The Powers Report Podcast

The Affordable Care Act authorized broadened Medicaid eligibility requirements, yet a sizeable minority of states have not expanded the program. This podcast was inspired by the referenda undertaken by residents in several states to expand Medicaid, and the reactions by some state leaders to block expansions supported by voters. Powers discusses the pros and cons of expansion and offers an opinion about whether or not Texas, where she lives, should expand Medicaid.

Key Citations

* Commentary on Medicaid Expansion in Utah: NPR

* Medicaid-to-Medicare provider fee reimbursement comparison: Kaiser Family Foundation

* Medicaid enrollment by group: Kaiser Family Foundation

* Medicaid spending by group: Kaiser Family Foundation

* Study of positive effect of Medicaid on enrollees’ financial situation: University of Michigan

* Study of effects of Medicaid expansion in Montana: University of Montana

Transcript

PDF Version for Download

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. These are major themes that will be discussed in each podcast. 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.

One of the things I’d like to do on this show is talk about current events. There’s always something breaking in the health care industry, so there’s always a lot to talk about. For this episode, I want to discuss the Medicaid expansion. The majority of states have expanded Medicaid as was intended when the Affordable Care Act or ACA was passed. Some states, like Utah, and where I live, in Texas, have not.

The genesis for this discussion is the Utah state legislature’s response to the state’s recent referendum approving an expansion of Medicaid. Voters supported an expansion, but some Utahn legislators don’t like the idea and are putting up roadblocks to stymie it. I want to dig into this a little more because both sides need to be heard. I’ll also give an option as to whether I think Texas should consider expanding Medicaid. It is important for us to discuss the pros and cons of Medicaid so we can work towards improving this important program.

Here’s some background. Medicaid is generally known as the health insurance program for the poor.

The health care system has been relentlessly skewered, which is useful in efforts to identify its problems. Yet problem identification cannot provide us with the seismic change that’s necessary to transform the system. Powers offers up her own original ideas in her explanation of the Longitudinal Health Care Plan. In short: eliminate traditional health insurance by leveraging genetic analysis and predictive analytics to project an individual’s lifetime diseases and conditions. Then, decentralize the payment system so Americans can self-fund their care based on their personal health care cost requirements.

Key Citations

* National Health Expenditure Data: Centers for Medicare & Medicaid Services

* Medicare Advantage Plan Description: Medicare Website

* Facts about Medicare Advantage: Kaiser Family Foundation

* Comparison between Medicare traditional and Advantage: Forbes

Transcript

PDF Version for Download

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. These are major themes that will be discussed in each podcast. 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 show I will talk about why we need a big new idea in health care. I’ve spent a lot of time talking in previous podcasts about what doesn’t work. I’m going to talk a bit more about the structural and financial imperatives that are driving the need for truly seismic change in health care. I think we have to get our heads around why small incremental solutions aren’t going to do the job so we can embrace bold new ideas.

Bold new ideas like mine…

So here we are, several podcasts into the show and I haven’t given an explanation of where I think health care will be in the next generation. Here’s what I think. Health insurance will be obsolete. This is an inevitability, especially when you think about what we use health insurance for. As I discussed in an earlier show, having health insurance doesn’t make us healthier. It’s not a useful tool in engaging us in ways that improve our health. And since we are so unhealthy as a nation, we need mechanisms that are going to better motivate us, behavior-wise.

Health insurance provides financial security and we need that. We need to know that we’ll be able to pay for our health care requirements. I think we can all agree that using health insurance as a mechanism to do so is inefficient. There’s tons of waste in the system on both the public and private sides. Since health insurance today is inefficient and doesn’t make us healthier, we have to find something else. The great part about this realization is that innovation is already helping to create an alternative to the current health insura...

Seven out of ten Americans are overweight or obese, and the numbers have been growing. Janis Powers considers obesity to be the greatest challenge to the American health care system. Obesity correlates to every major chronic disease. It negatively affects qualify of life, drives up costs and impedes worker productivity. Worst of all, it has become culturally accepted. Powers takes a serious, critical perspective on how, societally, we must change our views on being overweight and obese by separating the condition, which is severely problematic, from the person, who deserves support and compassion.

Key Citations

* Data on health factors in America: Centers for Disease Control

* Americans’ opinions about their weight: Gallup

* Study on adaptive thermogenesis: International Journal of Obesity

* Consequences of obesity: Centers for Disease Control

* The U.S. compared to other economically developed countries: Organisation of Economically Developed Countries

Transcript

PDF Version for Download

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. These are major themes that will be discussed in each podcast. Please subscribe to our show on i-Tunes 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 be talking about what I consider to be the greatest challenge in health care: obesity. Obesity is the biggest issue impacting the health care system for a number of reasons. First, it’s a precursor to so many chronic diseases, so it makes people unhealthy, lowers their quality of life and drives up costs; obesity impedes worker productivity, so it affects the entire economy; and critically, probably most disturbingly, it’s culturally accepted, which means it’s extraordinarily difficult to eradicate. We can’t bring down the cost of care and we’ll have less money to pay for our high cost system if we don’t reverse our public perceptions about being overweight and being obese.

