OP-ED

Does Life Expectancy Matter?

U.S. life expectancy declined in 2015 for the first time in more than two decades, according to a National Center for Health Statistics study released last week. The decline of 0.1 percent was ever so slight ― life expectancy at birth was 78.8 years in 2015, compared with 78.9 years in 2014.  However, this reversal of a long-time upward trend makes these results significant.

While many researchers are scratching their dumbfounded heads in utter astonishment, I hypothesize the decline in life expectancy is partly due to the decrease in the primary care physician supply.  Studies have shown the ratio of primary care physicians per 10,000 people inversely correlates with overall mortality rate.  It is a well-known and reproducible statistical relationship that holds true throughout the world.  In the U.S., increasing by one primary care physician per 10,000 population, decreases mortality by 5.3%, ultimately avoiding 127,617 deaths per year.

Headlines last week highlighted how much these unexpected results left the researchers baffled.   Jiaquan Xu, a lead author of the study told The Washington Post, “This is unusual, and we don’t know what happened…so many leading causes of death increased.”   Age-adjusted death rates went up by 1.2 percent, from 724.6 deaths per 100,000 people in 2014 to 733.1 in 2015.  Death rates increased for eight of the ten leading causes of death, including heart disease, chronic respiratory illness, unintentional injuries, stroke, Alzheimer’s disease, diabetes, renal disease and suicide.  Differences in mortality were most prevalent in poorer communities, where smoking, obesity, unhealthy diets, and lack of exercise are ubiquitous. 

For fear of sounding like a broken record, I reference a post published on this site about investing more in primary care if the healthcare system wants more people alive and healthy.  Funding a system with a primary care focus is not an innovative concept; it is a well- accepted winning strategy on which to build the health of a nation.  In 2007, the Director-General of the World Health Organization, Margaret Chan, said “A primary health care approach is the most efficient and cost-effective way to organize a health system.  International evidence overwhelmingly demonstrates that health systems oriented towards primary care produce better outcomes, at lower costs, and with higher user satisfaction.”  A thorough meta-analysis by Macinko, Starfield, and Shi (2007) addressed the question of whether increasing the number of primary care physicians could improve health outcomes in the U.S.   In every health outcome analyzed, the PCP/10,000 rate was associated with improved results.  You cannot find a more definitive conclusion than that. 

Health policy experts, IT executives, and politicians jumped on the ACA, HITECH, and MACRA bandwagon while clinging tightly to their misguided belief that more electronic records, ACO’s, care coordinators, administrators, pay for performance schemes, and other fads or gimmicks would improve health outcomes; it turns out one of the most fundamental measures of healthcare quality, our life expectancy, is no better than before. 

Unfortunately, thanks to predatory insurers, lobbyists, and self-serving CMS directors plundering the private health care practitioner, now there is another obstacle looming on the horizon which will prove to be a larger hurdle than originally anticipated.  The primary care physicians we so desperately need are running from clinical medicine like their hair is on fire resulting in a supply that cannot meet demand.   

Based on statistics in 2000, increasing by one PCP/10,000 required 28,726 more primary care physicians.  The situation has worsened as the plight of the primary care physician has become more unpredictable and calamitous.  Considerable gains in population health could be realized if CMS focused their efforts on more adequately reimbursing physicians rather than penalizing them.  Coaxing more physicians to enter primary care or strategizing ways to entice those “retiring” physicians to rejoin the workforce would be worthwhile endeavors indeed.   It would be far better than waiting to crank out a new generation from medical school.  After all, only 7% of graduates choose primary care as a career for reasons that should be clear by now. 

Fifty years ago, just over half of the physicians in the U.S. practiced primary care; today that ratio sits at 30/70.  The U.S. has a lower life expectancy and higher infant mortality rate than many other highly developed countries where the primary care to specialist ratio far exceeds ours.  Evidence from studies of those countries indicates a primary care centric system results in better health outcomes, fewer medical mistakes, cost-containment, and higher patient satisfaction.  If I have said it 1000 times, I will say it again:  expanding insurance coverage makes no difference if there are not enough primary care physicians in the workforce to care for patients in need.  Paying primary care doctors adequately enough to retain them is the only way out of this mess.    

