The Powers Report Podcast

Consumers are looking for ways to lower their health costs. Yet the biggest component to their health care budget is something they cannot change: monthly health insurance premiums. In this ...

Health care is almost a $4 trillion industry, yet it has yet to be “consumerized.” Politicians and industry leaders talk frequently about serving the consumer, but what do they really ...

The American hospital system has been under strain with the rise in Covid-19 cases. In some locations around the country, hospitals are busting at the gills, at full occupancy. The ...

Telemedicine, also known as telehealth, takes your doctor experience and makes it virtual. We’ve come to love it now that we’ve been sheltering at home. It’s convenient, but is it ...

Orders for self-quarantining and social distancing have been established across the country as communities battle the COVID-19 coronavirus. We’ve been asked to come together, to make individual sacrifices, all for the greater good of our fellow citizens. The pandemic has highlighted a number of interesting scenarios where individual behavior can benefit or harm broader society. In this show, Powers discusses how issues such as C-Suite executive compensation, body positivity and hospitals’ strategic tactics have had a negative impact on the American populace. She then offers some solutions to address the problems.

Key Citations

* Statement on the purpose of a corporation: Business Roundtable

* Racial disparities of coronavirus infections: The New York Times

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

I hope, in the shelter-at-home world where many of us live, that you’ve been able to realize the completion of some of your wish-list projects. Like cleaning out the garage. Or organizing your digital photos. Maybe you finally tried that recipe for spinach lasagna. Good for you.

Then there are other activities that, despite the online availability of many products, still require repeat trips to the store. I’m talking about things like scrapbooking or jewelry making or ironing decals onto shirts. Store closings, limited hours and just the pressure of getting in and out of craft destinations like JoAnn Fabrics or Michael’s have put a damper on pursuing these treasured stay-at-home activities.

Well, here in Austin, Texas, where I live, we’re getting a reprieve. As of this week, there’s a mandatory face mask order in place for Travis County. We can’t leave the house without a mask if we think we’re going to get within six feet of anyone. We’ve got to get face masks, and if we can’t buy them, we have to make them. Which means… fabric stores have been deemed essential businesses.

Do I think this new face mask order is ridiculous? Yes, I do. Am I going to abide by it? Yes, I am. What’s ironic is that we’re going to have people flocking to JoAnn’s because now, they can. They’re going to go under the pretense that they’re buying fabric to make face masks when their real goal is to get supplies so they can bedazzle their jeans. These people will enter a closed-in space with a bunch of other people and probably undo any of the good that staying at home was supposed to do in the first place.

As we move towards re-opening the economy – whatever that means – more and more people are getting anxious to both blaze ahead and to stay behind. Where you reside on the spectrum of opening up the economy depends on your:

* Health status and the health status of your loved ones

* Fear about the deadliness of the coronavirus

* Concern about your financial situation

* Concern about the economy

It seems we’ve all got an opinion about how global, national and local leaders are handing the coronavirus pandemic. In this show, Powers skips over all of that and talks about how COVID-19 is changing the way we look at different aspects of the health care system. She discusses nurses, doctors, epidemiologists and hospitals. Most provocatively, Powers addresses the issue of rationing and offers up an idea about how to control Medicare spending through a self-rationing system.

Key Citations

* Rates of prescription drug use by age: Centers for Disease Control and Prevention

* COVID-19 fatality estimates: Centers for Disease Control and Prevention/Emerging Infectious Diseases

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

Maybe by the time you listen to this, the panic over COVID-19 will have passed. Maybe there will be a vaccine or a cure. Or maybe the flu season will be over, and we’ll just be managing the disease by nipping it in the bud with much improved testing capabilities. As we record this show, I think a lot of us are feeling coronavirus fatigue as well as a big fat dose of cabin fever. So let it be known: this podcast isn’t about making predictions about how many people will die, or talking up potential cures, or critiquing our leaders for not doing a better job, or comparing the American response with other nations, or anything like that.

Instead, I want to talk about what the virus tells us about the American health care system. There’s a lot to learn.

Probably most importantly, we’re going to get a renewed respect for the health care worker, especially the nurses and other support staff. The people doing, literally, the dirty work. They’re not just diagnosing, but more critically, they’re taking care of the patients. These are the health care practitioners at the highest level of risk because they are in continuous person-to-patient exposure.

The virus isn’t changing our minds about what we think of nurses. It’s fortifying our opinion about an already well-respected profession. For years, Gallup has been polling people, asking them if they trust individuals with different occupations. When it comes to rating people on honesty and ethical standards, nurses have reached the top spot for 17 consecutive years. 84% of Americans rated nurses “very high” or “high” when it came to these criteria. Last on the list … members of Congress. They scored a pathetic 8% confidence rating. Clergy was at 37%, which was better than lawyers. They were at 19%.

