An Affordable Health Care System Would Look Nothing Like Obamacare
As I explained in last week’s Health Alert, the U.S. health care system is an unsustainable mess. In our economy one dollar out of every five is spent on someone’s medical care; Medical costs are growing twice as fast as incomes; Medical prices are rising at three times the rate of consumer inflation. The Affordable Care Act was supposed to fix those problems and make health care “affordable.” However, the method was ill-conceived: Obamacare required everyone purchase overpriced health insurance. That’s like throwing gasoline on a fire hoping to smother it. As a health economist, it’s hard to imagine a policy agenda that could be any less effective — or more damaging to the health care system.
The premiums in the exchange are rising to levels few can afford. It’s not hard to see why. Obamacare enrollees are sicker than average. Those with cost-sharing subsidies bear little consequence when they are wasteful and little benefit when they are prudent. Once their deductibles are met, Obamacare bans any limits on the services patients consume. Neither does it do anything to mitigate the perverse incentives for providers to squander resources. For example, medical providers have few financial incentives to control costs and keep beneficiaries out of the hospital — especially if the provider is a hospital. These problems could be improved with better incentives and better plan design in virtually all programs, including Medicare, Medicaid, employee health plans and private insurance.
Our health care system could be dramatically improved, but it must involve more efficient care for our sickest patients. Consider this: about 5 percent of patients spend nearly half of all health care dollars, while the sickest 1 percent consume nearly one-quarter of health care expenditures. These figures suggest there are more opportunities to reduce health care spending by carefully managing the sickest 5 percent instead of wasting our efforts on the 80 percent who are relatively healthy. Thus, health reform requires improving incentives that benefit the sickest patients. Increasingly, controlling costs means keeping people out of hospitals, where nearly one-third of health care spending occurs. Therefore, health reform must focus on reducing hospital spending on beneficiaries by better managing their chronic conditions before they end up in the hospital.
A dozen years ago health reformers successfully advocated for Health Savings Accounts (HSAs) coupled with high-deductible plans. A fair criticism of HSAs is that hospitalized patients have long since exceeded their deductibles. Moreover, critically-ill patients are unlikely to forgo a potentially beneficial medical service merely because they bear a portion of the marginal cost. This is true even if the benefit is likely to be marginal. Much more needs to be done.
To sufficiently slow medical spending, policymakers must allow plan designs that create price sensitivity among patients long after they have met their deductibles. To reduce health spending from the supply side, policymakers must allow insurers to promote competition among providers. In addition, plans and providers must be rewarded when they implement cost-saving programs that provide high-quality care at a lower cost.
Some examples: a few health plans are experimenting with a concept known as reference pricing, designed to boost price sensitivity for high-cost procedures. Reference pricing is an arrangement where enrollees face unlimited cost-sharing for all costs of a treatment or a procedure above a stated reference price set by the health plan. It is generally set close to an average or median price readily available in the market. Because enrollees are very sensitive to marginal costs above the reference price, providers have an incentive to price their services close to the reference price to avoid losing business. Many exchange plans are relying on narrow networks, where providers have negotiated lower prices and enrollees are steered only to those providers.
Next steps: more needs to be done to help enrollees ascertain the price of medical services when shopping for medical care. A recent study confirmed high-deductible plans lower spending, but not because patients shop for lower prices. The study found high cost-sharing merely caused people to skip care. Although skipping unnecessary care is a good idea, forgoing beneficial care is not. Patients who comparison shop and negotiate for services provide better price signals to the market than ones who suffer through a condition until they improve on their own. Without interacting with potential customers, medical providers may never realize they lost a sale due to high prices.
There are other methods that health plans could use to raise quality and reduce costs. Enrollees’ cost-sharing could be reduced in return for working closely with a plan’s patient centered medical home. Patients who first call their medical home’s care coordinator to inquire about medical tests or prescription drugs could be pointed to the appropriate provider and rewarded with lower cost-sharing. Indeed, some employers are hiring firms, such as Vitals and Compass Professional Health Services, to assist enrollees and provide price transparency tools.