Neither researcher, health policy expert, politician, nor economist, I am just a primary care physician on the front lines seeing sick patients who are getting sicker.  A decline in life expectancy was not unforeseen by many of us.  What if life expectancy continues to decline in 2016?  What if my hypothesis is correct as to the reason life expectancy is heading in the wrong direction?  Will the political machine and predatory insurance industry wake up and pay attention?   My hope is researchers, economists, and politicians holding the fate of our healthcare system in their hands take my words to heart.  Decreasing life expectancy may be just the tip of the iceberg.    The dwindling primary care physician supply will matter more as the predicted physician shortage materializes.  Before primary care physicians go the way of the dinosaurs, make sure to establish a relationship with one of us.  In the future, there is no doubt your life expectancy will depend on it.    

Niran al-Agba, MD is a pediatrician practicing in Washington State

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pjnelsonSteven FindlayJohn IrvineNorEasternWilliam Palmer MD Recent comment authors
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pjnelson
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pjnelson

Our nation’s maternal mortality ratio (MMR) is small in total numbers, as in 17 deaths per 100,000 live births. In 2013, there was just slightly less than 4 million births and about 600 maternal deaths. What’s important about this is not how much it contributes to the over-all longevity (very small) but what it says about our nation’s health care. Remember, the MMR has increased by about 2% a year for more than 20 years, AND among the developed nation’s of the world, we would need to reduce our MMR by 75% to rank among the 10 lowest/best developed nations… Read more »

Niran Al-Agba
Member

Interesting information Dr. Nelson. No surprise that there is a correlation between maternal mortality and longevity past age 65. There is an element to all of these statistics that the better the overall health status of the population (likely care is a contributor to this) the more longevity increases.

Steven Findlay
Member
Steven Findlay

Terrific dialogue on this surprising and sobering demographic development, which adds to other findings earlier this year out of Princeton about rising death rates among non-hispanic white people aged 25 to 55. Also great example of the role THCB can play in examining and probing issues like this. Entirely feasible that poor access to primary care is a factor, though there are obviously many factors at play. The CDC director in the coverage of this news prominently mentioned obesity, drug addiction and misuse, and deep malaise and ill-health among low-income white men of working age who have dropped out of… Read more »

Peter
Member
Peter

Stevan, I think much more spending on public health in those “at risk” communities where poor habits (not always a chose) contribute to poor health. I also think that the subsidy on corn should be replaced by subsidies on fresh fruits and vegetables. I am also in favor of a tax on sugar/calories where the tax would be used to offset the health care cost of bad habits – much like a cigarette and alcohol tax. People need to see a direct result of poor choices. Changing culture is long and arduous. But it seems we’ll never get there and… Read more »

Niran Al-Agba
Member

I am hoping that is not the case Peter. Rather, someone needs to start change somewhere.

Steven Findlay
Member
Steven Findlay

TOTALLY AGREE on subsidies for fresh fruits and veggies….though not sure how that would work….and taxes on sugar-laden products etc. Already happening in some parts of the country, and is widespread in EU. Very hard politically in US….but works with tobacco. We have to start seeing these food products as almost as bad.

Niran Al-Agba
Member

While I am surprised we agree on something… we finally do. There are many things at play and each of these individually moving targets likely affects the overall mortality rate. It is never easy to tease these details apart. It is difficult to know as well whether one’s risk for obesity, drug addiction and misuse, malaise etc. is altered considerably by access to primary care or if there are other unforeseen factors involved. Interested to see next years expectancy numbers for a trend.

NorEastern
Member
NorEastern

Given the current lifestyles of US citizens we possibly could be seeing the age of mortality already maximized. In which case such small deviations will become the norm going forward.

Niran Al-Agba
Member

Possible. There are a lot of people out there hoping you are right. But what if its more than just small deviations up or down, here and there?

William Palmer MD
Member
William Palmer MD

When you have only small changes like this for one hundred thousand people–724 deaths going to 733 deaths–you have to wonder about noise and artifacts: death certificates written for folks who are insured might be more accurate than for people who are uninsured. Does every person even get a death certificate? Maybe in 2014, there were more deaths without certificates for some reason? I mean we are only talking about an increase of nine people! …in a hundred thousand. Better to chalk it up to ststistical error.

