Eight Thousand Non-Health Jobs Lost in May

 

BLSThe true scope of this morning’s miserable jobs report is disguised by the headline figure of 38,000 jobs gained. In fact, health services added 46,000 jobs while civilian non-health, non-farm employment dropped eight thousand (Table I). The warping of our economy towards the government-controlled health sector has reached the tipping point I have suggested for months.

20160603 TI

Texas’ Largest Insurer to Increase Premiums 60%

 

An article by Ricardo Alonso-Zildivar of the Associated Press claims Texas’ largest health insurer plans to raise premiums by as much as 60 percent next year. The article assures us few people will be harmed — most enrollees have their premiums capped as a percentage of household income. Thus, it’s actually taxpayers who will get gouged. The article does admit that some people — those who are too wealthy to qualify for premium subsidies — may suffer sticker shock next November when they price their coverage for 2017.

Misleading Rhetoric on Medicare Cancer Drug Payment Reform

 

man-in-wheelchairA few weeks ago, Medicare proposed a pilot program to test a new way to pay doctors who inject drugs. Cancer is the big kahuna, cost-wise, when it comes to injected drugs. Medicare payment policy leads to certain industry practices to profit from the status quo. When the status quo is threatened, the “preservatives” immediately form a defensive coalition to stop the change.

Although I do not endorse this precise reform, the campaign to roll it back has become irresponsible and misleading. Currently, physicians who inject drugs are paid by Medicare a margin of 6 percent on top of a reported price called the Average Sales Price (ASP). The concern is that the oncologists make more margin off an expensive drug than a less-expensive drug.

The New Medicare Gold Rush

 

Cheerful Senior Man Having His Blood Pressure Taken(A version of this Health Alert was published by Forbes.)

Over the next few years, Medicare will significantly change how it pays hospitals, physicians, and other providers. This is sparking a gold rush among investors. BDO, a leading management consulting firm, released a report last month describing significantly increased private equity investment in long-term care facilities, rehabilitation facilities and home health agencies. BDO reported 79 deals in 2015, in which private equity sponsors invested $5.92 billion, up from just $1.67 billion in 2014. The previous high-water mark was $3.58 billion in 2011.

Health Construction Boomlet Collapses in April

 

Census2The boomlet in health construction from February and March lost its wind in April. While construction overall dropped at a seasonally adjusted annual rate of 1.8 percent, health construction dropped by 3.0 percent (See Table I below the fold).

The drop was much greater for private than public health facilities, especially relative to other construction. Construction of private health facilities dropped 3.6 percent, 2.2 percentage points more than the decline in other private construction.  Construction of public health facilities dropped 0.8 percent, 2.1 percentage points less than the decline in other public facilities.

This turnaround after a two-month boomlet puts health construction back on the longer term trend. For the twelve months from April 2015, construction of non-health facilities boomed 4.7 percent versus a decline of 0.6 percent for health facilities. Notwithstanding other factors, this is welcome because it indicates a shift from inpatient to outpatient care at lower cost.

Obamacare Exchange Average Premium Hike 16 Percent Next Year

 

CAM00109Caroline F. Pearson of the Avalere consulting firm has surveyed states which have already published 2017 Obamacare exchange premiums. Among eight states and the District of Columbia, the average requested rate hike is 16 percent for popular Silver plans:

Specifically, average proposed rate increases across all silver plans in the nine states examined range from 44 percent in Vermont to 5 percent in Washington. In 2016, 68 percent of exchange enrollees selected silver plans.

According to the data, in most states, proposed premiums for lower cost silver plans increased less dramatically or even went down for 2017, compared to higher-cost plans on the same tier. Lower-cost silver plans tend to be most popular with consumers, making this portion of the market more competitive as plans seek to attract enrollees.

The devil is in the details: The lowest premium Silver plan is going up seven percent, and the second lowest 8 percent, which means most Silver plans are going up more than 16 percent.

Health Services 30 Percent of GDP Growth

 

BEAThis morning’s second estimate of GDP for the first quarter was a little stronger than last month’s advanced estimate, although much of the adjustment was a smaller decrease in inventories than initially estimated.

Spending on health services continue to dominate weak GDP growth. Health services spending of $19.2 billion (annualized) comprised 30 percent of GDP growth. However, there was shrinkage in personal consumption expenditures on goods, private domestic investment, and exports. This meant personal expenditures on services grew much more than GDP overall. Growth in spending on health services amounted to a little less than one fifth of growth in services spending. Nevertheless, the quarterly growth in spending on health services indicates health services continues to consume a disproportionate share of (low) growth (Table I).

20160527 TI

Billions of Dollars Later, Veterans Health Administration Still Failing

 

man-in-wheelchairBack in July 2014, I described how Congress was preparing to reward the Veterans Health Administration for its failure to ensure veterans get timely, adequate care, with a multi-billion dollar bailout.

Because Republicans had taken the majority in both Houses of Congress, the bailout was camouflaged as a method of allowing veterans more choice of healthcare providers, outside the government bureaucracy. The results are pretty bad, according to a report by Dr. Sanjay Gupta:

Will You Ever Understand Your Medical Bill?

 

stress(A version of this Health Alert was published by Forbes.)

It is hard to exaggerate how painful the medical billing process is for patients. Steven Brill, an entrepreneurial lawyer turned journalist, became one of the most famous critics of American health care when Time magazine published a long article by him in 2013. It was a wide ranging criticism of pretty much everything in U.S. health care, which grabs and keeps our attention because it uses the absurd hospital bill as the fulcrum for his case:

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power. Dozens of midpriced items were embedded with similarly aggressive markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly.

(Steve Brill, “Bitter Pill: Why Medical Bills Are Killing Us,” Time, February 20, 2013)

It is hard not to get carried away on a wave of outrage when reading stories of patients faced with ridiculous bills, which (even if they can understand them) they might never be prepared to pay. A new crop of entrepreneurs is hoping to solve this problem.

A Health Reform Agenda to Replace Obamacare

 

The most pressing goal of health reformers in Congress should be to replace all the costly provisions in Obamacare with the consumer-friendly health plans Americans prefer. In the process, reformers must change the way medical care is financed so that consumers have control over their health care dollars, as well as the means to pay for medical care over their lifetimes. As a starting point, Congress should repeal the individual and employer mandates and taxes of the Patient Protection and Affordable Care Act (ACA).