So I think the nurses are going to come out of the COVID-19 crisis with enhanced status. Savvy nursing organizations are likely to use this unpaid societal debt as a means to better negotiate terms of employment. And I’m not just talking better pay and better benefits. I’m talking robust health and/or life insurance policies. If (and dare I say when) something like this happens again,

The American political apparatus imploded as the primary season kicked off in Iowa this February. Many wonder how things could have gotten so bad…but then again, many of us are wondering the same thing about the health care system.  In this show, I will describe some of the problems that arose in Iowa and draw some comparisons about what’s going on in health care. Specifically, I will discuss the importance of primary voting versus polling, the racial composition of Iowa’s audience and the mis-appropriation of funds that led to the Caucus’s technology disaster.

Key Citations

* Cancer rates in the U.S.: Centers for Disease Control and Prevention

* Health care dollars are spent on administrative costs: Annals of Internal Medicine

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

The most notable event of the 2020 presidential election season has already happened. The Debacle of Des Moines, the Meltdown in the Midwest, call it what you want. It took the Democratic Party in Iowa days, not hours, to identify a winner of the Iowa Caucuses. Given the scale of reported mismanagement, from precincts reporting more votes than they had been allotted to, of course, the massive technology glitch, results are being reviewed. It doesn’t matter. The damage has been done.

The 2020 Iowa Caucuses have given us plenty of opportunity to reflect on how to better run campaigns and elections. Interestingly, I think a lot of those lessons apply to what’s going on in health care. We can all agree that the industry is in dire need of help. Maybe looking at some of its problems through the lens of the political apparatus will make us think a little differently about what needs to change in health care and why.

First let’s talk about the importance of being first. Millions of dollars were invested by the candidates and their parties to make a big splash in Iowa for a reason. On the night of the Caucuses, theoretically, all the polling that went on beforehand becomes irrelevant. Someone’s going to win. Winners get delegates. Candidates need delegates to earn the party’s nomination.

Polling influences voters. Let’s say I can’t decide between Bernie Sanders and Tom Steyer. I hear repeatedly that Steyer is polling near the bottom while Sanders is at the top. Why throw away my vote on someone who’s not going to win? Those polling numbers are going to influence my choice to vote for Sanders.

Polling is a numbers game.  Results depend on who’s asking the question; how questions are asked; who’s being polled; where the polling is conducted; how many people are in the poll; when the poll takes place, etc.

For example, taking a national poll on a subset of voters pitting two candidates against each other for president – like Hillary Clinton versus Donald Trump – is pointless. That kind of poll adds up the number of people who want one candidate or the other.

Health care costs in America have skyrocketed and the cost of insurance is getting out of control. First premiums went through the roof. Then deductible levels went sky-high. If you’re relatively healthy, you’re definitely spending more on insurance than you use. Have you thought about what it would be like if you didn’t have health insurance? Well, I’ve not only thought about it, I’ve done it. 2019 was my first year without health insurance and I’m doing it again in 2020. Listen to this podcast for some personal stories about why I chose to ignore the Affordable care Act’s Individual Mandate and go it alone.

Key Citations

* Rising Rate of Uninsured Americans: Kaiser Family Foundation

* Concentration of Health Spending in the Population: Peterson-KFF Health System Tracker

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

2020 brings a new year and a new decade. We’re well into January and many of you may have already forgotten your new year’s or even new decade’s resolutions. I hope not, because most resolutions tend to be things that promote better physical and mental well-being. We pledge to do things like exercise more, sleep more, eat a healthier diet. Many of us want to get our finances under control or pay down debt. Please take time to double down on these commitments if you don’t have a mechanism in place to remind you to do so.

I enter this year with less of a resolution and more of a continuing experiment. It will be my second year without health insurance. Actually, I should qualify that. I have health insurance but it’s not the kind that I’m legally supposed to have. I have a short-term catastrophic plan, and I’ll explain more of the details about it in a bit.

What I am supposed to have is dictated by the Affordable Care Act, or the ACA, which was passed in 2010. A decade ago. The major components of the law went into effect in 2014, so much of what I’m going to say may be old news to you. The ACA established the legal requirement that all Americans have health insurance. That’s the so-called individual mandate. I’m self-employed. I can’t get health insurance through an employer, which is the source of insurance for about half of all Americans. I’m not on Medicare or Medicaid, so I don’t qualify for the government’s public health programs. I have to buy health insurance on my own.

