Developed at the Laboratory for Accelerated Medical Innovation at the Brigham and Women’s Hospital, the hydrogel—a solid material with high water content—can carry a combination of drugs, and matches its drug release to the level of inflammation around it.

When the gel is injected into the joint of an arthritis patient, for example, it will only release its anti-inflammatory payload when the patient is experiencing a flare, a spike in pain and swelling. When it encounters healthy tissue, it stays intact and does not release its payload."

Unpaid, Stressed, and Confused: Patients Are the Health Care System's Free Labor

I cite Sarah Kliff often for her articles on the health care system. Her latest is: Unpaid, stressed, and confused: patients are the health care system's free labor "I write a lot about health care for my job here at Vox, and have spent the past seven years covering and explaining the American health care system. But there was something I didn't understand about American health care until this experience. It is the considerable burden our fragmented system puts on patients to coordinate their own care."

Her problems of doctors giving her unfillable written prescriptions and telling her to schedule an MRI are not at all my experience. My doctors usually send the prescription directly to my pharmacy and I get a phone call or text message when it's ready to pick up. In fact my problem is I get too many 9am phone calls from my pharmacy, asking me about an out-of-date prescription and do I want to fill it and I can't seem to make them stop. Also, my doctors are good about scheduling tests for me. But coordinating among specialists is problem; you get handed off to another and never know when to go back to the first and then you get conflicting diagnoses. Then there's all the billing, from the insurance company, the doctor and the facility. The numbers often don't match up and the various billing codes are indecipherable. Some I can pay online, some I can't, even for doctors that are down the hall from each other. And of course, when you don't know what's wrong and they ask if you want a test that may help, you don't find out until two months after you have the test that it's $800 out of your pocket. Ugh.

Gene Therapy’s First Out-and-Out Cure Is Here

Gene Therapy’s First Out-and-Out Cure Is Here

A treatment now pending approval in Europe will be the first commercial gene therapy to provide an outright cure for a deadly disease. The treatment is a landmark for gene-replacement technology, an idea that’s struggled for three decades to prove itself safe and practical. Called Strimvelis, and owned by drug giant GlaxoSmithKline, the treatment is for severe combined immune deficiency, a rare disease that leaves newborns with almost no defense against viruses, bacteria, or fungi and is sometimes called ‘bubble boy’ disease after an American child whose short life inside a protective plastic shield was described in a 1976 movie. The treatment is different than any that’s come before because it appears to be an outright cure carried out through a genetic repair. The therapy was tested on 18 children, the first of them 15 years ago. All are still alive."

Inside the Koch Brothers’ War on the VA

Martin Longman writes Inside the Koch Brothers’ War on the VA

In the next issue of the Washington Monthly, investigative journalist Alicia Mundy reveals how the Kochs and their network have executed, with meticulous detail, a plan to get Washington to outsource the health care of millions of our nation’s veterans to corporate sector providers. Among other revelations, Mundy shows:

• that stories about veterans dying while waiting for VA care in 2014 (the ‘scandal’ that sparked the current call for privatization) turned out to be baseless.
• that these claims were cooked up by the Koch-funded group Concerned Veterans for America (CVA) and key Republicans precisely to stampede Washington into passing legislation to outsource VA care.
• that the first round of outsourcing has been a fiasco.
• that independent research mandated by that legislation shows that the VA continues to provide the same or better quality care than do private sector providers.
• that the commission now making the outsourcing decisions is stacked with members and allies of CVA and representatives of private sector providers.

To read the full story, click here. And check back Monday to see our whole new exciting March/April/May issue.

One In Three Americans Had Their Health Records Breached In 2015

One In Three Americans Had Their Health Records Breached In 2015, As Hackers Follow The Money From Retail To Medical Data "At least 111 million individuals’ data was compromised due to hacking or information technology problems in 2015, according to a report released Wednesday by cloud security company Bitglass, based on numbers made available by the U.S. Department of Health and Human Services. That comes after a December IBM report that found a 1,166 percent increase in reported healthcare breaches, resulting in the compromise of “nearly” 100 million records."