In conclusion, reforming our dysfunctional health care system requires more than high deductibles plans and HSAs. We must consider where the money is spent: on high-cost patients. Increasingly, slowing the growth in health care spending must focus on improving the care for patients in poor health. Health reform must also improve end-of-life counseling and better educate families about hospice care.
An earlier version of this Health Alert appeared in Town Hall.
Devon, you remind me of Stephanie Carlton who is a Medicaid MBA and Jeb’s healthcare policy adviser. The trick here is to stop wasting taxpayer money on over-priced employer-based plans like New Hampshire’s Community College system that is costing $33,000 a year for healthy employees with family coverage to Blue Cross Inc. All we can do is give these employees a choice of staying with this wasteful program that is costing the Feds $10,000 a year on lost Payroll Tax and Income Tax. If the employees’ option was Republican Reform and an age-based tax credit of $5,000 for a 30-year-old couple with 2 children the Feds save $5,000 and the employer’s cost and local taxpayers’ cost is dropped to ZERO! This family can purchase an HSA PPO plan for less than $5000 a year.
Trying to stop sick people from getting the best medical care is barking up the wrong tree like Hillary’s HMOs in Obamacare. In Houston 88,000 BCBS customers can no longer use MD Anderson starting 1/1/2016. Sure this will save money but you end up with a lot of dead people. There are tons of cancer patients that are currently using MD Anderson that are scared and won’t be able to continue after 1/1/2016 because not one plan on the Obamacare exchange has MD Anderson as a provider. We need to restore FREEDOM in the US and let consumers choose what insurance they prefer on their family instead of a Government functionary who doesn’t love these children like you.
Read the horror stories in Houston that are hot of the press here: Houston – We have a problem!
http://www.cruzforvp.com/hillarys-hmos-houston-problem/
True freedom won’t be restored until insurance becomes totally voluntary.
An uninsured patient who pays cash is much more price-sensitive. He has an infinite network, extending to docs and hospitals in Mexico, Costa Rica, Argentina, Cuba, India, Czech Republic, Thailand and Hungary, all of which offer medical and dental care at a fraction of what’s charged in the USSA.
Until insurance is eliminated and cash on the barrel-head becomes the norm for medical care in the USSA, the gummint could set up government-backed loans for medical care. These would mainly be used by the young and healthy, of course, which is why the idea will never fly, the reason being that our socialists want a plan like Obamacare that is a perverse wealth- and income-transfer plan instead of a healthcare plan — one that transfers wealth and income from poor to rich, from healthy to sick, from young to old, from singles to breeders, from risk-takers to the risk-averse, and from the health-sophisticated to the unsophisticated.
Jimbino, you would restore FREEDOM by outlawing insurance, that’s odd. The new type of health insurance, living benefits, allows a 30-year-old female to purchase $1 million of life insurance and if she gets cancer 90% of the death benefit, or $900,000, is paid so she can get treatment with cash anywhere in the world as you suggest. Her premium is just $50 a month.
Of course she should have an HSA PPO health insurance plan with world-wide coverage too so her $900,000 is safe from the Medical Mafia. Insurance is cheap, cheap, cheap. A medical delivery system for sick people will always be expensive. Anybody want to insure my daughter with MS who informed us this week her new treatment cost is $80,000 per year just for her RX?
Insurance is not cheap. It is nothing more than a bad bet that bad things will happen to you that returns about 80 cents on premium dollar, whereas the return on a spin of roulette is around 96 cents, making roulette a better bet than health insurance. And a lot more fun.
Car insurance and flood insurance admittedly return far less. It’s religious people who buy insurance, but all of us pay for SS, Obamacare, and car insurance, whether religious or not.