BobbyGvegas
Member

“Motivated reasoning.” Partisan ideological wishful thinking. The ACA haters want SO badly to find one adverse thing after another to pin on ObamaCare. The notion that in a span of just a few years a piece of insurance reform legislation can quickly CAUSE a significant decrease in national “longevity” is simply fatuous. Gotta love it.

Niran Al-Agba
Member

Bobby, I hope you understand this is not what this post is about. In fact, while I do not think Obamacare helped things, it is not responsible for the decline in life expectancy imo. We are not certain if this is statistical error, true reflection of current state of healthcare, and my post is hypothesizing some of the decline is due to reduced access to primary care physicians. I think we will know more when numbers come out next year….

Peter
Member
Peter

“In fact, while I do not think Obamacare helped things, it is not responsible for the decline in life expectancy imo.”

“Allan, it did cross my mind while writing this post the ACA maybe partially to blame.”

Obamacare made ALL types of care more accessible, including primary. Niran, you have not answered my question: Do you see patients with exchanges coverage?

Niran Al-Agba
Member

I promise I did. Answered below. Keep scrolling down. 🙂

Niran Al-Agba
Member

Dr. Palmer – life expectancy has trended in the right direction since 1993. The fact that we did not stay relatively constant over the years 2014-2015 when care was “better” is significant. You absolutely could be correct that this small change is a statistical anomaly, but what will you say next year if there is a small drop again? The big picture of what is happening to primary care is what concerns me the most. We are sorely needed… and will be missed once we are gone. Thank you for reading as always.

Peter
Member
Peter

“Differences in mortality were most prevalent in poorer communities, where smoking, obesity, unhealthy diets, and lack of exercise are ubiquitous.”

How is a PCP going to change those lifestyle habits? Did the “differences” not include death by violent crime?

Niran Al-Agba
Member

In reality, the PCP is not going to change lifestyle habits of patients. It is the longer term consequences of untreated morbidity from those lifestyle changes where a PCP can make a difference. For example, (remember I am a pediatrician so this is a stretch for me) an obese person with high blood pressure over a 30 year time period is at a significantly increased risk of suffering a stroke. Treatment for that hypertension over a 30 year time period has been shown to significantly reduce risk irrespective of being obese. Now, of course if the patient lost weight, he… Read more »

Barry Carol
Member
Barry Carol

I remember reading that Leonard Schaeffer, in his 2007 Shattuck Lecture, told us that the health status is determined 40% by personal behavior such as diet, exercise, smoking, drinking, etc., 30% by genetics, 20% by socioeconomic status and environmental factors, and only 10% by the quality of healthcare one has access to. In the U.S. the ten most common causes of death include accidents and suicide neither of which is likely to be influenced by access to healthcare or health insurance. Trends in deaths caused by accidents, murder, suicide and inadvertent drug overdoses can move the needle on death rates… Read more »

Niran Al-Agba
Member

Barry, I look forward to your points as they always make me think. Overall, you made some excellent points and could be correct on some of your assumptions regarding increased deaths of young or old seeking hospice earlier. However, not so fast on the accidents and suicide business. The majority of teenagers who commit suicide have seen their PCP within 3 months prior. Meaning, we have an opportunity to talk some of those off the ledge. We discuss proper weapon storage and access issues. I make my suicidal teens think through their potential funeral and how it will feel to… Read more »

Barry Carol
Member
Barry Carol

Thanks Niran. I’m learning plenty from you. Keep the essays and interactive comments coming.

Niran Al-Agba
Member

Allan, it did cross my mind while writing this post the ACA maybe partially to blame. However, that would not encompass what I see as an even larger problem. If we do not entice primary care physicians to stay in practice, outcomes for all our nations citizens will get worse. Your point is a good one, I have no doubt the ACA added insult to injury.