So let’s talk about what we mean by overweight and obese. A standard metric used to qualify the healthiness of an individual’s weight is Body Mass Index or BMI. BMI is simple calculation. It’s your weight in kilograms divided by your height, in meters, squared. You’re considered overweight if your BMI is 25 to 29.9. A BMI of 30 or over is considered obese. Now, this is not the be-all, end-all definition of obesity. Different people have different bone structures, body types, etc. But for the most part, BMI is a good indicator of whether an individual is overweight or not.

That said, I want to make sure that listeners recognize an essential nuance in this particular show. I will be criticizing the condition of obesity, not the people who are obese.

The single payer/universal health care/Medicare-for-All idea has become an increasingly popular subject, especially as the 2020 campaigns get underway. Powers discusses why, on the surface, the concept has merit. Upon further scrutiny, Powers counters that the single payer system is unworkable in America. Her perspectives about the uniqueness of America’s size and diversity make comparisons between our country’s health system and those of other developed countries invalid. In addition, under a single payer system, the multitude of options for medical care available today will not be rationed with financial discipline, pushing our country into further dubious fiscal territory.

Key Citations

* Report on Canadian health care system: Fraser Institute

* Comparison of health systems in economically developed countries: Peterson-Kaiser Health System Tracker

* Racial/ethnic population analysis in America: Kaiser Family Foundation

* Religious diversity in America: Pew Research Center

* Status of states that have expanded Medicaid: Kaiser Family Foundation

* Government underpayment to U.S. hospitals: American Hospital Association

* Insured rates for all and non-elderly Americans: United States Census Bureau

Transcript

PDF Version for Download

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. These are major themes that will be discussed in each podcast. Please subscribe to our show on i-Tunes 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.

There’s been a lot of discussion recently about adopting a single payer system in America. Since the Democrats gained political ground last November, the single payer or Medicare-for-All idea has been floated as a potential platform issue for the Democratic Party. You may identify as a Democrat, but that doesn’t mean you have to support every idea that’s presented by Democratic candidates. And the same is true for Republicans, Libertarians, etc. This is important now, more than ever.

America’s political divisiveness is driven in part, I think, by too much of a focus on the cult of personality – we evaluate candidates based on whether we like them. Yes, it’s important to identify with the moral code of a candid...

The notion that access to health insurance should improve health outcomes has long been accepted in the mainstream. Yet the data indicates that this conception is flawed. In this podcast, Powers will review key statistics that demonstrate that health insurance doesn’t improve health, and she’ll discuss a major policy issue that health plan designers keep getting wrong. In conclusion, Powers offers up an explanation of the factors that really impact our health.

Key Citations

* Insured rates for all and non-elderly Americans: United States Census Bureau

* Incarceration rate: Pew Research Center

* Historical life expectancy statistics: Centers for Disease Control and Prevention

* Current life expectancy statistics: Centers for Disease Control and Prevention

* Obesity rates: Trust for America’s Health and The Robert Wood Johnson Foundation

* Cancer statistics: National Cancer Institute

* Oregon Medicaid Study: The Oregon Health Insurance Experiment

Episode Transcript

PDF Version for download

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. Each segment features a different topic in health care, covering policy, technology, advancements in pharmaceuticals and changes to the health care delivery and payment systems. 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 across our community of 330 million people can only be achieved if we can afford it, and if we behave in ways that optimize our health. Only then will we be able to bring down costs and better engage patients so we can improve access to care. Please subscribe to our show on i-Tunes 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 podcast is sort of a “myth-busters” segment. It’s called “Health Insurance Doesn’t Make People Healthier.” It’s an idea that goes against the grain of what many of us believe to be true. That is, that the access to health care provided by health insurance should correlate to better health outcomes. The thought is that when we get health insurance, we should be healthier, because now we have access to care that’s covered under our insurance plan. Well, the facts show otherwise. As I will discuss, there’s a reality gap between the expectations of what health insurance can do and the how people actually use it. We need to come to terms with the notion that health insurance does not make people healthier so we can direct our resources to more effective financial mechanisms for funding health care services.

So let’s get to some data to prove the point. I’m going to give you high level data, but it’s going to sound a bit in the weeds. I am purposefully explaining the details of the data because for this topic, health insurance doesn’t make people healthier, the devil is in the details.

“Health care is a right” has become a mainstay slogan for political leaders, health care luminaries and many American citizens. Powers offers up her opinion – that health care is ...