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At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.

An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.

Democrats propose additional healthcare spending

by jerry on July 17, 2021

Kaiser Health News reported on some Democratic ambitions to increase healthcare spending. Highlights include adding dental, vision, and hearing benefits to Medicare, and extending expanding long-term care benefits. While most changes appear to subsidize the cost of health care, part of the plan is to also reduce the cost of prescription drugs by allowing Medicare to negotiate drug prices.

Kaiser Health News reported on some Democratic ambitions to increase healthcare spending. Highlights include adding dental, vision, and hearing benefits to Medicare, and extending expanding long-term care benefits. While most changes appear to subsidize the cost of health care, part of the plan is to also reduce the cost of prescription drugs by allowing Medicare to negotiate drug prices.

The plan includes non-healthcare related expenditures and seems to work out to about $3.5 trillion. Democrats are trying to pass this legislation as budget reconciliation, meaning that they do not need to have a super-majority to thwart filibusters. Currently, Democrats hold the slimmest possible majority when including the vice-presidential tie-breaker vote, meaning that the proposal might have to heavily cater to a few senators in order to pass.

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Travails when comparing procedure pricing

by jerry on July 11, 2021

Kaiser Health News published a column recounting the author's experience in comparing procedures across different hospitals. The author, a healthcare reporter, concludes, "The prices I examined were as transparent to me as hieroglyphics."

Kaiser Health News published a column recounting the author's experience in comparing procedures across different hospitals. The author, a healthcare reporter, concludes, "The prices I examined were as transparent to me as hieroglyphics."

Surprisingly, the author found different prices for the same procedures listed at the same facility, perhaps defeating the idea of pricing transparency. It appears that some of the differences arise from some prices including ancillary services (or add-ons) that others do not. So, it appears that as much as the Health and Human Services agency wanted to enable easier price comparisons across hospitals, the industry's response is not sufficiently standardized. Nevertheless, the agency's regulation is a step in the right direction.

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California Medical Association wards off additional oversight

by jerry on July 04, 2021

Kaiser Health News reported on California Medical Association's (CMA) response to some proposed legislation to raise physician licensing fees and to give non-physicians greater oversight of the medical board, whose mission is to "protect health care consumers." Presumably because of CMA's lobbying efforts, the increase in licensing fees was reduced to about a fifth of the original proposal, and non-physicians were not given greater oversight of the medical board. The medical board relies on licensing fees, and is reported to be "teetering on insolvency."

Kaiser Health News reported on California Medical Association's (CMA) response to some proposed legislation to raise physician licensing fees and to give non-physicians greater oversight of the medical board, whose mission is to "protect health care consumers." Presumably because of CMA's lobbying efforts, the increase in licensing fees was reduced to about a fifth of the original proposal, and non-physicians were not given greater oversight of the medical board. The medical board relies on licensing fees, and is reported to be "teetering on insolvency."

A bigger problem from the patient perspective is that in the fiscal year 2019 to 2020, cases "took an average of 548 days from start to end." Investigations taking a year and a half seems unreasonably long, and it would be interesting to hear a response from the industry. The medical board investigated about 20% of the 10,868 complaints that it received in the same time period, which also sounds rather low. Unredacted public disclosure of those complaints that were not investigated would certainly be problematic, so it would be good to have an independent review of those complaints to see if the board should be investigating many more complaints. Kaiser Health News additionally reported that "Patients and their families who have testified at legislative hearings describe an unresponsive and uncommunicative board that usually allows doctors accused of negligence or malpractice to continue to practice."

From the looks of it, it seems that the CMA has acted against patient interests. Of course, the CMA was organized to advocate for physician interests, not patient interests. The true issue might be the strength of CMA's political reach.

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When health care is not enough

by jerry on June 27, 2021

Kaiser Health News reported on a trend where policymakers are again opening up to the idea that simply increasing access to health care might not be enough to improve poor health for some patients. Other factors, such as not having stable housing or access to healthy foods, can hamper efforts to improve patients' health. To be fair, the article points out that some previous attempts to address these other factors have not produced the desired outcomes.