Allan
Member
Allan

Your point about primary care is a very good one. Life expectancy as a whole is a terrible metric to judge a healthcare system.. If the ACA is to blame for problems I wouldn’t use that metric as a type of proof though I would want to investigate why life expectancy decreased. A major problem for life expectancy is socio economic. We have had an increase in drug deaths and killings. If there are more drug deaths then one might assume more use of drugs which would also lead to higher infant mortality. Among other things early death takes a… Read more »

Niran Al-Agba
Member

If the drug deaths are ruled as suicides then yes, they added to the tally. However, homicide is not in the top 10 and while it may have added to the overall total, likely was not the cause being that 8/10 top causes of death increased.

Allan
Member
Allan

I think we are talking across one another. I was. probably inadequately, trying to demonstrate that numerous non healthcare problems and deaths can lead to a lower reported lifespan. Some of them are neo natal deaths due to drugs and the death or shortened lifespan of older drug users, those killed in auto accidents and other accidents, military deaths, etc. One that dies immediately upon being born removes about 80 years from the lifespan pool from which we calculate lifespan.

I am trying to make it clear that socio-economic problems have a tremendous impact on life-span, not on our healthcare system.

Peter
Member
Peter

The first intelligent thing you’ve said in a long time – and something we can agree on.

Allan
Member
Allan

But Peter, I have said that many times. I’ll take it as a compliment that is rare because almost everything seems to go over your head.

But, since we are in agreement with regard to SES don’t you think we shouldn’t be wasting money on healthcare programs that have little to do with the treatment of disease when that money could be applied to SES?

Niran Al-Agba
Member

Well said Allan. You are absolutely correct on this.

Allan
Member
Allan

Without providing opinion one way or another, the ACA was passed in part because supporters of the bill claimed our life expectancy was lower than it should be and that the ACA would increase life expectancy. Before, life expectency was increasing every year. Now with the passage of the ACA life expectancy is falling. Based upon the arguments of the left pushing the ACA maybe we should be blaming the ACA for our recent lower life expectancy.

BobbyGvegas
Member
Peter
Member
Peter

I expected as much Bobby.

So it seems Niran access to a doctor (because of access to insurance) makes you die faster.

Niran, do you treat people on the exchanges?

Allan
Member
Allan

More bad logic, Peter.

Niran Al-Agba
Member

Ah, Peter you just stumbled on my issue with the ACA. Access to insurance is not access to care. While I do not think it caused life expectancy to decline, it probably did not help matters. Some people still believe access to insurance makes them able to see a doctor, however where I am it only lets you get on a wait list. Yes, I do treat people on the exchanges, however it is really quite a mess. Three major plans offered would not cover any physician who is good enough to be on staff at Children’s Hospital. Since I… Read more »

Peter
Member
Peter

Well Niran, no access to insurance is no access to care. “The exchanges deemed my care too expensive” The “exchanges” are insurance companies and you are not “in network”, just like any other policy. It’s done to maintain costs – like everyone Republican wants. “Second problem with the exchange plans is they only pay the physician if the patient has paid their premiums.” Well duh. How is this different than any other insurance? You’re dealing with insurance companies, not the government. How long do you expect insurance to pay for care that is not paid for? “so premiums and deductibles… Read more »

Barry Carol
Member
Barry Carol

Ah, the Canadian system which, of course, includes lots of rationing for non life threatening conditions like hip and knee replacements, screening colonoscopies and non-emergency imaging. Also, doesn’t the Canadian Medicare system fail to cover prescription drugs? Canadian doctors also have to use billing codes to get paid just like American doctors do. However, as one Canadian primary care doctor told me, patients often think nothing of cancelling appointments at the last minute or just not showing up because they are not obligated to pay any cash at the point of service. This can leave doctors with open time for… Read more »

Peter
Member
Peter

Actually Barry, I’d take the German system also. However you are uninformed of the facts about the Canadian system – where few Canadians would choose the U.S. system and it’s costs given a choice.

Allan
Member
Allan

“I’d take the German system”

Peter does that mean that you like tiered systems where the rich and the bureaucrats are treated better than everyone else?

Peter
Member
Peter

“89% of the (German) population is covered by a comprehensive health insurance plan”

Not bad eh Allan, but if you want to make the 11% rich and bureaucrats use the same plan then I’d support you.

