You are either FOR Killer GPO PBM Kickbacks or Against Them

Bob Campbell, MD, co-founder of Physicians Against Drug Shortages writes:

Want to introduce an element of competition into healthcare? Ending the GPO/PBM kickbacks is the best place to start. Low hanging fruit and no room for compromise. You are either FOR sole source pay to play inflationary kickbacks or against.

So far since Trumps rumored new introduction of barriers to the kickbacks have been “rumored” to be “possibly written for possible introduction “ as new HHS rules Sen Warren and Hatch and Congressman Walden have emerged to keep the kickbacks in place and unfettered by HHS. They have not seen the rumored rules but if the rules might interfere with the essential kickbacks then the rules must never be enforced. Not good for America. Senators Toomey and Casey of Pennsylvania are both long time defenders of pay to play kickbacks. Pennsylvania Senate campaigns are very expensive and the PBM GPO cartels are very generous to supporters. Remember Trump can only erect barriers to access to the safe harbor. Congress made kickbacks and racketeering legal for GPOs and PBMs with the safe harbor law. Only Congress can make pay to play payola illegal again. That is an enduring solution. Trump cannot do that. Congress can.

A bill that is written, reviewed polished, and ready to go for any courageous Member of Congress. One version for the House and one for the Senate. President Trump says not one person in Congress is capable enough to take action on this matter. Is anyone willing to take him up on his challenge? All we need is a Healthcare Hero.  How about 100 new generic medication manufacturing plants with 200 jobs at each plant all in the state that leads the way. High paying clean manufacturing jobs that will stay busy throughout economic boom and bust cycles. Hundreds more just like it across the country, but the state of the Member of Congress who will introduce the bill gets first dibs.

A capital investment frenzy occurs if this bill passes. We need chemotherapy, saline, potassium chloride, potassium phosphate calcium carbonate, calcium chloride, sodium bicarbonate, epinephrine,ephedrine, norepinephrine, dopamine dobutamine, glucose, nitroglycerin, cardiac surgical drugs, antibiotics, obstetric medications, pediatric seizure medications and hundreds more.

I need drugs to paralyze people and unparalyze them. I need drugs to increase blood pressure and increase heart rates when they are too low. I need drugs to decrease blood pressure that is too high and slow down heart rates that are too high. Right now using smoke and mirrors. We should postpone all cardiac surgery until the Unsafe Safe Harbor is repealed. Right now we have Fake Anesthesia.

Trust me that is way more dangerous than Fake News. No more Fake Solutions from politicians for explosive healthcare costs and drug shortages. Exclusive Pay to Play Market Allocation Contracts is all that is keeping American companies from lowering costs for drugs and ending drug shortages. All contracts are written by an unnecessary extra layer of Middlemen inserted into the healthcare supply chain with a uniquely powerful ability to demand kickbacks from manufacturers to permit them to make lifesaving medications and medical devices for Americans who need healthcare. Drug Shortages never had to happen and can be ended. Healthcare Kickbacks never had to happen and can be ended.

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Aug. 30: Town Hall – Why Is Healthcare so Expensive?

The Healthcare Costs NJ 2018 Townhall with take place on Thursday, August 30th from 6:30pm ET to 8:30pm. It will be held at the Rastelli Market Fresh at Hill Creek Farms located  at 1631 State Hwy 45-S in beautiful Mullica Hill, NJ.

Contact: Craig M. Wax DO, office 856-478-4780 IP4PI@comcast.net

Why is Health Care so expensive?  This question is on nearly every American’s mind.  85% of Americans are more concerned about health care costs than other major expenses, and for good reason:  The average family of 4 will spend $28k on health care this year, $1200 more than last year. And even more concerning is that 44% of Americans skip care because of costs.

The Aug 30 event, featuring a word-class panel of experts on the drivers of medical costs, will explore and provide true solutions to this crucial problem, for both patients and policy makers. The townhall is held in conjunction with Practicing Physicians of America at PracticingPhysician.organd Independent Physicians for Patient Independence at IP4PI.wordpress.com. It is a free event and open to the public.

