John C. Goodman

What’s behind the slowdown in vaccinations? The consensus among experts is those not yet vaccinated either 1) don’t want the vaccine 2) harbor some doubts about vaccine safety or efficacy, or 3) simply lack the motivation to find vaccine providers and make an appointment. Vaccine hesitancy accounts for about one-third of adults. For example, the Kaiser Family Foundation ran a survey in April that found 15 percent of respondents who had not received the vaccine plan to “wait and see.” Another 6 percent will get vaccinated “only if required,” and 13 percent refuse to get the vaccine. 

One reader posed the question, how does the tax break for employee health insurance harm our health care system? Short answer: over time the practice reduced competition, which weakened cost-control and resulted in health care inflation three times that of consumer inflation. Consider this: once covered by generous health plans, workers cared less about what medical care cost because their health plans paid most of the tab. Employers didn’t care what things cost because they were passing on the costs to workers (indirectly) in lieu of higher cash wages. Third party administrators (TPAs), who manage the benefits for employers, didn’t much care what things cost because they were passing on the costs to employers with a mark-up. The more money spent, the more TPAs earn.

Why is it controversial to expand the physician supply, creating more competition? Doctors oppose it, just like they oppose expanding the scope of practice for nurse practitioners. Doctors don’t want me to be able to see a nurse practitioner or physician assistant for a wart on my toe unless that NP/PA works for them.

How did doctors get so powerful? In the first half of the 20th Century, the American Medical Association (AMA) waged a largely successful battle to close medical schools that trained competing physicians. …. More than half of American and Canadian medical schools were closed….  Thus, the job of a physician was yanked out of reach of all but the smartest, most disciplined, wealthy elites.

Can we transform the entire health care system by empowering the roughly 60 percent of patients who are in private health plans? That’s the premise of a new book I just read by Todd Furniss (@TFurniss on Twitter). The author ofThe 60% Solution: Rethinking Healthcare, believes there are five major reforms necessary to empower patients and help them get better care at better prices. These include: (1) change governance, (2) modify health savings accounts (HSAs), (3) clear prices, (4) standardize accounting and information technology in the medical industry and (5) emphasize primary care.