Later-Life Money Issues Dominated by Health and Bequests

At some point, everyone fortunate enough to still be around as they enter their eighth or even ninth decade will begin to think about their financial needs and resources in a different way.

Until then, a top concern is not running out of money in retirement, and having enough to pay the bills and enjoy leisure activities.

But there will come a time, if not a specific day, when you believe your personal hourglass is beginning to run out of sand. Your time on earth will then look very, very finite.

At this point, people look less at current expenses. Instead, they tote up their retirement wealth and see how it spreads over the years they are likely to have left.

Medical expenses and legacy issues move to the forefront. Medical expenses are up there because they often are the big unknown wild card in retirement spending. Legacy issues are activated because people can get a better line of sight into how much money will be available to leave to heirs or donate to important causes.

There is no “average” decision path here but there is good guidance at how our elders have wrestled with these issues. A recent economic analysis of how medical expenses and legacy issues interact in our later years is helpful. Mariacristina De Nardi, Eric French, John Bailey Jones, and Rory McGee have attempted to address the topic of “Why Do Couples and Singles Save During Retirement?”

To do so, they looked at mountains of data on the past spending decisions of thousands of older people. I risk making errors in providing general characterizations of their work, but of course that is exactly what I’m about to do. Please read their paper, particularly for details on how people in different income and wealth groups approach this matter.

“The interaction of medical expenses and bequest motives is a crucial determinant of savings for all retirees,” they write. “Hence, to understand savings, it is important to model household structure, medical expenses, and bequest motives.”

Couples differ from singles:

“Being in a couple allows its members to pool their longevity and medical expense risks, potentially reduces medical spending due to spousal care giving, but also exposes each member to their spouse’s risks, including the income loss and high medical expenses that often accompany a spouse’s death. A couple also cares about leaving resources to the surviving spouse, and potentially about leaving bequests to other heirs.”

More affluent couples are able to self-insure for their future health expenses. This causes them to be cautious about spending down their assets. For the same reason, they tend to squirrel away money for whichever spouse lives the longest. The death of a spouse is a watershed event for many reasons.

The surviving spouse is most often the wife, given longer longevity for women in general and the frequency with which women marry men a few years older then they, and sometimes much older. When a spouse dies, household income usually drops, often by a lot more than household living expenses.

Leaving money behind for the surviving spouse or other uses thus becomes more important here than being able to pay for medical expenses. As household wealth declines, so does the relative weight of what the authors call “bequest motives.” And while you’ve probably never thought of legacy giving in this way, it is viewed in economic terms as a “luxury good.”

“On average, the wealth of households experiencing a death declines by an additional $160,000 compared to those not experiencing it,” the study found. “While the decline begins up to six years in advance of death, a substantial share of the decline occurs in the final two years. . . . A large share of this drop is explained by high medical expenses before death, but not the majority, which is accounted for by transfers to non-spousal heirs. By the time the second spouse dies, much of the couples’ wealth has vanished.”

The impact of medical expenses on household wealth in later years is not great. But it has an outsized role here due to the uncertainty of such spending. To plan for this unknown, people practice “precautionary saving.” This boosts the odds they will die with money left over for distribution to their heirs and charities.

Employee Benefits Set to Expand

Employers are planning to sweeten their mix of employee benefits, according to a recent survey from workplace consultants Willis Towers Watson. The survey was based on polling done a few months ago, and it cited the pandemic as the cause.

Since then, of course, the attractiveness of expanded benefits has only increased. Many workplace managers are searching for more successful ways to recruit new workers as well as lure recalcitrant employees back to work.

“Employers view voluntary benefits as a cost-effective way to offer employees a wide range of benefit options that best meet their needs,” Lydia Jilek, senior director, Voluntary Benefits Solutions, said in a press release. “The pandemic has given rise to an increase in benefits that protect employees against big hospital bills and loss of income, and provide personal protection.”

The five benefits that employers plan to expand the most in the coming years are all related to insurance or other ways to protect employees from risks, many of which have been highlighted during the pandemic. They are identify theft, indemnity from big hospital bills, pet insurance, critical illness insurance, and group legal coverage.