Speaker Bios:

David Hyman, MD, JD is an adjunct scholar at the Cato Institute and a Professor of Law at Georgetown University. A doctor as well as a lawyer, Hyman served as the Ross and Helen Workman Chair in Law and Professor of Medicine at the University of Illinois, where he directed the Epstein Program in Health Law and Policy. He focuses his research on the regulation and financing of health care and has taught insurance, medical malpractice, law and economics, professional responsibility and tax policy in addition to civil procedure. Hyman served as special counsel on the Federal Trade Commission, where he organized and led hearings on health care and competition – leading to the first joint report issued by the Federal Trade Commission and Department of Justice, “Improving Health Care: A Dose of Competition.” Earlier in his career, he was an associate at Mayer, Brown & Platt in Chicago, practicing tax litigation and health care law. He has been a visiting law professor at the University of Texas and George Washington University, a law professor at the University of Maryland and a lecturer at the University of Chicago. Hyman earned his BA, JD and MD degrees from the University of Chicago. Dr. Hyman recently published a book called Overcharged: Why Americans Pay Too Much For Healthcare. https://www.cato.org/overcharged

Kimberly Legg Corba,  DO is a family physician in private practice in Allentown, PA.  She is a 1993 graduate of the Philadelphia College of Osteopathic Medicine.

She has owned and operated her independent, solo practice since 2003 and transitioned the office to the model of Direct Primary Care in January of 2016.

Dr. Corba has been a speaker for Docs 4 Patient Care Foundation, the Free Market Medical Association, and will be speaking at the 75th Annual meeting of AAPS.

She testified about DPC in December 2017 for the PA Senate Banking and Insurance Committee in support of S. 926 and authored an policy for in-office medication dispensing for PA practices supported and approved by PA Med Society.  On a federal level, Dr. Corba has lobbied several times in Washington DC with the other national leaders for health care reform and most recently met with HHS, White House Administration, The Department of Treasury in support of Direct Primary Care and was present for the May 2018 rose garden speech concerning prescription costs by President Trump and Secretary Azar.   She is a founding member of the Direct Primary Care Alliance and the original founder of the Mid-Atlantic Direct Primary Care Alliance.  Dr. Corba has also authored and published The Manual of Policies and Procedures for Direct Primary Care which helps DPC practices maintain compliance.

Craig M. Wax, DO, is a family physician that practices family medicine and health through prevention in private practice in Mullica Hill, NJ. He is a tireless advocate for the patient-physician relationship and free-market health care. He has a bachelors degree in Food Science Research from Rutgers University in NJ, and a Doctorate in Osteopathic Medicine from the New York College of Osteopathic Medicine in 1994. Dr. Wax serves on the U. S. congressional subcommittee National Physicians Council for Health Care Policy at NPCHCP.org. He is the Vice President for health policy at Practicing Physicians of America at PracticingPhysician.org. Dr. Wax served on Medical Economics journal editorial board and frequently published articles on topics of free market medicine. He is the health talk show host and executive producer for “Your Health Matters ,” on Rowan Radio 89.7 WGLS – FM at RowanRadio.com since 2002. Dr. Wax was honored by the Society of Professional Journalists of Philadelphia with an SPJ award for his ability to make complicated matters simple to understand. He blogs at Independent Physicians for Patient Independence at IP4PI.wordpress.com. Dr Wax began HealthIsNumberOne.com, a free public information source on health in 1999.

Med Student Debt: Veritas vos liberabit.

Guest post by Howard C. Mandel M.D., FACOG:

The electorate will be bombarded in both the 2018 and 2020 election about the $1.4 trillion in education loans outstanding and the 28% currently in default, though a recent Brookings analysis predicts it will increase up to 40% [https://www.brookings.edu/research/the-looming-student-loan-default-crisis-is-worse-than-we-thought/]

The overwhelming majority of these individuals were either sold a bill of goods by for-profit schools or never graduated the public institutions that they enrolled in. Although medical or dental student debt has been shown to impact career choices it rarely results in default.

Did we ever seriously ask ourselves why medical schools are currently so expensive? Where is all that money going? Do the faculties and administrations of our med schools deserve the salaries and benefits they earn?