The market I’m in is small. There are about 330 million people in America. According to the Kaiser Family Foundation, about 13.8 million people bought some sort of insurance – including non-ACA compliant plans – in 2018. Then throw in the number of people who are uninsured, which went up between 2017 and 2018. In 2018, according to the US Census Bureau, 27.5 million people didn’t have health insurance at all.

There’s been plenty of talk about Medicare, the public health program for the elderly. Many people don’t realize that Medicare does not cover most of the costs for long-term care. As a result, more and more elderly Americans and their families are facing some heart-wrenching choices about health care and about their finances. In this show, I will discuss coverage options for long-term care, the many ways to pay for it, the pitfalls we can avoid when funding it, and the conversations we need to be having now with our loved ones to prepare for this final phase in life.

Key Citations

* Public coverage for long-term care: longtermcare.gov

* Long-term care cost estimator by state: Genworth

Transcript

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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

In this episode, I will talk about an issue that scares me and should scare you, too: long-term care. Every day, 10,000 people age into the Medicare program. More people are getting older at a quicker clip and they’re living longer. The older people are, the more likely they are to need some sort of long-term care, which makes this topic especially important.

The thing that’s most concerning about long-term care is that we don’t know if we’re going to need it. If we do need it, we don’t know what kind of care we’re going to need, and we don’t know how long we’re going to need it. We can buy long-term care insurance but since we can’t articulate what we’re going to insure for, we won’t know if our insurance is satisfactory until maybe, it’s too late.

In this show, I will talk about the different kinds of long-term care there are, because it’s a big umbrella term. I’ll talk a lot about payment and coverage options because I always like talking about how things are supposed to be funded. And I’ll pepper in some advice about what you can do … besides pray that you’ll never need long-term care.

So, let’s take a step back. Long-term care is an all-encompassing term that can include a lot of different options. The most extreme long-term care is for patients who will never be able to live independently and are housed in facilities that offer a high level of clinical care. This applies to folks with major physical disabilities and/or those with cognitive issues, like dementia. On the other end of the spectrum there is Home Health Care that comes to a patient’s home a couple of times a week to help with non-clinical “life” issues, like shopping and cleaning. And there’s every permutation in between.

There’s also a dizzying array of coverage options. The most important thing to know is that Medicare offers limited coverage for long-term care. In fact, it’s easier to say that Medicare just doesn’t cover long-term care. When we’re talking about an extended condition which requires staying in a specialized facility, the entire stay probably won’t be covered.

This is the second in a two-part series about price transparency. In the first podcast, I discussed pricing as it relates to hospitals and other providers. In this episode, I will talk about the pharmaceutical industry – a little about how it works and a lot about the types of drugs that are sold and how many of the different kinds of these drugs that we use. In both podcasts, I will talk about efforts underway by the government to provide better information to consumers. The hope is that better access to pricing will increase competition and reduce prices. While I support this free market idea, it has its limitations. In each show, I will provide additional initiatives that should be pursued to not only increase access to better pricing but also to push prices down to realistic levels.

Key Citations

* Video about the drug supply chain in America: The Wall Street Journal

* Accessing drugs for Medicare enrollees: Medicare.gov

* Drug comparison website: GoodRX.com

Transcript

Download the PDF

Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.

Americans have become increasingly frustrated with the health care system, and pricing is a big part of the problem. Drug pricing in particular is a bee in almost everyone’s bonnet. And the reason is simple: about half of all Americans take a prescribed medication every day. Drug pricing is crazy and it matters a lot because it affects the daily lives of so many Americans.

As you know, I like to use this show to describe issues in health care but more importantly, to outline some ideas about how to fix them. I will provide an overview of the pharmaceutical supply chain. However, there are a lot of great resources out there that can explain in detail how things function. In particular, I suggest an excellent video “How Drug Prices Work” which was created by The Wall Street Journal. If you want to learn what’s offered to Medicare beneficiaries, I invite you to check out the Medicare.gov site about prescription drugs.

Ok. Let’s talk about drugs.

It’s important to note that there’s a difference between the price that pharmaceutical companies charge for their drugs – which is called the List Price – and the price that we actually pay. If you listened to my last podcast about pricing for hospitals, I talked about the Charge Master. That’s a hospital’s List Price for their services. Insurers negotiate down from these prices, so hospitals are incented to make them very high. Same kind of situation with a drug company’s List Price.

Except there aren’t just insurers in between the drug manufacturers and the consumers. There’s yet another intermediary complicating things,