Image credit: Johns Hopkins University
by Dick Hall-Sizemore
I just had an experience that illustrates the bewildering complexity of the finances of the American health care system.
Yesterday, I had a colonoscopy. I’m a veteran of this procedure, having had several because there is a history of colon cancer in my family. (No polyps this time, by the way.)
The protocol for the dreaded “prep” time has changed. No longer does the patient have to consume a gallon or two of sickening sweet liquid (others who have had this procedure know what I am talking about). Now, one has to take 24 pills in two stages between 6 p.m. the night before and 6 a.m. the day of the procedure, along with a lot of water. Continue reading
by James C. Sherlock
The Acting head of the Justice Department’s Antitrust Division, Richard A. Powers, yesterday delivered a speech that described the Justice Department’s new goals, strategies and resources for criminal antitrust enforcement.
The clouds have darkened over Virginia’s healthcare monopolies.
The Commonwealth. Virginia has failed in its duty to oversee its healthcare industry. The full extent of that failure has been detailed in previous columns.
It has failed in two major ways:
- The Virginia Department of Health (VDH) has been captured by the healthcare provider industry that it regulates. Indeed VDH has been actively complicit in industry evasion of antitrust statutes through its administration of Certificate of Public Need (COPN) law.
- The Commonwealth’s regulatory structure has a strategic vulnerability. Neither the VDH that regulates providers nor the State Corporation Commission that regulates insurers can adequately oversee integrated health care delivery and insurance companies to prevent or detect what amount to internal conspiracies in restraint of trade. In the wrong hands, integrated provider monopolies and regionally powerful insurers can serve as weapons against competitors to both.
by James C. Sherlock
The Business of Healthcare
I have written columns here and in various newspapers across the state for a number of years supporting health enterprise zones (HEZ’s) in underserved areas of Virginia.
I drafted and Republican Attorney General candidate Jason Miyares sponsored legislation of that title in the General Assembly.
It lost. Like night follows day, Democrats killed it. Fast forward.
The National Academy of Sciences, Engineering and Medicine released an implementation plan May 4 for the U.S. government, recommending it provide high-quality primary care to all Americans. The program proposed is simply too large in my view to be run effectively in 50 states by the federal government and its one-size fits all regulations.
But it contains good ideas — action items that Virginia can and should legislate without waiting for federal legislation that may never see the light of day. Continue reading
by James C. Sherlock
We write here often about senior care, the companies that provide it and the politics around that business.
It is useful to understand the continuum of care to make sure we also understand the different financial situations which companies in different parts of that industry find themselves and the way they are overseen and paid in Virginia.
The larger corporations that offer these services often offer both facility and in-home care.
The basic descriptions below are offered for considering the business interests and therefore the lobbying efforts of the companies that provide the services. They are not meant for personal counseling. Continue reading
by Peter Galuszka
The Texas freeze and ensuing energy disaster has clear lessons for Virginia as it sorts out its energy future.
Yet much of the media coverage in Virginia and certainly on Bacon’s Rebellion conveniently leaves out pertinent observations.
The statewide freeze in Texas completely fouled up the entire energy infrastructure as natural gas pipelines and oil wells stopped working, coal at generating plants iced over and wind turbines stopped working.
Making matters much worse, Texas opted not to have power links with other states. Its “free market” system of purchasing power meant utilities skimped on maintenance and adding weather-relative preventive measures such as making sure key generation components were weatherproof.
The result? Scores dead and millions without electricity. Here are more points worth considering in Virginia:
Climate Change is For Real
It is a shame that so much comment in Bacon’s Rebellion is propaganda from people who are or were paid, either directly or indirectly, by the fossil fuel industry. Thus, the blog diminishes the importance of dealing with climate change in a progressive way. Continue reading
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by James A. Bacon
Annual health care spending per person in Virginia is slightly below the national average — about $10,800 per person compared to $11,600 for the nation as a whole, but most of that advantage is eaten up by higher insurance costs, finds a new study by the Altarum Institute that was underwritten by the Virginia Hospital & Healthcare Association (VHHA).