Allan
Member
Allan

Peter, I am not comparing the two systems for if I did I would include a lot of things like outcomes in the US are better than the outcomes in Germany. Mine was merely a question. You said you would take the German’s healthcare system so one might assume that is your favorite plan in the world. Thus the question becomes “Peter does that mean that you like tiered systems where the rich and the bureaucrats are treated better than everyone else?” I am not asking for you to tell me how to fix their system rather if that type… Read more »

Peter
Member
Peter

No, I said “also”. But if you are trying to box me in a corner about “tiered” somehow trying to trap me to make a point, I’ll respond by saying no system is perfect or will ever be, they all require constant management and change.

I do not like tiered systems as we should all be in the same boat on health care. I would certainly take the German system (11% tiered) over our own, which is about as tiered as you can get, as they spend about 10% GDP on health care, about half of what we spend.

Allan
Member
Allan

Median household income ppp for US=$43,585 Germany = $33,333. I guess we have more money to spend in the first place. Take note how Germany manufactures different products for US consumption than for German consumption. Things they export to the US are bigger and more expensive. I wonder why. There are differences. But you say “we should all be in the same boat on health care.”. Let us say there are two surgeons doing a lifesaving procedure and many people need their services to survive. One is fantastic and the other is average with a higher mortality rate. How does… Read more »

Peter
Member
Peter

“How does one decide which patient gets to see the fantastic surgeon if we are all in the same boat?” The boat I meant was the access to health care and it’s cost. How would patients know which surgeon was better? How do we know now? In fact with high deductible plans they attempt to say that a procedure is a procedure – so pick the cheapest. What you seem to want is a way for richer people to get the best care and poorer ones to get the worst. I don’t mind paying for skill, but as been asked… Read more »

Allan
Member
Allan

“The boat I meant was the access to health care and it’s cost.”

But under Medicare for all both doctors would be forced to charge the same price.

Therefore, I repeat my question.

How does one decide which patient gets to see the fantastic surgeon if we are all in the same boat?

Allan
Member
Allan

Take note Peter you still haven’t answered a very important question asked in several of the paragraphs above.

How does one decide which patient gets to see the fantastic surgeon if we are all in the same boat?

Peter
Member
Peter

In Canada people are free to pick their doctor.

Allan
Member
Allan

Only as space allows. In other words he has to wait on line if there is time.

How does the doctor differentiate himself? The professor that has a tremendous success rate is paid the same as a first year graduate.

Barry Carol
Member
Barry Carol

The preference of Canadians for their system over the U.S, system tells us nothing about Americans’ willingness to accept the Canadian system. Regarding the German system, one thing they do that I think is good and would like to see us replicate is that their unemployment insurance fund pays the health insurance premium for people who lose their job as part of their unemployment benefit. If we had a guaranteed issue provision for those who maintain continuous coverage with no more than a 63 day coverage gap, unemployment and loss of income could cause people to stop paying their premium… Read more »

Niran Al-Agba
Member

I love this idea borrowed from the German system. That would catch so many hard working people who fall through the cracks. This is the meaningful type of dialogue I have been talking about.

Peter
Member
Peter

“I love this idea borrowed from the German system.” In for a penny, in for a pound: “Nearly all hospital-based doctors are salaried, and those salaries are part of hospital budgets that are negotiated each year between hospitals and “sickness funds” — the 240 nonprofit insurance companies that cover nearly nine out of 10 Germans through their jobs. (About 10 percent, who are generally higher income, opt out of the main system to buy insurance from for-profit companies. A small fraction get tax-subsidized care.) Office-based doctors in Germany operate much like U.S. physicians do. They’re private entrepreneurs who get a… Read more »

Allan
Member
Allan

“It’s a powerful incentive for doctors to exercise restraint” It’s a powerful way to delay needed medical care while the patient waits in line. What do you think the more affluent patient does? My wife is not American and lived under a socialized system. When one needed care they went to the doctors office and needed no money. The office would be filled and when the day was over the office was closed and the remaining people had to return the next day and the next day etc. In order to get care an envelope with money was dropped off… Read more »

Peter
Member
Peter

“My wife is not American and lived under a socialized system.”

