Today’s article is a little different. While Lazy Man and Money is almost always focused on personal finance, I have an interest in fixing broken systems. That’s probably the computer science nerd in me. It’s why I often write about MLM scams.

Healthcare seems to be one of the biggest problems that most of American can agree on. They can’t necessarily agree on the solutions, but they agree it is a problem. I think that’s why it has become a big political issue. People feel they are paying too much for it and they are right to feel that way. Long before the Affordable Care Act (ObamaCare), I had friends complaining about skyrocketing health insurance premiums at work. I couldn’t find exact numbers, but it felt like they were nearly doubling every year… and doubling from high starting point.

Here are just a few examples of what I consider a broken system:

• I’ve written about people paying for a $629 bandage at an ER that was unnecessary and fell off on the way home.
• I’ve also written about how a $30 TDAP shot at CVS was billed at $365 by my doctor… and how my insurance paid $169 for it.
• I never finished (or published) the EpiPen article I was working on simply because the news never ended. Fortunately, all that news coverage resulted in much more affordable options. People who were paying as much as $600 may be able to get an Epi auto-injector for as little as $10 at CVS.

There are hundreds of examples of problems, but if I tried to write about them, I’d never finish this article.

My focus will be to reduce the costs of rising insurance premiums, which I feel is the pain-point for most Americans. If we could access to great care at a reasonable price, we’d be happy right?

Some Personal Background

Our healthcare is covered by TriCare, which is the military’s healthcare. It’s generally great healthcare and I honestly couldn’t tell you much about the premiums as they come off my wife’s paycheck. I suspect that the premiums are very reasonable and greatly subsidized by the government. In fact, I just did a quick search and found that The mysterious $30, $169, $365 TDAP shot

Why did my doctor bill $369 for something that CVS does for $30? I don’t believe I was given better care. I don’t even think I saw my doctor that day, but instead an assistant. I suspect that the doctor knows that the insurance is going to lop off 50-60% and consider it a bookkeeping win (“we saved 60%!”). So I think she billed at an artificially higher price with that in mind.

However, that ends with insurance paying more than 400% than it had to. If they simply suggested that I went to CVS in the first place. Instead my insurance said that I wouldn’t be covered at CVS (if I recall) and that I had to go through my primary care physician.

I was happy to use insurance as I paid $0. My doctor’s office was happy as it got $169 for around ten minutes. The insurance company looks to be the loser, but they raise the premiums on employers and other people who buy insurance, so they aren’t left holding the bad.

It seems to me that the loser is the employer or someone paying premiums for health insurance… the two cogs in the system that can’t really do anything about it. People need health insurance for disastrous stuff so they have to pay the expensive premiums. It’s not like employers are suddenly going to stop offering health insurance and I don’t see them fighting back with the insurance companies.

Proposed Fix: For routine requests like this TDAP, doctors’ offices (or insurances) can quickly/easily electronically refer the patient to the low-cost provider or accept the same rate. Insurers will pay that accepted low-cost rate no matter who does it.

I apologize to all doctors in advance for losing out on $139 ($169 – $30) for each TDAP vaccine performed, but $30 isn’t really bad, when it’s done by some assistant in 10 minutes.

Why it works: Insurers are able to lower premiums significantly. Will they actually do that? I think we need a watchdog to make sure that they do, but that’s a different problem. At this stage we want to make it economically possible for insurers to lower prices on premiums.

I’m sure that TDAP vaccines alone aren’t a huge problem, but I think the example could be spread to a lot of routine care.

The United States MUST negotiate drug prices like other countries

Vox explained the real reason of sky-high prescription drug prices through a stick figure story. If stick figures aren’t your thing (and why not!) the Wall Street Journal explained it in more prose.

Here’s my takeaway from the Vox article, essentially the government (via Medicare) enables pharmaceutical companies to charge whatever it wants for every accepted drug. Other countries work together to negotiate lower rates. As the WSJ article stated: “The upshot is Americans fund much of the global drug industry’s earnings, and its efforts to find new medicines.”

Proposed Fix: Government creates a law that allows for negotiation of Medicare. Medicare creates a policy that they’ll pay the average of what the top 15 countries (or something like that) or it go with another drug. Pharmaceutical companies would have to pitch the cost-benefit of the drug vs. other drugs with similar profiles.

We’ll need a fix for private insurers, but fixing Medicare’s cost of drugs would save dozens of billions, maybe even hundreds of billions.

I apologize to Big Pharma executives and their profits… maybe it is time to raise the prices on the other countries. My understanding is that politicians don’t like this fix because Big Pharma funds their campaigns. I suggest only voting for politicians who are willing to stand up against Big Pharma on high drug prices.

I also apologize to the world, as Americans will not be able to subsidize the creation of cool new medicine. We should work on the system first

Why it works: It works for every other country and it simply makes sense. No need to overthink it.

Affordable Care Act (ObamaCare)

I can’t understand why anyone is against the Affordable Care Act (ACA) often referred to as ObamaCare. I had to research it and this LA Times article gives two explanations. One explanation is that most people simply don’t realize that how successful it has been in lower rates of uninsured people. The other explanation is that a political party has been vocally against it suggesting that the costs are too high or that it “doesn’t work.”

This goal of this article is come up with solutions, not get stuck in a partisan fight war of words. Any objective information I’ve found has shown the ACA to be a great success. Even the opposition who can’t seem to put together an alternative seem to agree that it is great for everyone to have access to health insurance and it should cover pre-existing conditions. So we’ve got a great starting point from the ACA.