Here are the half dozen most voluntary benefits overall are:

  • Financial planning/counseling through an existing vendor (93 percent)
  • Tuition reimbursement programs (88 percent)
  • Telephonic financial planning/counseling (77 percent)
  • Onsite fitness center (54 percent)
  • Backup childcare (48 percent)
  • Elder care (44 percent)



Inflation, Volatility, and Liquidity

Price increases at the wholesale and retail level – check out the numbers here — have rattled investment markets, and with good reason. The widely forecast U.S. economic boom was expected to be fueled by continued low interest rates.

That assumed people would return to the job market as employers expanded their businesses. But employers are struggling to fill job openings. Many people are not eager to return to work. The three main causes are pandemic concerns, low wage rates for many service jobs and, yes, expanded government benefits that allow some people to postpone re-employment.

While this is going on, President Biden is pushing his $4 trillion package to fund infrastructure improvements and provide the most substantial boost to the middle class since the 1930s. Putting aside the merits of his case, the prospect of such an enormous increase in federal spending is adding further jitters to an already nervous market.

With continued inflation and market volatility likely in at least the short run, it’s essential that retired investors develop enough liquidity in their portfolios to avoid having to sell investment securities – at least for six months and perhaps longer. This defensive posture may reduce overall returns but it avoids being forced to sell holdings when market values are depressed.

This is not the advice I would give younger investors. First, markets may bounce back quickly. We don’t have a lot of experience recovering from a pandemic, and the resilience of the U.S. economy has proven itself many times over the years.

But retirees need to be more defensive, both in their investing and spending plans.

Look at the four primary spending needs – day-to-day living expenses of things you need, discretionary spending on things you don’t need but would like to have, travel and other bucket-list items, and emergency spending, most likely involving health problems.

Guaranteed income from pensions and Social Security should be enough (I know they’re often not) to cover essential needs, with anything being left available for “nice to have” items. Retirement funds would cover big-ticket items, and this is the place where cash from your holdings would be especially nice. Home equity is the ideal piggy bank for emergency spending needs, although wealthier investors can likely squirrel away cash for unexpected events.

Going on a financial diet may be unpleasant but can produce great results. With a slimmed-down spending footprint, you can handle a market correction. And if things don’t get that bad, you’ll wind up with more money at the end of whatever cycle we’re now entering.

Real Health Reform Not on the Menu

Providing private and public health insurance to more people is a pale imitation of the kind of health reforms Americans need. Yet it is the focus of nearly all discussions in Washington about how to change the nation’s health care system. The rest of Capitol Hill’s bandwidth is devoted to rolling the price-cut rock for drugs up the hill and watching it roll down again and again.

Outside the Beltway, health experts and researchers have been begging policymakers to pay serious attention to glaring health shortcomings. Research studies this past week emphasized some of them. My health care book tries to pound away at them as well.

Primary Care

Despite all the wonder drugs, digital monitoring tools, and other “smart” health tech, a continuing relationship with a primary care physician remains the single most healthful behavior that Americans should pursue. Research shows that such continuing care literally extends life spans.

“High-quality primary care is the foundation of a robust healthcare system, and perhaps more importantly, it is the essential element for improving the health of the U.S. population,” according to a report from the National Academies of Sciences, Engineering and Medicine. “Yet, in large part because of chronic underinvestment, primary care in the United States is slowly dying.”

The fixes are easy to list but not to make: loosen the American Medical Association’s chokehold on medical school slots for new doctors, change the financial compensation system that places primary doctors at or near the bottom of physician pay scales, and support promising new models of primary care that product better health outcomes for less money.

The Research:
Implementing High-Quality Primary Care

Unneeded Care

As much of 30 percent of the health care Americans receive is unneeded. With annual health spending of $3.8 trillion in 2019, that’s a lot of meatballs, so to speak. But which is the 30 percent we don’t need, and how do we push back against the recommendations of our doctors, hospitals, and other medical experts whose recommendations we’ve been conditioned to passively accept, if not enthusiastically welcome?