Which system?

Allan
Member
Allan

It makes no difference. The incentives exist. I have Canadian friends that are doctors. Special people are moved ahead in their lines all the time while others choose to pay for care that is being delayed. They cross the border and have what they need in the US. There are actually companies that assist Canadians in doing so. If you look at what happened in Quebec a number of years ago a case was decided (In the Quebec Supreme Court) in favor of the patient, not the government, calling the wait time for certain treatement inhumane and against the Constitution… Read more »

Peter
Member
Peter

“It makes no difference.”

It makes a lot of difference. Why are you so secretive?

You are so misinformed on the Canadian system. The case in Quebec involved only PQ. It gave the right of people in that province to buy private insurance. After the decision no one purchased private insurance – I wonder why.

Allan
Member
Allan

I don’t know if what you say is even true. But, assuming it is, governments have ways of preventing private businesses from functioning. You accuse others of being misinformed when you don’t even know the basic regulations affecting physicians here and in Canada. My corrections of your errors are in black and white on the multiple threads. I will bet for many Canadians it is less expensive to obtain certain studies and treatments in the US than in Canada if paid for privately. I’ve treated enough Canadians to know a good deal of their problems. They can choose whatever system… Read more »

Allan
Member
Allan

“few Canadians would choose the U.S. system and it’s costs given a choice.”

52,513 Canadians received non-emergency medical treatment in the U.S. and elsewhere in 2014 which was a 25% increase from the prior year. (Fraser Institute). If Canada were the size of the US that would mean over 450,000 crossed their borders for healthcare. Check my numbers for I was a bit shocked as well by such a large number.

Peter
Member
Peter

The population of Canada is 35 million. I said few. Now tell me the incomes of those 52K. Not sure how many were vacationing with travel insurance or how many had the Canadian health care system pay for the treatment. Not sure where they get the numbers? What is non-emergency, does that mean an MRI? The Frazer Institute is Canada’s right wing “think tank” (an oxymoron). And actually the article you quote says,” Traveled Abroad” , not exclusively to the U.S. I’ve seen published statements about 1.4 million Americans traveling outside the U.S. through medical tourism for care. I went… Read more »

Allan
Member
Allan

Peter, you quote your left wing think tank and I’ll quote Fraser. At least Fraser’s numbers are real and not contrived like those metrics so dear to your heart and that of the left. Yes, Americans will travel to other countries especially those with inadequate insurance.. But, Canadians? They have universal health care already paid for them. Why would they want to leave? Why do our uninsured have as many mammograms and pap smears as the universally insured Canadian? These are questions that are begging for answer. But the biggest question left unanswered is the question near the bottom of… Read more »

Allan
Member
Allan

Peter writes: “Well Niran, no access to insurance is no access to care.” The problem is clear. Peter believes an insurance contract is a guarantee of good medical care. This is so ridiculous one has to question Peter’s ability to separate his intellect from his ideology. Over the years countless numbers of patients have been treated for cash. In fact that was the way one obtained medical treatment before the days of insurance contracts. At least in my personal experience many patients even without adequate funds have been treated and even hospitalized without such a contract. Today there are even… Read more »

Allan
Member
Allan

Peter writes: “Well duh. How is this different than any other insurance? You’re dealing with insurance companies, not the government. How long do you expect insurance to pay for care that is not paid for?” Duh is the only right word Peter should be using when discussing this issue. Why? Because it is obvious, Peter, that you don’t know what the law says yet you babble on almost incomprehensibly to anyone that understands the law. I’ll let you figure out what the specific law actually says and why the specific law is such an abomination. In the meantime I will… Read more »

Niran Al-Agba
Member

I am going to try one more time to answer and then I may just give up… I was not out of network because I was expensive. I was “out of network” because I had courtesy privileges at Children’s Hospital. The hospital sued Premera for discrimination and won. The only place a child can get specialty care is at Children’s so Premera was in essence, rationing care and refusing to pay if a child got lymphoma. What kind of “care” is that? #2, you can keep trying to insult me with words like Duh, however this does not contribute to… Read more »