You are no doubt one of the socialist types who likes to choose winners and losers in life, who likes to spread the wealth around. Do you also advocate food, entertainment and sex insurance so that your deprived favorites can have them too?
Insurance is asset protection for people with assets to protect. I have insurance on our house in case of fire, theft or natural disaster. It only costs my wife and me about $1,500 per year. Admittedly, it’s somewhat of a waste. But one big Texas hailstorm or a windstorm that blew one of our big oak tress into the house would make us glad we have it.
Car insurance is more expensive. Insurance on an Audi twin turbo, a Corvette, a Mercedes, a GMC truck and a Harley sets us back about $3,500. Cars can be stolen and totaled. Drivers can get sued for damages. My deductible is $1,000 on my cars and $500 on my wife’s Audi. I don’t have a problem paying for car insurance.
Health insurance is a whole different story. If you take our home owners insurance and the insurance on our vehicles and then DOUBLE it, that’s almost what our health insurance costs. If something happens, coverage doesn’t begin until we’ve spent $6,000 apiece.
Something is wrong with this picture!
Devon raise your deductible on that Audi, $500 deductible on a car like that does not make economic sense. You are supposed to be an Insurance economist 🙂
Devon, that is Individual Medical (IM) that is governed by Federal law. I told you your wife could get a PPO for $208 a month that is governed by Texas law. If your wife got ovarian cancer it could cost a whole lot more than replacing the Audi. This also has a $100 deductible on accidents which might come in handy for a woman who exercises because replacing a knee would probably cost more than an Audi too.
Remember, as always, medical underwriting is required.
I agree that those in the middle class with a few assets to protect are the main market for insurance. The wealthy, whether individuals or corporations, will self-insure, saving a great portion of that 20-50% above the insurance “loss-ratio.”
A young man, taking a year off to found a start-up, sail around the world or climb Everest is in the same boat. If he has any sense, he will self-insure, not possible under Obamacare but still possible in other, freer countries like Germany.
The non-risk-averse young man is facing great un-insurable risk in his endeavors, all the while paying through the nose to cover Obamacare perinatal care for the breeding women and for the old folks, while NO actual Obama healthcare is available to him in Nepal or midway to Easter Island. He is huuugely screwed, and it is amazing that any young man ever considers voting for socialists like Obama, Clinton or Sanders.
The religious folks who insure have no sense when it comes to mathematics and especially actuarial science or game theory.
Some religious folk don’t believe in insurance, like the Amish. They pay for everything out of pocket, and band together for loss of houses, barns, livestock etc.
I’m not sure what they do with big medical bills, probably take up a collection from the congregation.
Right, the Amish have escaped SS and Obamacare, but that option will never be available to mere Humanists, at least not in Amerika.
You can still, however, fiddle with your withholding allowances so as never to leave a cent on the IRS table for them to capture, but it’s a lifetime commitment about as bad as Amishness.
The main problem with the current systemd is the dis proportinatly rising cost which will kill the system if nothing is done. Nobody will stop drinking or eating and sleep under a bridge just to afford insurance premiums. The reason for this out of control cost spiral is that nobody is responsible for their health care cost. This would at least partially be fixed if patient had skin in the game and would shop around for the best deal. I realize this is not in all cases possible but even in the cases where patients have this choice it would make a big! difference. This is where health savings accounts come in. What the authors fail to mention are other cost savings measures: 1. The health care industry is overburdened with federal regulations that are totally unnecessary, in many many cases counterproductive ( I know, I am a doctor) and compliance with them and control of them accounts for an estimated 20 to 30 % of health care costs.Nobody ever checks whether new regulations actually achieve what they are intended to do and abolishes them if they don`t. In stead new regulsations are piled oto old ones and we are drowning in them at tremendous costs with no benefit.2. Insurance companies have monopolies in every state. In my state, Alabama, it is BC/BS. Let insurance companies compete on a national level. 3. Tort reform to stop frivolous law suits.