We need enlightened practitioners to help us, plus more government focus on the worrisome rise of vertical integration among hospitals, doctors, and other providers. Study after study shows us that medical practices controlled by hospitals and private investors regard their bottom lines as their most important patients. They simultaneously raise prices and reduce the quality of care.

The Research:
Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations
Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group
Vertical Integration
Hospital Employment Of Physicians In Massachusetts Is Associated With Inappropriate Diagnostic Imaging
Is your hospital performing unnecessary tests and procedures?

Setting the Table for Serious Healthcare Changes

President Biden’s address to Congress omitted little when it came to fundamentally changing the nation’s healthcare system. We heard about expanding enrollment and financial supports in the Affordable Care Act, affecting private insurance plans and state Medicaid participation. More child care and health workers would remake home-based care in a post-pandemic era. Drug prices would be reduced. Medicare coverage would be expanded either to those 60 and older, or 55 and older, or even 50 and older.

Do we need such changes? Your views carry as much weight as mine. How much of Biden’s healthcare agenda will be enacted? I have no idea.

What is clear, however, is that healthcare is more ripe for change than at any time in my memory. Since Medicare was enacted in 1965, the nation has for the most part has not been committed to major changes but has simply moved the healthcare chess pieces around the board, Even the ACA’s main impact was to get more players into the health insurance game, and not to change the game itself.

Four drivers of change stand out today as fundamentally more impactful than previous change agents: the pandemic, health equity, affordability, and acceptance of a broader role for government.

  1. Pandemic

People and institutions are more open to change during an emergency than when times are good. The pandemic has created an expanded role for government, a la point number four below. It also has changed the delivery of health care, providing a showcase for telehealth and digital healthcare tools that can be both better and cheaper than traditional forms of care.

These traditional channels have been under great stress and the pressure for finding better solutions is sending existing players back to the drawing board and drawing disruptive entrepreneurs in droves.

Big tech, in particular, is becoming ascendant in health care just as it has in other parts of our lives. We’re still in the first inning of this new game but it’s clear that it will not be the game we’re used to seeing played.

  1. Health Equity

The impact of the pandemic has been distressingly uneven on different groups of Americans, falling particularly hard on women, people of color, and those with low incomes. Cynically speaking, America has long worked this way.

This time around, however, the human toll of inequality has been displayed in public for everyone to see. Equally meaningful, it has occurred during an unprecedented reckoning with the effects of race-based differences in how police do their jobs and in the sustained public outrage over sexual harassment and assault.

Public support for more people and money to combat healthcare inequality is strong. Some Republicans may not admit that investing in child care and at-home caregiving is an infrastructure issue. Nearly everyone else does.

  1. Affordability

The nation’s healthcare bill was $3.8 trillion in 2019 – roughly twice as much per person as in any other developed country. The relentless increase in prices paused during the pandemic as people cancelled doctors’ appointments and elective surgeries. But the resumption of strong economic growth will also revive health care inflation. This trend is not sustainable and had already begun to drive business-led efforts to curb costs before the pandemic changed our healthcare priorities.

  1. Government

President Biden’s singular impact on health care may be reestablishing the federal government as a welcome and relatively trusted source of support for the nation’s citizens. His first 100 days has gone far to reassure many people that a motivated and focused government has been able to make a big difference in COVID vaccinations and provides a source of consistent and credible advice to Americans.

Expanding acceptance of a more active government role to other parts of health care is not a big stretch. The usual suspects here are opening Medicare to younger participants and using the government’s negotiating muscle to lower drug prices. So far, the White House is not using its political capital on these measures. It has more than enough to do to secure movement on the more than $4 trillion in infrastructure, education, and other child support initiatives.

While the public’s support of these measures has been strong from the beginning, the business community has lately emerged as a powerful and non-traditional supporter on the social equity and infrastructure fronts, both of which entail a degree of acceptance and support for stronger government roles.

