The world needs to know- Right food, right lifestyle, right zip code, right genetic code, right doctor, right medication and diagnostics at the right time, maybe the right job, maybe the right spouse, maybe the right state governor, keep you healthy. The right health plan? Not so much.
And, it’s important not to demonize anyone in the system. It’s also important for us to understand reality; to understand business incentives which predict organizational behavior.
Health plans (and their brokers and benefit managers and TPAs and intermediaries) are Financial organizations which exist for one single reason- to manage someone else’s money and to retain as much of that money for themselves as legally possible; while following extensive (and we should note, expensive) regulations which are put in place to theoretically protect patients (“members”) from harmful health plan processes or policies. Generally speaking, the most successful health plans (and benefit managers) have the smartest financial engineers, actuaries and the best complex contracting attorneys; not the best networks of doctors, not the best drugs, not the best hospitals, not the best pharmacies.
What can we do? Let’s make 2026 the year that DIRECT and COST-PLUS goes parabolic. Direct Primary care (include concierge, integrative care and similar models), direct to patient pharma programs (ie- Lilly Direct), direct to pharmacy programs which pharma and some distributors are championing, support the efforts of honest benefit managers promoting fully transparent and rebate free Pharmacy Benefit Management such as Judi Health (formerly capitalRx); support patients in their efforts to receive DIRECT price quotes on their cost of care whenever plausible-
(See the efforts of AfterTransparency)
If we patients want to pay less for our care, to regain choice, to receive quality, compassionate non-corporatized-profit driven care, then we all need to get engaged. We the People means all of us. Thank you Wendell for all you do! /RH MD
Mr. Potter does a magnificant job of desribing all the things that are wrong with the American Healthcare System. However, he never mentions the insurance industry's SECRET Provider Agreements that: 1.) Can be accessed as public documents, 2.) Are essentially identical across the country, 3.) Are overseen by the States not the Federal Government, and 4.) Provide far greater care and coverage than the public is allowed to know. And, as a past senior manager, Mr. Potter has to know how important these Contracts are to any discussion on healthcare. So I have to ask "Why Mr. Potter?" " Why all the silence on the most ccritical part of the American Healthcare System and the contracts that define the very care and coverage we are ACTUALLY owed from our health insurance? i. e. the care and coverage we should be getting but are NOT! - - - And, I'm very open to being told where I'm wrong.
i read all of the posts here---lots of solid insights, but also a singular point of view as to that government care end to end is apparently the only way to go. The country of course has tried to live in the middle and that is not working well with high priced drugs, local hospital monopolies that make true competition impossible, and of course, the greedy insurance companies. Leaving it to physicians to determine care levels seems to be the other half of the answer---but I think we all know that's another imperfect solution. The populace is hungry for simple sounding solutions and suspect we are headed for price controls as the only politically and administratively actionable solution. I am wary of any silver bullets---even though I want one, our health insurance climbed almost 50% this year with several employees on high priced drugs. But I also wait every year on CMS to publish key rates----and whether our business model works or doesn't work, so leaving it to faceless regulators in Aberdeen MD is not particularly attractive either.
question- if doctors, who study and train for a decade to get their licenses to practice medicine, are not who you imagine should be the ones that determine what care you need…i mean what are you talking about?
great deference to doctors but guard rails too, that's the tension obviously. I may differ quite a bit from other readers here but i think a blank check to doctors is not the answer---too many examples of bad actors here too
Glad to see the post, informing people about problems with those measures.
Actually, in recent weeks I've been probing myself into a bit into the standard measures "CPI" and "wages" and "real wages", to see what they might miss on healthcare costs and elsewhere.
And, actually, on the substack version of the Dean Baker post that you cite, I have two comments about that. One of them indicated that the CPI would completely ignore the cost of living increase from the lapsed expanded subsidies that just happened. (Because ACA subsidies are means-tested, and omitted from CPI.)
where I first explained the CPI will completely miss showing any effect at all of the expired expanded subsidies (even though some people, say couples around 62 with an income of $88,000 a year in say WY, had their premiums jump from about $6,000 a year to about $40,000 a year, and experienced about a 50% increase in what we would think of as their cost of living).
(If the ACA subsidies were all stopped entirely, in fact, the consumer price index would miss that increased cost, as well. And, I'm not sure, but I think if Medicare were also stopped, the CPI would completely miss it!)
--
(The other part of that substack post is about "wages" and "real wages", which, over the long term, miss a lot.)
Mr. Potter has made a business of telling us everything that's wrong with our healthcare system. So why hasn't he mentioned the Insurance Industry's SECRET Provider Contracts that guarantee us far greater care and coverage than we are allowed to know? Why? - - Go to <www. killAbill.com> and judge for yourself. Because you and I really do have away of winning this dishonest game on our own.
Wendell- your writing inspires!
The world needs to know- Right food, right lifestyle, right zip code, right genetic code, right doctor, right medication and diagnostics at the right time, maybe the right job, maybe the right spouse, maybe the right state governor, keep you healthy. The right health plan? Not so much.