I find it hard to believe that last year a third of Americans had their healthcare data "compromised" (whatever that means). No one I know has mentioned such things happening to them (maybe it's just not being exploited?). I get that's it's a viable way to get information for identity theft, but again, I don't believe a third of americans had their identities stolen last year. Still it makes complete sense to me that with no oversight or consequences, healthcare providers have really crappy security.

Still a frined on Facebook was asking if when changing pediatricians could they just ask for their health records. The general response is yes, they're your's but you get a copy and the doctor keeps a copy. That sounds reasonable but she was charged $50 for copies, because...copiers. I did find it cool that I could get copies of x-rays for free on a CD at the time of the x-ray. Now if only my iMac had a CD drive :)

Bernie Sanders has released his Medicare-for-All plan

Vox explains, Bernie Sanders has released his Medicare-for-All plan. Here’s how he pays for it.

Hillary Clinton's campaign has been charging that Sanders' health care vision necessarily entails higher taxes on the middle class. Sanders plan is structured to try to avoid that accusation — levying its payroll tax on employers rather than employees and calling its 2.2 percent flat income tax "premiums" rather than a tax. But in effect, working people — whether wealthy or not — will be paying higher taxes. The Sanders camp's real argument is that, all things considered, the average family would save money.

Friedman finds that a typical family of four with wages of $50,000 and an employer health-plan with $4,955 in annual premiums and a $1,318 deductible would pay only $466 through the new 2.2 percent tax, and save $5,807, or 12 percent of income, on net. Friedman also finds that an employer paying $12,591 toward an employee's health plan would pay $3,100 in the new 6.2 percent payroll tax, and save $9,491.

Reinventing Cancer Surgery--By Designing A Better Hospital Experience

Co.Design writes Reinventing Cancer Surgery--By Designing A Better Hospital Experience "Memorial Sloan Kettering’s new $300 million cancer center focuses on the well-being of the patient—even as they move you through the process as quickly as possible."

Inside the nearly finished Josie Robertson Surgery Center (JRSC), the waiting room feels more like a fancy co-working space for families to camp out, play games, get work done, and grab a bite to eat. The patient rooms—all private, with private bathrooms—have floor-to-ceiling windows; the floors have unique art and poetry, central gathering places for a buffet breakfast and socializing; the figure-eight hallways double as walking paths for post-surgery exercise. Even the 550-person staff will get a well-thought out space that goes far beyond the usual hospital cafeteria. If cancer wasn't involved, it’s a place you could imagine wanting to hang out.

Other health care trends may also help explain JRSC’s unique, patient-friendly setup. The hospital, a nationally leading cancer center, is facing more competition, as many hospitals build fancy facilities to attract business from aging baby boomers. And in the Obamacare era, both patient satisfaction and cost efficiency are important metrics for insurance reimbursement. So a one-night stay will obviously cost less than two, especially if a patient leaves without feeling rushed. "While it might not be that hard, medically, to get someone out the door, having them emotionally and spiritually happy and feeling supported is really a big deal," says Simon.

They describe lots of changes. "Everyone in the hospital—doctors, staff, and most importantly, patients, and their family—will wear a real-time location badges, which, says Ohayon, 'changes the whole notion of what a hospital serves to do.'". Less pagers and phone calls and more hospital staff going directly to patients. Also the rooms are designed so the patient can stay in them and nurses and equipment can come to them.

Hospitals expect you to price shop before you give birth. Good luck with that.

Sarah Kliff wrote on Vox Hospitals expect you to price shop before you give birth. Good luck with that.