So why should we get rid of the ACA? It has never been more popular according t this NBC News article. And getting rid of it would raise insurance premiums which exasperates the problem we’re trying reduce.

If cost is a problem that can easily be tweaked. I’ve already outlined a couple of ways to do that and there are more coming. There are probably quite a few other fixes that can be made. For example, why is Justin from Root of Good paying $16 a month for healthcare? He has a 1.5 million-ish net worth. I tip my hat to him (and consider him a virtual friend), but as he wrote, “If this is evil commie government health care I’d like some more, please.”

Proposed Fix: Look into ways to create a more competitive marketplace. For example, don’t let Aetna pull out of the exchanges as a political tool. They wouldn’t need to leave if we were successful in reducing costs as explained elsewhere.

Why it works: Because it was already working in many ways. The ways that it appears to not have been working are addressed elsewhere. There’s no need to throw the baby out with the bath water.

Borrow Cuba and Other Countries

It seems that Cuba has a great healthcare system that works extraordinary well. Here’s a detailed Huffington Post on that, but I prefer this article from The Atlantic.

As the later article notes:

“Cuba has long had a nearly identical life expectancy to the United States, despite widespread poverty… the rate of infant mortality in Cuba has been lower than in the Boston neighborhood of his own prestigious hospital, Harvard’s Brigham and Women’s.

All of this despite Cuba spending just $813 per person annually on health care compared with America’s $9,403.

In Cuba, health care is protected under the constitution as a fundamental human right. As a poor country, Cuba can’t afford to equivocate and waste money upholding that. This pressure seems to have created efficiency. Instead of pouring money into advanced medical technology, the system is forced to keep people healthy.”

There’s a lot more information about how Cuba’s system works, but it makes a lot of sense. We don’t have to take everything that Cuba does, but it shows how throwing more money at the problem isn’t the fix.

Why it works: By economic necessity Cuba has had to adopt a system that works efficiently. We can expand on this more in the comments, but this article is getting long and I have a lot cover still.

Incentivize People to Eat Healthy and be Active

There’s zero immediate monetary incentive for preventing health problems by being healthy. If I log a ton of walking on my Fitbit this month, it’s just a number. If I balloon up to 400 pounds, it’s just another number.

Is it possible for your health insurance to give you money back for meeting certain guidelines like walking steps or maintaining a healthy BMI (not the most ideal metric, but it’s at least a starting point)? We have safe driving incentives for car insurance? Can we apply that to healthcare to give people an economic reason to make healthier decisions?

Additionally, the most unhealthy foods are often easiest to access and the cheapest… just compare the cost 200 calories of a (dressing free) salad at McDonalds and a McDouble. Sugar is very cheap and we know it isn’t healthy. Can we apply things like a soda tax to subsidize the healthier food?

Why it works: It can be hard for people to take interest in their health. Sometimes they don’t have the time for the gym. Sometimes they don’t want to spend $5 on a salad vs. a McDouble (I’m guilty of this). If people are given an immediately visual benefit to be healthy maybe we can reduce the amount of healthcare we need in general.

Required Vaccines for All

Why it works: Because it does.

Crack Down on Supplements

They’ve been exhaustively proven not to help with the exception of a few very specific conditions that your doctor can work with you on.

Americans aren’t educated to understand that Dr. Oz is an entertainer. As that article points out, “The FTC told Elizabeth Cohen, CNN senior medical correspondent, that there are just ‘too many’ weight loss products using deceptive advertising to sue them all. But consumers should be wary of certain phrases that are most certainly false, the FTC said, including any that claim to help you lose weight without diet and exercise.”

Big Supplement has lobbied congress to make it easy for them to put such products out:

And one of the things I’ve found is that when a supplement is tied to Multi-Level Marketing (MLM), it can cost consumers thousands of dollars. Truth in Advertising found “that 97 percent of DSA member companies selling nutritional supplements have distributors marketing their products with illegal health claims”.

Maybe with the right education, consumer protection, and law enforcement, we could divert these billions of wasted out-of-pocket consumer costs to real healthcare. It can be something as simple as a gym membership or eating healthier food in the first place.

Finally, this article points out such misleading information undermines the trust in doctors and healthcare. When people choose quackery over medicine, it can create further health risks, and for our purposes expenses, down the road.

Why it works: Because people making smart, informed decisions about their health is much better than buying likely-illegal hype from a carny.

“Health Care is a Business”

At nearly 2500 words now, I’m going to wrap this up. I had quite a few more notes that didn’t make the cutting room floor and I don’t have the energy to put together a pretty image. (Ironically to the subject at hand, there’s been a bad stomach bug passed around our town and family.) There’s a lot of things that I couldn’t touch here like in the $629 bandage article which covers facility fees of emergency rooms.

I’d like to leave you with something that I’ve read in quite a few places: Healthcare is a Business. I understand that it is, but I don’t think it should be. I think that’s where the system breaks down. It seems that everyone is trying to push to create the greatest profit for themselves, which is generally not a terrible thing. With the system we it seems to push all the expenses to higher insurance premiums with everyone taking a cut along the way.

Eventually it is the employers and consumers who are left footing the bill for all those people.

It’s a lot like Parkinson’s Law that says, “work expands to fill the time available.” In this case, the costs expand to fill the budget available… but the budget is effectively unlimited.

Maybe it’s because I often view things through a personal finance lens of cost-benefit analysis, but I feel like some kind of comptroller is necessary to step in and say, “Whoa! Let’s go with the frugal option with this.”