Ron
I live in Sugar Land which is a Houston suburb
My understanding in that BCBS has eliminated PPOs in Texas starting in 2016
Reference pricing would eliminate the need for networks
It would also steer prices toward the reference price as long as it was calculated based on actual median prices
It would also eliminate the all or nothing coverage of HMOs
And it would introduce competition in prices if all insurers in a state were held to the same reference price
No more bullying by the big guys to get a leg up on premiums by negotiating lower network discounts
Say hello to more humane pricing and competition based on unique products and servuces
You raise an interesting point. A reference price is still something of a price control.
Health plans would need to be careful they don’t inadvertently institute prices too high by creating a ill-conceived reference price. Maybe a method would be for health plans to allow enrollees to keep 50% of every dollar they save below the reference price and apply towards future cost-sharing.
A “reference price” is much like UCR, Usual-Customary-Reasonable, that used to be the way health insurance used to be before HMOs reduced Out-Of-Network pricing to ZERO.
So it’s back to the past?
“Reference pricing would eliminate the need for networks”
Which would be fine with me if all physicians were equally skilled.
Don, do you believe all physicians are equally skilled?
Although a reference price may eliminate the need for a network, health plans could survey providers and make a list of those willing to stay within the reference price. Patients may be free to seek care anywhere they want; with any doctor they prefer. But willing providers could be told they stand a better chance of attracting insured patients if they allow their names to be added to the Reference Network.
Controlling healthcare costs and providing affordable health insurance, while related, are really two separate issues.
While, in any given year, 5% of insured members account for 50% of healthcare claims costs and the sickest 1% account for 20% – 25% of healthcare costs, they are not the same people from one year to the next which implies that the chance that any given person could incur very high claims in a particular year is higher that it might appear at first glance.
Reference pricing is a reasonable concept where it makes sense. It lends itself to discrete procedures such as surgery, imaging and blood tests. It doesn’t lend itself well at all to situations where doctors need to run a number of diagnostic tests to figure out what the patient’s problem is and how to treat it. It also does not work for care that must be delivered under emergency conditions when, by definition, there is no time or opportunity for price shopping.
Better management of chronic disease would be easier to achieve with payment models other than pure fee for service. There would be flexibility to employ a nurse case manager to assess a patient’s needs by visiting the home. Electronic devices that could monitor patients remotely could be provided. E-mail and phone communication could be offered reducing the need for in person office visits. While not cheap, these approaches have been successful in reducing ER visits and hospital admissions especially for patients with CHF, COPD, diabetes and mental illness.
With respect to health insurance, the real challenge is to provide decent coverage for the unhealthy and the already sick at a premium they can afford which I would define as between nominal cost or nothing at all for those with income below the FPL and 10% of pretax income for those with incomes above 300% of the FPL. These are the people who need insurance the most and, if the cost of covering them is not factored into the broader insurance pool, they would presumably have to be covered separately in a high risk pool. The problem with that approach, as I’ve noted before, is that politicians have never been willing to spend the money that it would take to make high risk pools work because the cost is seen as too high for the number of votes likely to be in play.
The ability to buy relatively inexpensive coverage for those who can pass medical underwriting works great for the healthy until they become unhealthy. I almost never had to go to the doctor from my early 20’s until my late 40’s when I started to develop some medical problems that were costly to treat. Under medical underwriting, I would have been denied coverage when I needed it most even if I dutifully paid premiums for the 27 years of adulthood that I was healthy. I actually had employer provided insurance the whole time but you get the picture.
If health insurance doesn’t work for the unhealthy and the already sick, it’s no good in my book. By contrast, Medicare and Medicaid accept everyone who meets the age or income criteria and employer coverage doesn’t discriminate between the healthy and the sick either. The downside there is that for employees who are too sick to continue working and have to give up the job, they lose the insurance as well except for 18 months of COBRA coverage which only about 2% pick up because they can’t afford the premium, especially after they’ve lost their income.
