@HConomics I’m so sorry it has hurt your business. As a non-Dr, I can’t begin to know what y’all have gone thru. So, from the other side – 34 yrs of helping small businesses untangle this mess – let me make a few points (cont…)
@HConomics 1.It has killed my business, too. It’s not easy being the kid who tells the truth! Saying “THE EMEROR IS NAKED!” is tough when everyone else is saying how wonderful his clothes look…
@HConomics 2. You can always tell who the pioneers are because they have arrows in their back and are lying face down in the dirt!
@HConomics 3. It’s not easy to stand up for what’s right, but the person who pays extortion money is guilty of perpetuating the protection racket – even though it feels easiest at the time – the bullying will continue and expand.
@HConomics 4. In 2003, the only “health plan” that had $200 deductibles were HMOs, which are not really insurance. They are our capitalistic version of socialized medicine. In fact, the initial HMO success story was not an insurance company. It was a hospital system… Humana.
@HConomics 5. I started in 1984. Back then, most health insurance was what we used to call “hospitalization” plans. My average client had a $100 deductible and they were like Medicare. They paid up to a set amount. Back then it was called Usual and Customary Charges (UCR).
@HConomics 6. Major medical plans were like umbrella policies. They were high deductible plans that picked up where the basic “hospitalization” plans left off. Very few people bought major medicals back then.
@HConomics 7. But, doctors and hospitals didn’t deal with insurance companies back then. Patients were expected to pay their own bills. Just like every other kind of insurance, the policyholder filed the claim and their insurance company “indemnified” them.
@HConomics 8. Even though Nixon signed the HMO law in the 70s, it wasn’t until Hillary scared the daylights out of the insurance industry in the 90s that HMOs took off. The insurance industry said, “TIME OUT! We don’t need the government doing socialized medicine. We can do that.”
@HConomics 9. Initially, the HMO pitch was, “No deductible, 100% coverage. Just a $5 copay when you see your doctor. But you MUST pick a Primary Care Physician (PCP). It sounded too good to be true and we all jumped on this bandwagon…
@HConomics 10. Especially doctors! The PCP was the HMO's key to wealth. Here was the pitch to the Drs. “We will fill your practice up and we will pay you $30 (or some set $) per month (called Capitation) for everyone who picks you as their PCP… BUT WAIT, THERE’S MORE!
@HConomics 11. Dr PCP, we are going to give you a yearly budget. If you stay inside your budget, you can get huge BONUSES each year! BUT THE CATCH IS…
@HConomics 12. You must get everything approved by us! And we have GAG CLAUSES in your contract... you must sing the company song. If you feel the need to do a certain treatment, but we tell you "No"... You can only tell your client about our treatment… even if you believe it’s wrong!
@HConomics 13. The money was too good so, most doctors signed up. Internally, you were called the GATEKEEPER. And the HMO controlled the gate. This is how the HMOs controlled medical costs for a decade. BUT WAIT, THERE’S MORE!
@HConomics 14. Under ERISA, patients could not sue anybody. They could not sue the doctor, the hospital, the HMO… nobody. Docs could remove the wrong organ and the patient couldn’t sue. The 90s were the HMO heyday!
@HConomics 15. But… at the turn of the millennium, there was so much bad publicity for HMOs... they became synonymous with BAD MEDICINE! Americans revolted… and with the help of the PPO… health insurance financing and delivery were changed... again!
@HConomics 16. This is where your book takes up the story. (Loved the book, btw!) In the late 90s, the Preferred Provider Organization (PPO) was born. Doctors were also fed up with HMO bureaucrats controlling how they practiced medicine. So, the PPO had a fertile field…
@HConomics 17. Initially, the PPOs were an ingenious group of entrepreneurs (Think young cartel bosses.) The PPO went to the PCP and made them an offer they couldn’t refuse. They said, “We won’t tell you how to practice medicine. We'll fill up your practice and we just want a discount.
@HConomics 18. Initially, that discount was about 50%. But then doctors got wise and simply doubled their retail price. Y’all have stayed at about the 50% range, but hospitals took this as a challenge! They not only doubled their rates but…
@HConomics 19. Hospitals brought in high-dollar business consultants who taught them how to split up the procedures and bill for every little piece of a procedure at 5 to 10 times their original price. This is how the infamous "Chargemaster" was born.
@HConomics 20. Then the insurance companies brought the PPO negotiations in-house and started ratcheting down the discounts... which made hospital systems come up with more devious and ingenious ways to jack up their retail bill. So…
@HConomics 21. Through high-dollar lobbying, BUCA (Blue Cross, United Healthcare, Cigna, and Aetna) and other players like PhRMA and the "Big-Government" crowd created the PPACA… Obamacare. This killed competition. As you know we now have only a few major carriers in each market.
@HConomics 22. This gave the BUCAs tremendous negotiating power. But never underestimate the power of the “NON-PROFIT” HOSPITAL MONOPOLY. They started buying up all of their competition, including local doctors' practices. The BUCAs had no choice but to fold...
@HConomics 23. One of the unforeseen prizes that Obamacare created for the BUCAs was the Medical Loss Ratio (MLR). By mandating that insurance carriers must pay out 80-85% of premiums in claims or refund the difference…
@HConomics 24. Obamacare unwittingly gave the BUCAs a reason to allow the hospital monopolies these ungodly bills we see today… because the higher the claims the BUCAs had to pay, the higher the premiums could be… and the higher the BUCAs profits!
@HConomics 25. The moral of this story is… the Direct Primary Care movement… the Free Market Healthcare movement, the old hospitalization (now rebranded and called “Indemnity”) plan movement… and the Healthcare Sharing Ministry movement...
@HConomics 26. This is true American Free Enterprise in actions. This is the answer to our American Healthcare Financing System. Now we need everyone who has a voice and a vote to jump on these movements and let’s take back healthcare…
@HConomics 27. From The Syndicate (or The Cartel, if you like)... the BUCAs, the “Non-profit” Hospital Monopolies, the PhRMA Monopolies (which is a whole other sordid story) and the Big-Government goons.
