Let’s admit it federally … we are spending ONE TRILLION more than we are taking in… have been doing it for over a decade.. our total national debt is some 22-23 TRILLION DOLLARS and while most states have some sort of law on the books that requires them to have a balanced budget… most use “creative accounting” to demonstrate that they are meeting those laws.
The oldest baby boomer will turn 74 Jan 1, 2020 and the youngest will turn 56 in 2020… so in another 9 yrs… all living baby boomers will be on Medicare and will – or could be – drawing a monthly check from social security.
High acuity pts – the sickest of the sick – many times ends up on Medicare disability and/or on Medicaid. Costing both the Feds and the states money to support these people. As the numbers and dollars expended grows… the bureaucrats only view these people as $$$ signs on the Fed/state balance sheet.
From the insurance/PBM perspective… it is a financial (bottom line) benefit for requiring Prior Authorizations , imposing quantity limits or days supply limits, and just out right denial of coverage.
As the many entities that have the authority – or takes the authority – to limit/deny therapy increases… the more pts that will become house, chair, bed confined and by the vary nature these people become PASSIVE PTS and generally PASSIVE PTS get POOR OUTCOMES. Likewise, they are no longer physically capable to fight for a change in their health therapies.
In turn, the pt’s QOL deteriorates, many times their co-morbidity health issues are aggravated resulting if a premature death from “natural causes” or as in the case of a unknown number of suicides are committed by those pts.
Every person who dies prematurely … is one less expense on the various financial balance sheet both in the short and long term.
We have seen that two states NY and RI have implemented Rx opiate tax.. that is being imposed on pharmas, wholesalers and pharmacies and with NY being the first to implement… there are reports of wholesaler not operating in the state have stopped shipping into the state. There has been no information if the pharmacies can pass this added cost along to the insurance/PBM or the pt, but most all contracts that pharmacies have with PBM’s mandate that the pharmacy not charge the pt more than the PBM states is due by the pt’s insurance policy, and PBM in general has not known to be a generous industry. So the PBM industry may look at this as a means of adding to their bottom line as pharmacies decline to stock and fill opiates for chronic pain pts.
So there are many rumors that chronic pain pts are having increased difficulty in finding pharmacies that have stock and/or willing to fill their Rx and bill their insurance company.
The DEA considers it a RED FLAG for a pt to pay cash for a controlled substance when they have insurance and if a pt lives near a border… and thinks that they can go to an adjacent state to get their Rxs filled… DEA also consider it a RED FLAG if a pt travels a LONG DISTANT to get a controlled substance filled. So some pts may find themselves painted into a corner.
Then it was announced today that CMS is implementing new requirements for pts to get their diagnostic tests paid for CMS to implement new appropriate use criteria for advanced diagnostic imaging in 2020
Are the various entities treating our entire healthcare system as a HUGE JENGA GAME… attempting to reduce the overall healthcare expenditures by pulling out pieces of the stack… trying to figure out how many they can pull out without the entire system imploding. Every piece that they pull out… how many “dead bodies” will it represents.
Did you know that there is an increase in organ donations from opiate OD’s and suicides ???
Filed under: General Problems
It is a really profitable Jenga game! In a nation where people believe alternate facts, and the news is a wholly owned subsidiary of the healthcare industry, it is not going to get any better without systemic change. Medicare for all would be a really good start. It is really easy to see how liars, propagandists and corporate CEO’s are making billions on a misinformation and disinformation campaign..
We are already paying around 10K per year, per American for the most ineffective and expensive healthcare system in the developed world. Years ago they came up with plan to profit from the boomers, while denying healthcare to most of them. Clever industry insiders made sure that OSHA could not regulate musulo skeletal injuries, due to workplaces, or long term damage from work. In order to deny that these injuries were a problem, they came up with the opioid scare. Millions of Americans who could not afford quality healthcare or a few days off, are now dealing with long term intractable chronic pain.
The industries had to smear them, demonize them and make sure their problems were not tracked. In Fact no agency tracks these injuries, nor are they allowed to track outcomes from the many mistakes caused by the healthcare industry. They even told blue collar workers, that they needed to exercise, even thought they already got plenty of spine damaging repetitive “exercise” at their workplaces. Employees who spent years at seated at computers are another group that were not allowed to mitigate workplace ergonomics, and many health agencies removed words like ergonomics and musculo skeletal injuries from discussion. They made sure that any employee who reported back pain was suspect. The only option any of these people had was opiates, even after multiple surgeries.
Of course it was easier and more profitable to label them as craven drug addicts, mentally ill or morally defective than address workplace injuries ergonomics or the high number of “medical mistakes. They knew very well how to make a profit from these people. The FDA even withheld reporting data on the number of people killed or injured by medical devices or drugs, to protect industry profits.
Note that none of the so called researchers are researching any of this even though it is the most expensive and life altering issue facing healthcare and millions of Americans. Researchers who rely on industry money and our corrupt NIH, are not researching this or doling our any funds to research it. Even when injured workers, have their conditions ignored until they are unable to function, and lost their insurance and end up on Medicaid if they are lucky, or turn to illegal drugs and alcohol to relieve the unrelenting pain, no one at the NIH or any of the academic institutions they fund did any research on this.
We are all being Gas Lighted to protect industry profits! A little denial and targeted misinformation go a long way!
Corruption and power over choice are why I don’t want government-run health care. I don’t have to have preapproval or go through some type of permission to see a specialist with my private insurance. I was a nurse for 25 years, and I agree that more should be done to obtain affordable care for all Americans. On the surface, government healthcare sounds like it would achieve that, but dig into it, and the sad reality is that government-run healthcare would not only threaten access to quality care but could even cause hospital closures, a shortage of health care professionals and less innovation for new treatments and cures. It has around the world in government-run systems. Personally, I like the way healthcare is done in Hong Kong, Japan, Singapore, and Australia. Try living in Canada or the UK or live on a Native American Reservation for the first four months of the year because they don’t have the money for you to get sick the rest of the year. You might talk to veterans in our largest cities and see how good the healthcare is too.
So, you’d rather have corporations control your healthcare?
At least government has to answer to the people to some extent.
Oh, and the for profit industry is why rural hospitals are closing. Medicare4all would EXPAND rural access to healthcare.
Medicare reimbursed 10 to 15 cents on the dollar. Why do you suppose an office visit is billed at 400 bucks? Multiply that to every patient and how long do you suppose a small rural hospital can survive? No new doctors no new treatments. No incentive to create. Bernie Sanders who said bread lines are a “good thing” also said “universal” healthcare would bankrupt the nation. So what changed? Fear.