That is precisely what I’m talking about. I’ve talked to executives with Medicare Advantage plans about this. The name of the game is keep seniors out of the hospital. The care coordinator is not paid piecemeal; they are paid for care and docked if costs rise unnecessarily. Physician visits are encouraged.
We can never get a handle on medical spending unless we better manage the big spenders.
Regarding the most expensive cases, I wonder if we should take another look at the dialysis model….by which I mean that perhaps the most expensive illnesses could be moved into Medicare. This could include stage four cancer, congestive heart failure, hepatitis and I am sure a few other diseases.
This would drive up the cost of Medicare, of course, but Medicare is funded by essentially every working person in America. But I wonder if that is better than our current practice, which is to make sure (under the ACA) that all insurance policies have unlimited lifetime maximums.
Could it be we would have a little more taxes, but much cheaper health insurance?
Now my idea assumes that Congress would have the guts to actually raise Medicare taxes by 1% or 2% to cover these diseases, versus our recent history of expanding Medicare and leaving taxes alone on the vast majority of Americans.
Bob –
I think there is something unseemly about letting insurers just insure healthy people and make good money doing so. Then, as soon as one of their healthy members get sick and is no longer profitable for them to cover, they get to dump them into Medicare or a high risk pool and let taxpayers pay to cover them. It doesn’t pass the smell test.
In all other developed countries, whether they use health insurers or not and whether they finance their system with taxes or not, accept the idea of community rating. In Switzerland, everyone above the age of 25 pays the same premium for a similar health insurance policy in a given canton. Young people between age 18 and 25 pay a slightly lower premium and children are each insured at about one-quarter of the adult rate or a bit more. Roughly 45% of the population qualifies for a subsidy to help them pay their premium.
If we as a society are not going to just let people die on the floor of the ER if they don’t have insurance, they should contribute toward paying for it one way or another. I think the Swiss basically have it right though I would allow a broader range of deductibles and perhaps several different variations in the scope of coverage if it were up to me. Private supplemental plans could fill in the coverage gaps for people who want to buy them and can afford to but they would be subject to underwriting if they don’t buy the policy when they first become eligible.
I agree it’s not good policy to allow insurers to somehow kick out enrollees once they become sick. There has to be vesting with guaranteed renewability for those who maintained continuous coverage. There also needs to be a mechanism that does not allow the healthy enrollees to be moved to an insurer’s (healthy) risk pool so that all the unhealthy people are left behind in a (sick) risk pool where they can be gouged because the average costs are higher. (I understand this used to happen as a way to jack up the premiums for sick enrollees who could not legally be kicked out)
But at the same time, I know it’s not efficient to ask 25-year olds to pay the same premium as 55-year olds. I also don’t believe it’s good policy to penalize people who followed healthy behaviors and subsidize those who maintained unhealthy lifestyles.
A system I think would be preferable is one where 25-year olds pay a “community rated” premium (or maybe call it a benchmark premium) that goes into their HSA account. From the HSA account, they buy health coverage on a risk-rated basis. Thus, after paying insurance premiums healthy young people (and healthy middle-aged people) have funds left over for use later in life. They would spend down the excess deposits as they age. People would still be rewarded for healthy lifestyles.
I describe this as similar to the lifecycle theory of saving for retirement. There would still be cross-subsidies from healthy to unhealthy. But it would be young people subsidizing their own health later in life.
“I agree it’s not good policy to allow insurers to somehow kick out enrollees once they become sick.”
Devon, the issue is: If you were controlling the dollars would you buy insurance if you knew that when you got sick you would be kicked out?
I think your answer would be no as would the answers of most people. If that is the case the insurers would have to offer an alternative or else go out of business.
Al, you are talking about employer-based health insurance that automatically TERMINATES a sick person’s coverage if the can’t work the required 30-hours-per-week, the ELIGIBILITY REQUIREMENT.