Portraying corporate America as “woke” is certainly a stretch. But a survey of business attitudes toward healthcare costs produced a strong consensus that private business health insurance needs government help to combat rising costs.

The Kaiser Family Foundation was one of the organizers of the survey. According to its head, Drew Altman:

“87 percent of the corporate officers we surveyed said they believe the cost of health benefits will become unsustainable over the next five to ten years, and 85 percent said the government needs to take on a bigger role in controlling costs and providing coverage.

“78 percent expressed some level of support for government action on hospital prices, in areas where there is limited competition. And perhaps more significantly, coming from what has always been an anti-regulatory crowd, less than 5 percent opposed such regulations. . . .

“65 percent expressed some level of support for a public insurance option for their workers, and a large majority also supported lowering the age for Medicare eligibility.”

If employers begin using their influence in Congress to support such change, it will happen.


Billion Dollar Medicare Drugs Highlight Stakes in Price Fight

Congress talks a lot about high prescription drug prices but for the most part it’s all talk. Pharmaceutical companies continue to charge U.S. consumers prices much higher than they charge outside the U.S.

Once all the rhetorical hot air has been blown from the room, the most compelling reason for this is that they shaft U.S. consumers because they can. And the primary reason they can is because our government lets them, while governments in other countries do not.

Nothing is ever so simple and that’s the case here. But this simplified narrative contains much truth.

Hope springs eternal for lower drug prices and so it is today, given the pro-consumer bent of the new Biden administration. But with Democrats needing a tie-breaking vote in the U.S. Senate to achieve a bare majority, lowering drug prices will require some bipartisanship. This assumes the Senate filibuster is not nuked or that Democratic leadership doesn’t further stretch the bounds of budget reconciliation to write a prescription for lower drug prices.

The Kaiser Family Foundation has studied 2019 drug prices for Medicare beneficiaries using the programs Part D program for self-administered drugs and its Part B program, which administers drugs in outpatient settings.

The distinction is important because Part D and B pay differently for drugs. The private insurance plans that administer the Part D program have different tiers and coverage levels for drugs, with an annual cap on total consumer drug spending of $6,550 plus no more than 5 percent of the cost of drugs once spending has exceeded that cap. (Of course, 5 percent of a big number can still be a lot.)

Part B of Medicare pays only 80 percent of covered prices, which saddles beneficiaries for the other 20 percent. That could devastate the household budgets of people who must have expensive medications. Some Medigap supplement insurance plans will pay all of that 20 percent, meaning that out-of-pocket Part B costs are close to zero after backing out the annual Part B deductible).

Here is Kaiser’s take on the billion-dollar drugs in the Part D and B programs. These budget busters tend to have no competition and often are exploiting legally creative strategies to extend their patent protection well beyond the legal maximum period enacted by Congress.

“The 250 top-selling drugs in Medicare Part D with one manufacturer and no generic or biosimilar competition (7 percent of all Part D covered drugs) accounted for 60 percent of net total Part D spending” of an estimated $145 billion in 2019. “The top 50 drugs covered under Medicare Part B (8.5 percent of all Part B covered drugs) accounted for 80 percent of total Part B drug spending” of more than $37 billion in 2019.