Kaiser Health News reported on a trend where policymakers are again opening up to the idea that simply increasing access to health care might not be enough to improve poor health for some patients. Other factors, such as not having stable housing or access to healthy foods, can hamper efforts to improve patients' health. To be fair, the article points out that some previous attempts to address these other factors have not produced the desired outcomes.

Understandably, Medicaid appears to have been designed with certain restrictions in mind: funding for the health of the indigent was not to be spent on other things. However, working only within the silo of what is normally considered health services may severely restrict the usefulness of that work for certain patients. What appears to be shifting is that with the passage of the Affordable Care Act and many states expanding Medicaid coverage, researchers have years of additional data that "simply increasing access to health care is not nearly enough to improve patients' health." With that realization, some state governments have requested waivers from the original Medicaid restrictions, allowing them more flexibility to address these other factors.

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Supreme Court upholds the ACA again

by jerry on June 20, 2021

The Supreme Court of the United States heard a third challenge to the constitutionality of the Affordable Care Act (ACA), and in a 7-2 decision, decided to dismiss the legal arguments on the basis of a lack of standing, or the ability to show that the plaintiffs were actually or were about to be harmed. The first challenge to the ACA that went to the Supreme Court was one of overreach: that the federal government lacked constitutional authority to require citizens to purchase health insurance (known as the individual mandate, to be enforced with a fine administered through tax filings). In that case, the Supreme Court decided that the individual mandate was actually a tax, which Congress is allowed to levy (never mind that some proponents of the ACA specifically said that the individual mandate was not a tax). The crux of the second challenge to the ACA that the Supreme Court heard rested on whether "State" only meant a state (like California), or if it could mean the federal government; the Supreme Court decided on the expanded meaning. Between the first challenge and the most recent challenge, a Republican-controlled Congress legislated that the fine for the individual mandate would be set to zero. The third challenge then refers back to the first challenge: if there is no tax, does the federal government have the authority to pass the ACA, requiring individuals to buy insurance? Interestingly, the court majority decided that the plaintiffs lacked standing, thereby dismissing the case. The dissenting justices provided examples in which they believed the plaintiffs would indeed be harmed by the ACA, as well as cases in which plaintiffs had a more tenuous connection to harm and yet were allowed to sue.

The Supreme Court of the United States heard a third challenge to the constitutionality of the Affordable Care Act (ACA), and in a 7-2 decision, decided to dismiss the legal arguments on the basis of a lack of standing, or the ability to show that the plaintiffs were actually or were about to be harmed. The first challenge to the ACA that went to the Supreme Court was one of overreach: that the federal government lacked constitutional authority to require citizens to purchase health insurance (known as the individual mandate, to be enforced with a fine administered through tax filings). In that case, the Supreme Court decided that the individual mandate was actually a tax, which Congress is allowed to levy (never mind that some proponents of the ACA specifically said that the individual mandate was not a tax). The crux of the second challenge to the ACA that the Supreme Court heard rested on whether "State" only meant a state (like California), or if it could mean the federal government; the Supreme Court decided on the expanded meaning. Between the first challenge and the most recent challenge, a Republican-controlled Congress legislated that the fine for the individual mandate would be set to zero. The third challenge then refers back to the first challenge: if there is no tax, does the federal government have the authority to pass the ACA, requiring individuals to buy insurance? Interestingly, the court majority decided that the plaintiffs lacked standing, thereby dismissing the case. The dissenting justices provided examples in which they believed the plaintiffs would indeed be harmed by the ACA, as well as cases in which plaintiffs had a more tenuous connection to harm and yet were allowed to sue.

It appears that the majority justices would allow unconstitutional laws to remain in place, as long as there was no penalty. To someone outside the legal profession like me, this allowance seems to place an uneven burden on citizens who wish to be law-abiding even if enforcement is not relevant. The majority's opinion also delays clarity on the merits of the case, allowing for potentially unconstitutional laws to remain in effect until harm can be proved and someone affected sues and that plaintiff is successful in reaching the Supreme Court (which is never guaranteed).

I have read elsewhere that this was probably the best result for both political parties. Portions of the ACA have become popular, and if Republicans are known to dismantle the legislation, they might encounter difficulty getting re-elected. Politics can be messy.

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