I have been trying to get Devon to admit this for years but he just keeps dodging the question. Devon could save America if he would just try a little harder.
Donald Trump has been selling health insurance to his own Florida employees that TERMINATES after a short COBRA and TRUMP laughs all the way to the bank. Trump is a smart guy and he knows terminating a young woman’s insurance 18 months into her cancer is depressing at best and deadly at worst. I bet if you were a non-licensed Trump HR person and asked Donald if this is right to kill young women with no hair Trump would say, “You’re Fired!”
Apparently I didn’t realize there was any doubt that employer-based coverage ultimately goes away (after COBRA) if someone leaves their job. That includes situations where workers die or are too sick to work. That is precisely why the NCPA spent years touting personal and portable health insurance. Three or four years ago I sat in on several meetings with BlueCross, to discuss how such as system might work.
Devon, Blue Cross is not going to pay any attention to you because employer-based insurance terminating the sick is their cash cow. If Blue Cross couldn’t terminate their sick employees then Pat Geraghty CEO of Blue Cross of Florida couldn’t get paid $6.7 million per year.
Pasco Schools are selling life insurance to their employees that they lose if they get cancer and can’t work 30-hour-per-week. They don’t even have an 18 month extension.
It should be illegal for an employer to sell any benefits to employees because that slimy 30-hour-per-week trick is dangerous to the employees’ health and financial well being.
Ron, I agree employer-based health insurance can do what you say. However, I was referring to insurance where no type of community rating exists.
Barry seemed to be making an argument for community rating in order to prevent insurers from dumping patients once they got sick.
Devon seemed to be trying to find a solution, but I believe that the insurers would automatically create the appropriate method to manage the situation or go out of business. The insurance industry is very profitable so it is my contention that they will provide the appropriate mechanism which could be based upon ideas created by consumers or their experts.
Al, you are correct. I do think Devon is trying to find solutions too. Barry wants to be in charge of American healthcare and rule like a dictator. He doesn’t like, or says its unseemly that insurers should make money on healthy people. But that is America and what FREEDOM is all about.
I think if an insured person was sick and was late on their premiums the insurance company should notify the government so us taxpayers could pay the $400 a month premium and make the insurance company pay the $500,000 in cancer treatments instead of the taxpayer paying the bill.
We need to hold these insurance company’s feet to the fire for the benefit of all taxpayers.
The industry is profitable in the employer market, but lost an average of $163 on each covered life in the exchange in 2014.
One question I have: with respect to cost-control, why is the low-hanging fruit ignored? Policy wonks have been talking about HSAs, HRAs, HDHPs, reference pricing, selective contracting, medical tourism and transparency tools for years. But it’s like pulling teeth to affect a change.
For example, why don’t all health plans tell patients where a MRI is $350 instead of allowing them to waltz into hospital outpatient departments and have one done for $2,700?
My only possible answer is that our system of getting health insurance is so convoluted that price signals get lost in the process (along with incentives).
Workers assume health benefits are nearly free (as opposed to $15,000 annually) so they don’t demand cost control and are unwilling to tolerate the inconvenience of cost-control measures. Employers sense that workers like the status quo so they don’t demand cost control from insurers. Insurers sense employers accept the status quo so they don’t implement cost control. Hospitals maximize revenue against reimbursement formulas so they don’t strive to be efficient and pass on the savings to remain competitive because their feet are not being put to the fire by insurers/employers/workers.
Devon, there is a powerful tool in the insurance industry called Return-Of-Premium (ROP). When I started in the insurance industry in 1987 I sold health insurance with ROP from Life Investors. The insured got every premium penny back at age 65 less claims. It cost more depending on your age but a client would shop for the $350 MRI instead of the $2,700 cost if the difference was taken out of their ROP on their 65th birthday. For a 40-year-old the additional premium was 20% but if they got a brain tumor and huge expenses they could drop off the ROP and their premium would drop 20%. There was a partial ROP after 5 years that increased every year to 100% at 65-years-old.