Peter
Member
Peter

Nothing you have said Niran is a result of the ACA, it is a result of insurance running our health car system. Tell me of an insurance company that pays for treatment when the insured does not pay their premium – because I’d like that. “I want the ACA repealed and replaced with a system that is organized, humane, effective, and fair.” Did we have that system before the ACA? Did the people who were helped by the ACA have that system before they were given subsidies to buy insurance? Do you think Republicans, taking away subsidies so people can… Read more »

Niran Al-Agba
Member

Yes, it is the result of the ACA! These things are ONLY occurring on the exchange plans. That was your original question to me. Every point I have made were in regard to the terrible plans offered on the exchange. We do not see these issues with regular insurance. Other insurances have you pay by the month if you are self-employed… therefore if you don’t pay your premium, it is pretty clear quickly and the physician can collect the one or two office visits from the patient directly. On the exchange plans, it is near impossible to chase a family… Read more »

Peter
Member
Peter

Niran, I find it hard to believe that the same insurance companies who provide coverage outside the exchanges are any different (and more difficult to deal with) inside the exchanges. They’re the same companies. Why is verifying coverage at the front desk different for exchange insurance over non-exchange coverage – even if you could tell? As to affordability, where did patients with exchange policies, who complain about rising premiums (which is happening everywhere), get their (subsidized) coverage before the ACA? Were they happier then? And if you’re not on the list of docs who’s patients with exchange coverage can use,… Read more »

Niran Al-Agba
Member

Peter- You may find it hard to believe, but that is the way it works. I was actually “out of network” only on exchange plans for Premera, not regular Premera plans. After Children’s won the case, we were all back on but it took a while. Doesn’t matter if they are the same companies, they “named” themselves a little differently. ie Lifewise created “Bridgespan”, same company; completely different rules, networks, coverage etc. The reason verification is different at the front desk is exchange plans would “confirm” eligibility for 90 days, then suddenly “un-confirm” it and take the money back. This… Read more »

Peter
Member
Peter

I see the problems Niran, but still fail to see how these insurance rules are written in the ACA act. Insurance networks have been around for a long time and it’s frustrating for anyone with any insurance. I don’t agree with networks and I also don’t agree that insurance can establish separate risk groups – but the ACA did not create this and repealing it will not relieve the insurance problem in this country.

Maybe if the ACA is repealed all those then uninsured could be brought under Tricare – a government program you seem happy with.

Allan
Member
Allan

” but still fail to see how these insurance rules are written in the ACA act.” It is simple. go to the act and do a search for “the secretary shall decide” or a variable of the phrase and one sees that the ACA is something of a skeleton where many of the most important things are left open for the secretary to approve or deny. If the secretary didn’t want that type of clause she would have denied it. The government determines which insurance plan is compliant. The ACA is almost totally to blame as are every single legislator… Read more »

Peter
Member
Peter

Assuming that’s correct (I doubt but will search), I guess you favor insurance companies paying for medical care when premiums are not paid and the elimination of narrow networks/out-of-nerwork contracts since this is what Niran is complaining about.

Allan
Member
Allan

It’s correct. The number of times decision making was left to the secretary was high.

When premiums aren’t paid I think the physician should be allowed to know. This type of grace period is typical of leftist generosity. The leadership gets praised for giving, but that giving is someone elses expense. It makes the entire group of patients suspect and probably diminishes their level of care.

Narrowing networks are a phony way of making believe prices aren’t as high as they are. They can be quite dangerous for the sick.

Niran Al-Agba
Member

Exactly Allan! They are “giving” at someone else’s expense. Only ACA plans were allowed to do this. Its highway robbery.