And, it’s important not to demonize anyone in the system. It’s also important for us to understand reality; to understand business incentives which predict organizational behavior.
Health plans (and their brokers and benefit managers and TPAs and intermediaries) are Financial organizations which exist for one single reason- to manage someone else’s money and to retain as much of that money for themselves as legally possible; while following extensive (and we should note, expensive) regulations which are put in place to theoretically protect patients (“members”) from harmful health plan processes or policies. Generally speaking, the most successful health plans (and benefit managers) have the smartest financial engineers, actuaries and the best complex contracting attorneys; not the best networks of doctors, not the best drugs, not the best hospitals, not the best pharmacies.
What can we do? Let’s make 2026 the year that DIRECT and COST-PLUS goes parabolic. Direct Primary care (include concierge, integrative care and similar models), direct to patient pharma programs (ie- Lilly Direct), direct to pharmacy programs which pharma and some distributors are championing, support the efforts of honest benefit managers promoting fully transparent and rebate free Pharmacy Benefit Management such as Judi Health (formerly capitalRx); support patients in their efforts to receive DIRECT price quotes on their cost of care whenever plausible-
(See the efforts of AfterTransparency)
If we patients want to pay less for our care, to regain choice, to receive quality, compassionate non-corporatized-profit driven care, then we all need to get engaged. We the People means all of us. Thank you Wendell for all you do! /RH MD
Mr. Potter does a magnificant job of desribing all the things that are wrong with the American Healthcare System. However, he never mentions the insurance industry's SECRET Provider Agreements that: 1.) Can be accessed as public documents, 2.) Are essentially identical across the country, 3.) Are overseen by the States not the Federal Government, and 4.) Provide far greater care and coverage than the public is allowed to know. And, as a past senior manager, Mr. Potter has to know how important these Contracts are to any discussion on healthcare. So I have to ask "Why Mr. Potter?" " Why all the silence on the most ccritical part of the American Healthcare System and the contracts that define the very care and coverage we are ACTUALLY owed from our health insurance? i. e. the care and coverage we should be getting but are NOT! - - - And, I'm very open to being told where I'm wrong.
i read all of the posts here---lots of solid insights, but also a singular point of view as to that government care end to end is apparently the only way to go. The country of course has tried to live in the middle and that is not working well with high priced drugs, local hospital monopolies that make true competition impossible, and of course, the greedy insurance companies. Leaving it to physicians to determine care levels seems to be the other half of the answer---but I think we all know that's another imperfect solution. The populace is hungry for simple sounding solutions and suspect we are headed for price controls as the only politically and administratively actionable solution. I am wary of any silver bullets---even though I want one, our health insurance climbed almost 50% this year with several employees on high priced drugs. But I also wait every year on CMS to publish key rates----and whether our business model works or doesn't work, so leaving it to faceless regulators in Aberdeen MD is not particularly attractive either.
question- if doctors, who study and train for a decade to get their licenses to practice medicine, are not who you imagine should be the ones that determine what care you need…i mean what are you talking about?
great deference to doctors but guard rails too, that's the tension obviously. I may differ quite a bit from other readers here but i think a blank check to doctors is not the answer---too many examples of bad actors here too
Medicare for ALL will not take a premium and then deny your care.
A compelling case for Medicare for all
Single payer. Period.
Glad to see the post, informing people about problems with those measures.
Actually, in recent weeks I've been probing myself into a bit into the standard measures "CPI" and "wages" and "real wages", to see what they might miss on healthcare costs and elsewhere.
And, actually, on the substack version of the Dean Baker post that you cite, I have two comments about that. One of them indicated that the CPI would completely ignore the cost of living increase from the lapsed expanded subsidies that just happened. (Because ACA subsidies are means-tested, and omitted from CPI.)
(The comments on Dean's post are here:
https://substack.com/@normspier828307/note/c-215372015
However, my exposition there was little weak.
I probably did better a little later, when I stuck issue on my own page:
https://normspier828307.substack.com/p/consumer-price-index-and-wages-these
where I first explained the CPI will completely miss showing any effect at all of the expired expanded subsidies (even though some people, say couples around 62 with an income of $88,000 a year in say WY, had their premiums jump from about $6,000 a year to about $40,000 a year, and experienced about a 50% increase in what we would think of as their cost of living).
(If the ACA subsidies were all stopped entirely, in fact, the consumer price index would miss that increased cost, as well. And, I'm not sure, but I think if Medicare were also stopped, the CPI would completely miss it!)
--
(The other part of that substack post is about "wages" and "real wages", which, over the long term, miss a lot.)
Wendell, I read all your stuff! I appreciate your expert knowledge. For your consideration:
https://welcometheeagle.substack.com/p/does-cms-and-obamacare-have-any-responsibility
Mr. Potter has made a business of telling us everything that's wrong with our healthcare system. So why hasn't he mentioned the Insurance Industry's SECRET Provider Contracts that guarantee us far greater care and coverage than we are allowed to know? Why? - - Go to <www. killAbill.com> and judge for yourself. Because you and I really do have away of winning this dishonest game on our own.
Have you written about APMs?