In the future when we reform health insurance there will be 100 companies selling Individual Medical (IM) and I’m sure the intense competition will lead to innovative solutions like ROP.
I liked ROP because it was easy to train agents to ask, “Do you want all your money back, less claims, at age 65 or not?”
I agree with you Devon and think the cause is that the free market doesn’t really exist in the healthcare market.
The only way to actually accomplish the goal of a sustainable healthcare system (“Increasingly, slowing the growth in health care spending”) is to mimic the marketplace as closely as possible or to actually use the free market place. That means that the patient directs his care and determines the insurance he requires by dealing directly with insurers or his own chosen agent. Some will fall through the cracks and perhaps be reliant upon some charitable or governmental agency. In this case the marketplace should be affected as little as possible.
All the other stuff being pushed that has significant effect on the marketplace only transfers pain from one person to another whether it be in the present or in the future. We saw that with the ACA and will see it again unless socialist ideas are removed from policy making.
Incentives for meeting biometric standards have been an effective tool for adding to the HSA and supporting better health and healthcare decisions. A diabetic who is compliant and stabilized is much lower cost. That person can have rewards and shared savings granted even if he has already met the deductible.
The only avenue for improved efficiency that’s not paved with gold must lead to improved Primary Healthcare for each citizen, community by community, for the Basic Healthcare Needs of Each Citizen. How?
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Read about NATIONAL HEALTH at:
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http://www.nationalhealthusa.net
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In addition to its ‘unholy’ cost, our nation’s healthcare is also not very effective. Among the other developed nation’s of the world, we are the only nation that has a worsening maternal mortality (MMM) ratio. It is now 18 deaths per 100,000 live births annually. To rank in the top ten nation’s of the world, we would need a MMR of <5. Given 3.9 million births in 2013, there would have been nearly 675 maternal deaths. At a MMR of 5, there might have been only 200 maternal deaths. Nearly 500 women who died with a pregnancy in 2013 might still be alive if they lived in Denmark.
Again, if you are really interested in an alternative to carefully considered change, see the url cited above.
Paul Nelson
Paul, did George Harrison go to Denmark with his cancer? Do the Saudi Prince go to Denmark or do the bee-line it to America? We have really big hospitals here. When I was in Paris in 1996 getting the award for the 1st tax-free MSA in the USA I looked at those Paris hospitals and it is a totally different deal. A Paris hospital is about as big as an American 7-Eleven. In Nice, France their hospital was this itty-bitty place using the second floor of a building.
We were staying at the Le Grande Hotel in Paris getting ready for the formal dinner across the street in the old Paris Opera and my wife tells me the hotel is on fire. She calls the front desk and they can’t understand her and ask her to slow down so she screams, “FIRE, FIRE!” About 10 minutes later the Paris fire truck shows up and it’s this little van, here again, not like an American Fire Truck. They tried to get my wife to leave the room but she wouldn’t go because she was putting on her makeup for the formal across the street in the old Paris Opera. I have pictures of these Paris fire people on our balcony silhouetted against the Paris Opera.
I know that room was used by German Generals in 1942. It had a wonderful view from the balcony. The fire was just the electrical wires on the outside of the building that were really old. The building was just fine but there was a lot of smoke.
Devon, this was Nov. of 1996 and Golden Rule still didn’t have their MSA product on the street yet. They didn’t hit the streets until Dec. 1996 so you should correct your History of the tax-free MSA and give credit where credit is due.
Imagine a Socialist popping up here at the NCPA.
It looks like the only way the managed-care companies participating in Obamacare are going to actually “save money” is a restrictive HMO staff model. Open access Provider networks are too costly so it looks like the only way to save money is to restrict access to salaried physicians and nurses who are incentivized to control costs. Freedom be damned my fellow Americans.