Are you aware that many medical schools are now paying hospitals to place their students in 3rd and 4th year clinical rotations… what audacity. These hospitals couldn’t exist without Medicare, Medicaid and DSH federal funding——they should be honored to have students on their wards.

Bad policy and Medicare financing of graduate medical education have created the debt crisis for America’s health care workers. There is a major shortage of doctors and nurses and Congress is ignoring treating this because of the economic costs associated with addressing it.

Yet, the inside the beltway crowd has seen a symptom it can campaign on. The right:  Loan default, and made the wrong diagnosis—–people are not educated with the “right major that’s marketable…”  The left: public college should be free for all. Quoting the late community activist, Mimi West, “Free ain’t Cheap…”

National data is biased by the defaults of mostly students that went to extremely large public institutions [not their state flagships] that either dropped out or took 6+ years to graduate. These students probably were not four year college ready and their loans were compounding all the time that they were finding themselves, experimenting with living on their own and maturing into adulthood. The last few decades have seen ever increasing college costs including tuition, fees, room and board.

http://articles.latimes.com/2011/oct/26/local/la-me-college-costs-20111026
 
http://www.learnliberty.org/videos/how-do-we-break-cycle-higher-t/

Society and government leaders pushed an idealistic desire to have every American attain a college education. This goal was encouraged and supported by government employee unions including most public colleges and universities, unionized workers including in many states, professorship. This led to major impacts on state budgets and college costs.

https://object.cato.org/sites/cato.org/files/serials/files/cato-journal/2010/1/cj30n1-5.pdf
 
https://www.heritage.org/jobs-and-labor/report/how-government-unions-affect-state-and-local-finances-empirical-50-state

It also led to inefficiency as well as difficulties for dedicated students to graduate within four years.

https://www.wsj.com/articles/SB10001424052748704657704576149941061124736

 http://www.hup.harvard.edu/catalog.php?isbn=9780674027886

In 2004, Johns Hopkins professors Robert Balfanz and Nettie Legters published an analysis entitled, “Locating the Dropout Crisis. Which High Schools Produce the Nation’s Dropouts? Where are they Located? Who attends Them?”
https://files.eric.ed.gov/fulltext/ED484525.pdf    These schools and other “Factories of Failure” pushed through students who ended up either going to For-Profit Institutions, over crowded Community Colleges or large state institutions.  At the California State Colleges/Universities——-75% of these students need remedial English or Math.  Is it any wonder that the majority never graduate but have accumulated debt?

LAUSD administration claims that “56% of their graduates” are college ready. They are not—-most go to Cal State and need remedial work to even begin introductory college level classes. This 56% is of the only 70% that make it to high school graduation. Unfortunatel, they have previously manipulated data and created sham’s, like their credit recovery program, that inflate the success of students only on paper. As a society we are letting the students in the LA district down.  https://achieve.lausd.net/cms/lib/CA01000043/Centricity/domain/414/documents/Dropout%20and%20Graduation%20Statistics%20for%202010-2011.pdf    

Unless we honestly look at the results we will never develop programs that educate our students to succeed. Of the cohort of students entering high school in LAUSD, only 12.25% actually graduate with either a two year or four year college degree in a total of 6 years after they graduated LAUSD. When looking at the percentage of kids who graduate with “A’s”, only 52% will even graduate any 4 year college within 6 years. Looking at the last year that national comparisons were available, only 1,071 students (4.6%) were in the top quartile of the SAT/ACT.   https://ucla.app.box.com/s/xd8lth2fgy1qdyphmwuj2i7cgyurdwf5

So lets look at who is getting loans in America—-by the numbers, the vast majority are at Community or 2nd tier state colleges. 48% of straight “A” students from LAUSD will not graduate by 6 years and most of the those never graduate. As the school’s tuition’s are not extremely expensive, the overwhelming majority of their loans were used for living expenses for 6 to 8 years and the majority of their debt directly related to inflated costs of living on or near state college campuses, “special fees” to support athletics and recreational centers, bank fees and compounded interest on their balances.