Peter
Member
Peter

“They are “giving” at someone else’s expense.” Like your Tricare benefits are the taking my tax dollars and “giving” it to someone else? Or Medicare is taking tax money and “giving” it to someone else? Or employer subsidies are “giving” it to employees so that people who buy their products are “giving’ it to someone else. I guess it’s all “highway robbery.” And by the way Niran, narrow networks and in-network is wide spread across all insurance plans except those “Cadillac plans” and very expensive plans. You yourself said the ACA Gold plan puts you “in-network”. And by the way… Read more »

Allan
Member
Allan

To Niran Peter says: “Like your Tricare benefits are the taking my tax dollars and “giving” it to someone else?” That is a military benefit similar to any benefits provided by our bureaucracy. I don’t think her husband was paid very well in the military and there is a good chance he had to risk his life protecting yours. However, I think Niran and others would be open to discussing all the benefits given to those working for the federal government. If anything we could reduce the total salary and benefits provided to the bureaucrats and increase it to those… Read more »

Allan
Member
Allan

Bobby, apparently you didn’t get my point. I was raising the question, if ACA supporters pushed the ACA because it would increase this type of metric then they should similarly look at the ACA as a failure since those metrics decreased.

I didn’t hold the former view nor do I presently hold the latter view. I am just pointing out one of the many false claims of ACA supporters. You can see a lot more of this type of false proof from Peter in his many comments.

Peter
Member
Peter

“maybe we should be blaming the ACA for our recent lower life expectancy.”

Ever look up the preventative services covered with no co-pay under ACA?

I always look forward to your unbiased and informed opinion.

Allan
Member
Allan

I am very familiar with Preventive services. What is your point?

Additionally, just to help you out with your arguments preventative medicine is not the same as early diagnosis.

Peter
Member
Peter

Well early diagnosis can “prevent” mortality.

Here’s a list of the covered ACA preventative services – you pick what’s early diagnosis and what’s preventative and tell me how these contribute to mortality.

https://www.healthcare.gov/coverage/preventive-care-benefits/

To attempt to blame the ACA for increased mortality is just plain stupid.

Allan
Member
Allan

“Well early diagnosis can “prevent” mortality” That is true. However, both pap smears and mammograms are relatively inexpensive and affordable. By making them free the insurer has burdened itself with the cost of the mammogram plus the cost of administration. That increases the premium and we know for every increase in premium a certain percentage of people drop insurance. A number of years back a comparison between the US and Canada was performed to see how much of this preventative care (really early diagnosis) was performed in each country. The surprising thing was that though a large segment of our… Read more »

Peter
Member
Peter

“By making them free the insurer has burdened itself with the cost of the mammogram plus the cost of administration. That increases the premium and we know for every increase in premium a certain percentage of people drop insurance.”

So how does that relate to your claim the ACA is causing the increase in mortality? The ACA provided subsidies so people could afford coverage and get those tests – valid or not. Not having those tests covered also prevents people from having them.

As usual you change the subject and argue in circles.

Allan
Member
Allan

I can’t help it if you have trouble reading the English language. My comments, Peter, contradict what you are saying above. “***Without*** providing opinion one way or another” “Life expectancy as a whole is a terrible metric to judge a healthcare system.” What you should learn from this discussion is that stupid comments that favor your position can later be used to dismiss it. “The ACA provided subsidies so people could afford coverage and get those tests” Your premise above may or may not be true, but your rhetoric is empty of data. It doesn’t sound like you have a… Read more »

Niran Al-Agba
Member

You two always go back and forth…which makes me afraid to jump in but here goes… many of the insurance plans actually do not cover immunization charges such as administration etc… This business that everything preventative is covered without a copay is not what is happening in reality. There are loopholes and the insurance (especially GEHA) and others are taking advantage.

Richard Lippin
Member

Thanks Dr. Al-Agba- Thanks for shedding some light on a likely contributor to the recent report about declining life expectancy in the US. Yes- this is the tip of the iceberg indicative of the general decline of US healthcare. And it should command our immediate attention-“Paying primary care doctors adequately enough to retain them is the only way out of this mess”. I stand with you on this an important solution. But I am weary of this recommendation and others which have been painfully obvious for many years. I guess ultimately consumers will have to demand necessary change through the… Read more »

Niran Al-Agba
Member

Thank you for reading and commenting Richard. I do think this is a significant contributor to the declining life expectancy. It IS likely the tip of the iceberg. As with all things, likely there will be no immediate attention paid to the need for primary care docs to be paid what they are worth. It is so simple it is likely going to take years to get action. I absolutely agree consumers will have to drive this change when they see the system flaws . It might take a few more years but it is coming. I will see it… Read more »