2019 Billion Dollar Medicare Part D Drugs
Brand Name Generic Name Total Spending
Eliquis Apixaban $7,305,511,813
Revlimid Lenalidomide $4,673,676,342
Xarelto Rivaroxaban $4,077,247,672
Januvia Sitagliptin Phosphate $3,535,983,474
Lantus Solostar Insulin Glargine,Hum.Rec.Anlog $2,495,768,702
Imbruvica Ibrutinib $2,440,072,734
Trulicity Dulaglutide $2,273,120,393
Lyrica Pregabalin $2,025,948,600
Symbicort Budesonide/Formoterol Fumarate $2,016,077,018
Novolog Flexpen Insulin Aspart $1,844,090,302
Ibrance Palbociclib $1,826,419,730
Humira Pen Adalimumab $1,749,521,125
Levemir Flextouch Insulin Detemir $1,622,206,517
Victoza 3-Pak Liraglutide $1,527,143,436
Advair Diskus Fluticasone Propion/Salmeterol $1,449,351,617
Jardiance Empagliflozin $1,447,765,688
Myrbetriq Mirabegron $1,445,078,415
Xtandi Enzalutamide $1,420,960,113
Restasis Cyclosporine $1,355,395,141
Breo Ellipta Fluticasone/Vilanterol $1,339,667,821
Enbrel Sureclick Etanercept $1,291,577,655
Spiriva Tiotropium Bromide $1,275,581,786
Invega Sustenna Paliperidone Palmitate $1,249,951,724
Humalog Kwikpen U-100 Insulin Lispro $1,218,126,351
Latuda Lurasidone HCl $1,207,659,482
Humira(Cf) Pen Adalimumab $1,205,602,277
Pomalyst Pomalidomide $1,192,203,838
Tradjenta Linagliptin $1,187,579,077
Lantus Insulin Glargine,Hum.Rec.Anlog $1,158,911,973
Tecfidera Dimethyl Fumarate $1,131,050,801
Jakafi Ruxolitinib Phosphate $1,125,223,954
Biktarvy Bictegrav/Emtricit/Tenofov Ala $1,119,648,620
Epclusa Sofosbuvir/Velpatasvir $1,015,526,591
2019 Billion Dollar Medicare Part B Drugs
Eylea Aflibercept $2,911,408,262
Keytruda Pembrolizumab $2,673,427,541
Opdivo Nivolumab $1,782,346,828
Rituxan Rituximab $1,738,104,061
Prolia Denosumab $1,605,208,840
Lucentis Ranibizumab $1,266,791,097
Neulasta Pegfilgrastim $1,168,110,100
Avastin Bevacizumab $1,034,812,259

Many Hospitals Refuse to Follow U.S. Price Transparency Rules

New rules requiring hospitals to let patients know ahead of time what their care will cost – covered here and here – continue to be badly implemented if not ignored altogether, according to a new study posted by the Peterson-KFF (Kaiser Family Foundation) Health Tracker.

The new rules took effect Jan. 1 but hospitals have known — and complained and litigated — about them since they were announced last fall. Many news organizations have done solid stories since then that illustrated enormous price differences for the same medical procedures even within the same hospital. Variations between hospitals can be even greater.

These findings, of course, stemmed from hospitals that complied with the rules. Most have not done so and some have actively worked to avoid the scrutiny that public pricing information is likely to trigger.

The Wall Street Journal, for example, reviewed more than 3,100 hospital web sites and found that hundreds of hospitals embedded computer code in their disclosure documents that prevented hospital prices from showing up in search-engine results.

The KFF study documents extensive non-compliance with the new rules. It looked at the two largest hospitals in each state. These are generally the largest and most affluent care providers, with the budgets and staff expertise to implement the new rules. If they chose to do so.

The new rules require hospitals to list no fewer than five prices for 300 common services and medical procedures. Hospitals are free to choose 230 of them, with the other 70 being mandated by the Centers for Medicare & Medicaid Services (CMS).

CMS said its list included services that consumers could shop for thus compare. The rise of high-deductible health insurance plans has created  compelling reasons for consumers to have access to pricing information.

For the 300 procedures, the KFF study noted, hospitals must provide “1) gross charge; 2) payer-specific negotiated charge; 3) de-identified minimum negotiated charge 4) de-identified maximum negotiated charge; and 5) discounted cash price.”

In plain English, these requirements would permit consumers to know the hospitals’ gross sticker price (which may have little to do with its true cost of providing a service), what different health insurers agreed to pay it, the minimum price it accepted for the service, the maximum payment it received from a health insurer, and the cash price it would accept, presumably from someone without health insurance.

KFF researchers found that nearly 80 percent of the big hospitals provided their gross rates and about 55 percent posted their discounted cash rate. Tellingly, however, only three hospitals let consumers see what different insurers paid for the 300 services.

Given that 90 percent of Americans have some form of health insurance, failing to let them see what their insurers agreed to pay for a service effectively guts the new rules.