Among the major components of healthcare expenditures, spending on hospital services is 12% less per capita in Virginia than the national average, 18% less for nursing homes, and 3% less for physicians and clinical services. But Virginians spend 7% more per capita on prescription drugs, says the study, based on 2019 numbers. Overall, per capita health spending on providers is 7% lower in Virginia than it is nationally. Continue reading
Roanoke flooding in 1985
by James C. Sherlock
There were lots of comments in my last post about government programs to mitigate flooding damage in flood plains, specifically about buying and tearing down houses that repeatedly flood.
One of the carrots to do so is Community Rating System (CRS) discounts to flood insurance in communities that take an active role in flood plain risk mitigation.
CRS is a part of the National Flood Insurance Program (NFIP). It is an incentive program that recognizes and encourages community floodplain management activities that exceed the minimum program requirements.
When that happens, not only is the risk of flooding diminished, but flood insurance premium rates for all citizens of a community that accomplishes the goals are appropriately discounted to reflect the reduced flood risk.
To quote the program web page,
“For National Flood Insurance Program Community Rating System participating communities, flood insurance premium rates are discounted in increments of 5 percent.
By Dick Hall-Sizemore
For the past 17 years, my wife and I have rented a house at Sandbridge in Virginia Beach for a week in late May. My daughter and her family, including the three grandkids, come down for the week. It is the highlight of our year.
This year was no exception. A year ago, we reserved the week of May 16-23. Then, of course, the coronavirus intervened. The Governor issued an executive order telling everyone to stay at home unless it was absolutely necessary to go out. Stores and restaurants were closed. Would we be able to go to the beach? What about all that money I had already paid (the entire balance due)? Continue reading
Wise King Ralph
by James A. Bacon
According to Governor Ralph Northam, the way to ensure access to quality, affordable medical insurance for Virginians is to reject bills that would… expand access to health insurance for Virginians.
Yesterday Northam vetoed two bills passed with broad bipartisan support that would have allowed self-employed people to buy insurance through professional groups such as Realtors’ associations. He also vetoed a third, which would have permitted small businesses to band together to buy group health insurance for employees.
Northam’s logic was that the legislation could undermine the Affordable Care Act by providing an alternative to buying coverage on the state exchange, reports the Washington Post.
“Governor Northam’s administration has worked to expand access to affordable quality care for all Virginians,” said a statement released by the Governor’s Office. “The vetoed bills would address health insurance cost concerns for targeted segments of the population, but in doing so, could increase the cost of insurance for sicker Virginians in the marketplace.” Continue reading
Money (And Hypocrisy) In Politics
By Steve Haner
The following is one of my “revise and extend” follow-up posts, this one adding detail to an exploration of the raging attacks on Republican efforts to offer alternative health insurance plans. You can read the original post on the Jefferson Policy Journal.
Not many months ago, it was a safe bet that by late October the campaign attack ads would focus on utility contributions. There is still time for that to appear. Dominion Energy clearly expected that, as evidenced by a full page, very defensive advertisement in Wednesday’s Richmond Times-Dispatch. Then there is its most cloying television ad yet.
You’ve seen it, of course – the lovely young lady whose Daddy is a deployed Dominion employee. Instead of wearing a U.S. Army or Blue Star cap, she sleeps and poses for school pictures in his Dominion Energy hat. Now, how could a company engendering that kind of love and loyalty be misbehaving?
“You Only Pay For What You Need”
By Steve Haner
As the state campaign debate rages about health insurance plan which are short term or less comprehensive than the Affordable Care Act, two on-going national ad campaigns may cross-pollinate the debate. They are bolstering the Republican position nicely.
The first are the spots with people saying they are worried about the various Medicare for All proposals. They express concerns about a more expensive one-size-fits-all approach. Well, isn’t that exactly what Democrats like Senate candidate Debra Rodman and other others are demanding in Virginia? One size fits all? In several districts they are attacking Republicans who voted to allow lower cost alternatives that didn’t offer all ACA features. Continue reading
by Steve Haner
The arguments which have paralyzed Virginia General Assembly efforts to end surprise bills from medical providers are surfacing again in comments to the State Corporation Commission. It is considering an internally generated regulation that requires advance consent from patients to be treated by someone outside their approved health plan.
As proposed in June and reported by the Richmond Times-Dispatch, the regulation addresses only elective medical procedures, not emergencies. It is tied to legislation which passed in 2019 that requires written notice to patients of the possibility some provider on their care team might be “out of network” and thus send them a separate bill outside their insurance contract. Continue reading