A few years back a Johns Hopkins University study on emergency room prices found they were outrageous. I mean, who knew that hospital emergency departments overcharge? The study looked at 12,000 billing records for emergency medicine doctors nationwide. Researchers found patients were charged 340 percent more, on average, than what Medicare pays for the same service. Charges ranged from 1 to nearly 13 times what Medicare’s fee schedule.
Category: Single-Payer/Medicare-for-All
Congress Wants to Reform Pharmacy Benefit Managers
Pharmacy Benefit Managers (PBMs) have been portrayed as a boogeyman for quite some time. PBMs manage drug benefits for health plans, including employee health plans, Obamacare, Medicare Advantage, Medicaid managed care and private insurers. PBMs raised the ire of independent pharmacies years ago because PBMs bargain down the fees pharmacists receive from government programs like Medicaid. For instance, most state fee-for-service (FFS) Medicaid programs pay small pharmacies dispensing fees that exceed $10 for a prescription, while some states pay small dispensing fees of more than $13 a prescription, while others pay more than $15. Dispensing fees are the professional fees (basically for counting pills and placing them in a bottle) in addition to the ingredient costs. Keep in mind that Walmart will dispense a month’s supply of certain generic drugs for a total cost of $4, a fee that includes the dispensing fee and the cost of the drugs themselves. Paying $15 to $20 for a Medicaid FFS prescription that Walmart sells to uninsured consumers for $4 seems excessively generous.
Mission Creep: Housing for Homeless is Another Medicaid Expansion
Some states have begun a novel experiment: diverting health care funds for housing assistance.
States are plowing billions of dollars into a high-stakes health care experiment that’s exploding around the country: using scarce public health insurance money to provide housing for the poorest and sickest Americans.
At last count nearly 40% of states – 19 so far – are diverting funds from Medicaid into housing assistance. The Biden Administration is encouraging others to follow.
The Corporate Practice of Medicine and a Physician Cartel is a Bad Combination for Patients
Physician licensure has created a cartel. There I said it and I said it out loud. The right to practice medicine has high barriers to entry, both in terms of high standards and high costs. It takes 7-to-11 years beyond college to train a new physician, but it really begins long before medical school.