Beyond the percentages, even those hospitals that did provide pricing information did so in different ways that make direct comparisons of prices difficult. Comparing auto prices would be impossible if cars did not have to provide standard information.

Adding injury to insult, the new rules specifically require hospitals to give this information without requiring consumers to identify themselves. Most of the big hospitals did not comply.

“Most hospital website’s consumer tools that we examined generally required patients to input personally-identifying information,” the study found. “Such tools required patients to know complex medical terminology or billing codes to search for prices. It is unlikely that most patients would use these tools as they exist.”

Imagine That. Infrastructure Includes People, Too!

Health care was all over the news last week, but you are forgiven if other events got in the way.

Voting rights restrictions adopted in Georgia literally threaten Americans’ right to vote. They led to forceful condemnations from major area companies, the decision by Major League Baseball to move the All-Star game out of Atlanta, and a predictable flurry of reprisal threats from Republicans.

Then there was the White House’s $2 trillion infrastructure proposal, including higher corporate taxes and higher taxes on the wealthy in the offing. If you have sympathy for the wealthy or, if you are wealthy and believe you’re being unfairly targeted, read this academic study of how successful wealthier people have been in gaming our tax system.

This story also sucked up a lot of news bandwidth, but it also featured a major health-care provision, so let’s start there.

The plan includes $400 billion to support in-home caregiving for low-income and disabled Medicaid users. This would be such a game-changer that it deserved its own news cycle.

The Biden Administration’s definition of infrastructure is focused on people. How refreshing! This might appear odd at first glance but is there any doubt that many human beings are hurting even more than our neglected roads and bridges? Most Republicans decried the proposal as welfare socialism. But is there any compelling case that fixing people shouldn’t take precedence over fixing things?

The proposals are also jump-starting efforts to lower the qualifying age for Medicare to 60 and perhaps even younger. “Eighty-five percent of Democrats and 69 percent of Republicans favor lowering the Medicare age to as young as 50, according to a poll taken in 2019 by the Kaiser Family Foundation,” The Wall Street Journal reported.

Even such overwhelming support did not deter Republicans from again rolling out their left-wing, socialism rhetoric. Senate Minority Leader Mitch McConnell had four years to propose a Republican alternative to the Affordable Care Act (ACA) under a Republican president and could not. As Republicans call for bipartisan solutions, it might help if they had some solid proposals to suggest.

Speaking of the ACA, President Biden has extended sign-ups into summer. Why not open the enrollment window year-around? If you think you or your family might be eligible either to get health coverage or improve the coverage you’ve got, check out It now has full details of the ACA’s expanded coverage and cost subsidies.

I will end today’s rant, um, blog, by noting that there is a good reason that things in our pandemic-strained times might be better than you think. Beyond a booming stock market and a huge surge in employment. Beyond resuming nuclear talks with Iran and any number of other Biden-team initiatives that are reasserting traditional American values around the world.

According to a fascinating research study, a major underlying reason our glasses seem half-full is that the news media – left, right, and center – has a pronounced bias toward emphasizing bad pandemic news and ignoring the good things that are going on.

Perhaps it has always been so. The old local-TV news axiom – if it bleeds, it leads – has hardly gone away. But news has always been what’s different, and these days, what’s good can legitimately qualify as news on many days.

As the Bard said, “The fault, dear Brutus, lies not within the stars, but in ourselves,” according to this summary of the study:

“Ninety one percent of stories by U.S. major media outlets are negative in tone versus fifty four percent for non-U.S. major sources and sixty five percent for scientific journals. The negativity of the U.S. major media is notable even in areas with positive scientific developments including school re-openings and vaccine trials. Media negativity is unresponsive to changing trends in new COVID-19 cases or the political leanings of the audience. U.S. major media readers strongly prefer negative stories about COVID-19, and negative stories in general. Stories of increasing COVID-19 cases outnumber stories of decreasing cases by a factor of 5.5 even during periods when new cases are declining.”


So Far, Health Reforms Are More of the Same

If less is more, today’s post is a lot more.