Our philosophical desire to be egalitarian and support college education for all has been manipulated by a public college industrial complex that accepts kids that are not college material at the point they enter. If those students went to community college and lived at home, the billions saved could be given to support smaller but higher quality state colleges and make tuition lower for all who attend. Additionally, extra funds would be left over that could actually provide free housing for academically qualified students that are currently homeless, larger graduate student stipends, medical student scholarships and funding for post docs as well.

Until we truly address the problem, we’ll waste time, money and energy on snake oil that will not cure the disease. The government wants to force physicians to be paid for “performance”, yet the public schools from K through University just want Carte Blanche funding sponsored by taxes or at the college level, loans that often get written off.

Howard C. Mandel M.D., FACOG
Dr. Mandel is an advocate and philanthropist for indigent health care, inner city educational opportunity and a smaller, more efficient government
Los Angeles

Physicians: See the movie that hospitals don’t want you to see

SNEAK PREVIEW!

Do No Harm: physician suicide documentary

Angelika Film Center
18 Houston Street New York City
Wednesday September 12th 7:00pm
Thursday September 13th 7:00pm

In honor of Suicide Awareness Month- a special medical community SNEAK PREVIEW screening of the groundbreaking documentary film “Do No Harm.” Two time Emmy winning filmmaker Robyn Symon follows four people bonded by tragedy on a mission to expose a toxic medical culture beginning in medical school that puts the lives of doctors and patients at risk.

2 NIGHTS ONLY.

JOIN US LIVE: For a panel discussion following the movie with filmmaker Robyn Symon and stars Dr. Pamela Wible, John and Michele Dietl and others.

Password for tickets: DNH

https://www.eventbrite.com/e/do-no-harm-documentary-film-about-the-hidden-epidemic-of-physician-suicide-tickets-48224914016

Making American Medicine Great Again in 10 Simple Steps #MAGA

1. Price transparency for all healthcare services and supplies.
2. Site neutral payments (no hospital advantages).
3. Legislation to open and eliminate closed insurance networks. Networks are the third parties strangle-hold noose on healthcare.
4. Care must not be limited by insurance red-tape “referrals,” pre-certifications of imaging tests, and prior authorizations of medicines.
5. Reconsider tax exempt status of hospitals. They should have no advantage over physician offices or other services.
6. Patients should shop for all non emergent healthcare services and supplies and keep their savings.
7. Repeal 1987 GPO PBM anti-kickback safe harbor. Enable freemarket competition.
8. Define DPC as healthcare service contract between patient and facility or physician, not insurance. Keep DPC simple, direct, third party and government free, and patient empowered.
9. HSA expanded for DPC and OTC meds.
10. Legislation to permit physicians to see charity patients in return for either tax deduction or  malpractice insurance.
Two supplementary short editorials:
To solve U.S. healthcare crisis, think small, not big
The American hospital: from volunteer charity to tax-exempt patronage pit

Less is More: take the deductions for MACRA non-compliance

Friend of IP4PI, Jane Hughes, MD writes in:

Greetings,

Read this BS sent to us by our “professional” organization whose mission is to preserve the profession, etc etc. For the love of God I cannot understand why any physician can’t see by now that this is a fool’s errand and meant to be. Our clarion call should be to all doctors: Take the deductions for non-compliance because: you will save in essence $40,000/yr in compliance costs that would take $430,000 in Medicare payments at the 9% top reward to equal your $40,000 reimbursement before you see a penny in increased payments. More importantly, you can proudly state that you are saving the government (taxpayers) money at the same time. And the best, wait for it- it would go away because no one would be doing it.

This is not to say I have given up on reform. But, to change Medicare we have to straighten out the private sector, and then, with insolvency looming, we can give Medicare ppl a choice- defined monthly contribution (i.e. check like Social Security) or continued traditional Medicare, which would also be a fast disappearing institution with the current costs to “beneficiaries.” Gee, HSAs with no networks, Medicare as catastrophic, and cash pricing versus what we have now… pipe dream worth fighting for. As you can see I almost came off the rails reading this stuff.

Warm regards,
Jane