The two women are co-workers with the same insurance plan. By coincidence, they happened to become pregnant around the same time and gave birth at the same hospital. They both selected in-network obstetricians to deliver their babies. Both chose to receive an epidural from an anesthesiologist as they gave birth — and that’s where things began to diverge. Here’s more from their co-authored blog post at Health Affairs:

Layla received an unexpected bill for $1,600 for anesthesiology services and warned Erin to expect the same. Yet Erin’s bill never came. Layla happened to deliver on a day when an out-of-network anesthesiologist was on call, while Erin was seen by an in-network anesthesiologist. Purely by chance, one of us received an expensive physician bill and the other did not have to pay a dime.

The two later figure out what happened: While the hospital they chose was in-network for the health insurance plan, Layla’s anesthesiologist was an out-of-network provider. Just because he worked at the hospital, that didn’t guarantee that he was one of the doctors that the insurer had in contract."

It’s the obvious problem of treating healthcare like a market, you can’t always shop around (even if you did have enough information to compare providers or treatments). The out-of-network doctor at an in-network hospital hadn’t occurred to me. She also pointed to this NY Times story, After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know.

In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives.

Obviously you want doctors to help each other when needed, but there has to be a more rational way to compensate them. Particularly when in and out of network fees are so staggeringly different:

digby displays the requisite outrage:

If a person is in their network approved hospital they should not be charged for services by people who have not contracted with that hospital. Period. This should be something that the insurance companies battle out with the hospitals not something about which an individual should even be aware. You follow the rules and go to your designated facility that should be the end of your responsibility. How it isn’t already is just mind-boggling.

The hoops you have to go through if you’re travelling or if you’re taken to a hospital out of network are already ridiculous. Emergencies should be paid by insurance without question wherever we are in the country. But this takes it to a whole new level. You’re in an emergency medical situation and you’re expected to inquire as to whether your doctors are in your network? And what if they aren’t? Are you expected to stop treatment until they offer you someone who is? It’s crazy.

How a Health-Care Reporter Shops For Health Insurance

Sarah Cliff explains, I’m a health-care reporter. Here’s how I shop for health insurance.. Yeah, the process sucks and "it's impossible to predict your medical costs" but she has some tips.

She also wrote, This study is forcing economists to rethink high-deductible health insurance.

In 2006, about one in 10 employees had a health insurance deductible over $1,000. Today? About half do. To health economists, this sounded like good news; they've long theorized that higher deductibles would force down health-care costs. The idea was that higher deductibles would make patients become smarter shoppers: If they had to pay more of the cost, they'd likely choose something closer to the $1,529 appendectomy than the $186,955 appendectomy (yes, some hospitals really do charge that much). This would push the really expensive doctors to lower their prices so cheaper physicians didn't steal their business. This was, however, just a theory. And a massive new study suggests it might have been all wrong.

When I read this I first thought, "of course, no one can tell you the price of healthcare when you have to choose, you just get an incomprehensible bill a month later. Ask a doctor what something costs, they have no idea. Mine couldn't even tell me the room number of the x-ray suite they were sending me to in the same building. Apparently, "This study tried giving workers both the tools to compare costs and a financial incentive to go with the less expensive option." I wonder how good those tools were. I always comment to healthcare professionals how I'm a software person and I'm amazed at how crappy their systems are. That at this point, everyone has seen Google and Amazon and know that systems could be simpler and yet they all have to put up with crazy complex systems that never seem to work.

33 Million Americans Still Don’t Have Health Insurance

FiveThirtyEights break down the fact that 33 Million Americans Still Don’t Have Health Insurance "It isn’t a surprise that some Americans still don’t have health insurance. Despite aiming to insure ‘everybody’ in the U.S., the Affordable Care Act (ACA) left significant gaps in coverage, and decisions made by the law’s opponents have denied benefits to millions of people it was designed to help. But the new numbers reveal that most of the uninsured last year were people who should have been able to access insurance under the law. That presents a major challenge for President Obama in the final years of his term, but also an opportunity: Millions of Americans qualify for coverage but, for whatever combination of reasons, haven’t yet signed up."