Through legislation and executive order, the Biden administration is bringing health insurance to millions of additional people. These efforts include continuation into the summer of Affordable Care Act (ACA) sign-ups and sweetened subsidies to help pay for the plans.

Efforts include extending a financial olive branch to Republican-led states to encourage them to provide expanded Medicaid coverage to their residents, millions of whom have lost health insurance because of pandemic layoffs.

While the ACA and Medicaid sound a lot like government-run health care, private health insurers are offering nearly all the expanded coverage. They’re always been providers of ACA plans and, increasingly, dominate Medicaid managed care plans.

So, if you think private health insurers are part of the problem and not part of the solution, nothing much has changed.

Hospitals, which collect more than 30 percent of our health care dollars, run the gamut from struggling rural systems to bloated health-care hotels with opaque billing systems that often charge several times as much for privately insured care as the rates allowed under Medicare rules, and even higher multiples than charges in other developed nations with health outcomes superior to those in the U.S.

New hospital pricing rules took effect January 1 that require public posting of hospital prices. To date, hospitals largely have thumbed their noses at the new rules and the still-evolving team or Biden health-care leaders has yet to invoke the law’s non-compliance penalties, paltry as they may be at $300 a day.

As rural hospitals await expanded government funding to help them stay afloat, their better-heeled fat cats are waiting to greet and continue over-charging people who have avoided elective surgeries and deferred care due to fears of COVID-19 and related hospital-borne illnesses.

There are no signs of reforms for this sector of health care, either.

Doctors, nurses, and other health-care workers are today’s pandemic heroes, and nearly no one wants to cut their numbers or compensation. Just the opposite is true, given the enormous staffing shortcomings uncovered by the virus. This is another 20 percent of the nation’s bloated health-care spend that is off the table.

Even drug companies no longer top the most-wanted lists of health care villains. Their spectacular work in quickly devising and producing effective COVID-19 vaccines has restored their Teflon coatings and protected the industry from meaningful pricing curbs.

Plus ça Change, plus c’est la même chose.


Biden lengthens Affordable Care Act insurance sign-ups until mid-August

FACT SHEET: The American Rescue Plan Will Deliver Immediate Economic Relief to Families

Hospitals Reported That the COVID-19 Pandemic Has Significantly Strained Health Care Delivery

Hospitals Hide Pricing Data From Search Results

Low Compliance From Big Hospitals On CMS’s Hospital Price Transparency Rule

Gallup Polling on Public Healthcare Attitudes

Public opinion of pharma companies improving despite rising drug costs, poll finds

Updates on Nursing Home Safety, Hospital Pricing Rules

Two recent pieces of journalism are worth a close read.

The New York Times published a devastating indictment of how nursing homes have gamed government quality rules to mask low staffing and care levels and still qualify for top government ratings. The headline was tough to stomach over breakfast:

Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public

As I recently posted, it’s never been more important to do your homework in choosing a nursing home for yourself or a loved one. The Times story provides troubling specifics on what happens when people depend on flawed government ratings systems, which is the case with Medicare’s Nursing Home Compare tool.

The second story I want to share comes from Healthcare Dive. It took a close look at five hospitals around the country and how they are complying with new Medicare rules that took effect January 1. They require hospitals to publicly post the prices they’ve negotiated with different health insurers for many common health procedures:

Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

As I recently wrote, “The government’s price transparency rules would require health insurers to provide consumers with ‘personalized out-of-pocket cost information, and the underlying negotiated rates, for all covered health care items and services, including prescription drugs, through an internet-based self-service tool and in paper form upon request.’

The Healthcare Dive story found enormous variations in the prices hospitals negotiated with participating health insurers for identical procedures. Many hospitals have not yet complied with the new rules, and even many that did so have made it hard to find the information or easily compare the different charges.

This will get easier over time, providing consumers with a powerful set of new healthcare shopping tools. In the meantime, self-insured employer health plans and insurance companies will be poring over the new data and looking for ways they can reduce the charges paid on behalf of the individuals covered by their plans.