Justin Donald Leader

The very last blog I wrote was on November 10, 2016 in regards to the opportunities that President Trump had to fix our healthcare system. Unfortunately, the past few months we have observed political business as usual with no true relevant understanding of US healthcare and its major cost drivers. My “light bulb” moment today is based on 7 years of navigating the Patient Protection and Affordable Care Act (PPACA) otherwise known as “Obamacare”, as well as reviewing the recently proposed regulation, the American Health Care Act (AHCA) or “Trumpcare” which was halted before a vote even took place. My final conclusion is that no US president will ever, I repeat ever fix Healthcare.

Our problem with Healthcare isn’t a government problem, it is a societal problem. Government’s role unbeknownst to them involves the psychotic dumping of gasoline on an already out of control fire. They rely on experts in the industries that stand to profit most from our asinine system. They do this thinking that regulation on one side, or deregulation on the other will lead to a free market and cost control. Depending on what news channel you watch on any given day the ongoing ideocracy of finger pointing continues often with “experts” spouting rhetoric they heard from Fox News, CNN, a health insurance company, drug company, etc., regarding why pricing is out of control. I can tell you that 99% of what you read and hear is being paid for by the very companies that make astronomical profits off of rising costs. Thinking that either side of the aisles will legislate to a reasonable solution is foolish when I think they are missing the bigger point; What is the true cost and what value are we getting?

Most days, I just want to scream at the top of my lungs, “STOP”! The societal problem here is that we over complicate everything when it comes to healthcare. I’m not sure if it is sheer laziness or a deep-seeded thought that healthcare is far too difficult for the layperson to understand.  I really think the responsibility of fixing healthcare falls on the back of every US citizen as well as the employers that employ them. Simply put we strive to understand every purchase we make and to make the best buying decision possible for everything except for Healthcare. Most corporations have a whole department dedicated to effective buying; procurement! Even in our households we typically have a CFO spouse.

Anyone who has read the book Catastrophic Care by David Goldhill or is a healthcare transparency advocate knows exactly where I am coming from. I encourage you to buy that book for a crash course on what is wrong with the US healthcare system.

Let’s face it with health insurers posting record profits, PBM’s taking massive cuts of employer and employee “rebate” dollars as well as egregious prescription drug pricing it’s no wonder we are in the situation that we are in. The people we trust to monitor our money and how claims are adjudicated are the same people getting rich off of the health issues that we have. I am not talking about you independent TPA’s. It is no wonder that as soon as someone is diagnosed with a catastrophic illness their first thought is “how can I afford this”? A statistic I read recently stated that 51% of US citizens NET under $30,000 per year with most spending almost $15,000 on healthcare. Honestly, how can we continue?

Until we as a society push back by educating ourselves on what the true cost drivers are we will continue to spin our wheels. An example being the fallacy that we need health insurance for day-to-day routine care based on a discounted provider “network”. It is not much of a discount when the provider is authorizing the company to pay 300% of what Medicare is willing to pay for a service or procedure. Not much of a discount in my opinion and once the employer pays that you better believe the employee is going to feel the sting in a raised premium next year.

My company posted a video not too long ago and tweeted it repeatedly to Donald Trump. Not a single aspect of that video or the key points addressing the $1 trillion in wasted spend were utilized in the formation of this bill. I am all for capitalism and people making a profit that is fair. Sadly, there are billions in lobbying dollars being dumped into our government preventing any real-world fix to our broken healthcare system from a sitting President. These opportunistic profiteers create a following of political “Kool-Aid drinkers” who believe that we must rely on insurance networks, expensive drugs and even more expensive procedures.

There are some key figures in our industry including some very brave employers who are finally fighting back and asking why? This societal shift in our thinking and understanding of the purchasing of healthcare is the only solution to our sad state of affairs. In many ways, this is a revolution against an establishment that has done nothing but destroy the financial status of many people and companies alike in the United States.

A short list of ideas for employers and the average layperson to research below:

• Adopt a Reference Based Pricing (RBP) model with full transparency. Utilize what Medicare will pay as a baseline and allow providers to “duke” it out from there.
• Pharmacy Benefit Manager (PBM) reform. Process the claim without robbing the payer(s). No more spread pricing and no more “rebates”.
• Standard value metrics to easily rank and rate providers.
• A national healthcare database to share information.
• Stop direct advertising of pharmaceuticals to consumers. Only 2 countries in the world allow this. We are one.

This is only a start, comment below your suggestions for fixes to our current healthcare system?

– Justin Leader is Vice President of Business Development with Benefit Design Specialists, Inc. BDS is committed to a two-fold goal; delivering quality, cost-effective employee benefit plans coupled with hassle-free benefits management for our client’s HR departments.