BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Senate passes last-minute deal to avert government shutdown
The Senate on Thursday afternoon just passed a deal party leaders reached late Wednesday to avert a government shutdown that would have affected hundreds of thousands of federal workers and slammed an economy still struggling to recover from the pandemic, all with just hours left to stave off a crisis.
How much will it cost you to start a dental practice – with Business Plan?
There are many costs to consider to set up a successful dental practice. Note that the following values are not the exact amount but an average of setting up a dental practice:
Purchase price – this includes valuation fees of between $1,000-4,500, solicitor fees of between $4,000 – 17,000, accountancy and bank fees of around $3,000, and bank solicitors, which can be up to $3,500. Many of these can be reduced or obliterated.
Materials – $40,000
Lab fees – $36,000
Staff costs – $82,000
Other costs (associates fees) – [$245,000 – $295,000]
Other Factors
“Big” Tech – Many startup doctors want to include CBCT or CAD/CAM or 3D printing in their startup, any of which can add $25,000-$175,000. In other situations, waiting is the best option.
Cabinetry Preferences – Costs for cabinetry can range from $5,000 to $175,000.
Practice Management Software (PMS) – Pricing will range from a few thousand dollars to $25,000; OR none at all.
Mechanical Delivery – Typically referred to as chairs, lights, and units, this category of dental equipment costs will range between $5,000 and $100,000 based on your startup plans.
Vision – Ignore the so-called “experts” who will try to create a cookie-cutter model for your equipment costs. That is the thinking of corporate dentistry. You want a customized private practice vision that allows you to create a model matching your standards. Prioritize your vision, so your values and philosophy will lead your dental equipment budget and purchasing decisions. Your equipment budget will be—and should be—customized.
It has been well documented that the COVID-19 pandemic resulted in unprecedented increases in telemedicine utilization across the U.S. However, rural providers and patients, as evidenced by their lower rates of telemedicine usage during this time, have not been able to take advantage of the opportunities provided by telemedicine to the same extent as urban providers.
On August 18, 2021, the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) announced the latest attempt to ameliorate this issue – the distribution of nearly $20 million to 36 recipients for the purpose of strengthening telehealth services in rural and underserved communities and expanding innovation and quality. (Read more…)
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care and service. More than 190 million people are enrolled in health plans that report quality results using HEDIS.
The National Committee for Quality Assurance is an independent 501 nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation.
Carried interest, or carry, in finance, is a share of the profits of an investment paid to the investment manager in excess of the amount that the manager contributes to the partnership, specifically in alternative investments (private equity and hedge funds).
In small businesses that are not blind pools, such as single property real estate, the investment manager often funds the business prior to the formation of the partnership. It is a performance fee, rewarding the manager for enhancing performance. The structure also takes advantage of favorable tax treatment in the United States.
However, critics of carried interest want it to be reclassified as ordinary income – not capital gains – to be taxed at the ordinary income tax rate. Private equity advocates argue that the increased tax will subdue the incentive to take the kind of risk that is necessary to invest in and manage companies to profitability.
The International Franchise Association (IFA) estimates that that about $1 trillion in sales, or 40% of all retail sales, were made through franchised establishment last year. On the positive side, franchises offer a branded practice concept with management training and access to proprietary methods, marketing and advertising campaigns and a host of support.
Moreover, there are franchises available for virtually every healthcare product or service, including: diet, weight loss and fitness; vein care and laser surgery; vitamins, nutriceuticals and pharmaceuticals; plastic and cosmetic surgery; dermatology, tanning and skin care; home healthcare and extended, etc. Some well know established healthcare and medical franchises are: Doctors Express, Being There Senior Care, Home Care Assistance, Personal Training Institute, Inches-A-Weigh, Remedy Intelligent Staffing, Visiting Angels, Unlimited MedSearch, prnYourHealth and Any Lab Test Now, etc.
On the downside, franchises incur high start-up costs, rules and obligations, payment of franchise percentages and many contractual obligations. Questions to consider when contemplating this business entity include:
Franchise stability, track record, licensing and costs.
Training, support and proximity of other franchises.
Independence, ownership laws, contracts and dispute resolutions,
Screening methods, market size and potential market share.
Replacement cost and transferability?
For more information on Uniform Franchise Offerings Circulars (UFOCs) contact www.FranChoice.com or:
Have you been frustrated in your efforts to attract, engage and serve doctors? In this episode, colleague Dr. Vicki Rackner shares 5 common mistake financial advisors make; with more.
Hospitals, a local family practice office, a pharmaceutical company, all likely have one thing in common. Somewhere within these companies or partnerships, there are key employees or profit makers. Due to their expertise, management skills, knowledge, or “history of why,” they have become indispensable to their employers.
If this key employee were to die prematurely, what would potentially happen to the company? In many cases, especially in smaller companies, it would have a devastating effect on the bottom line, or even precipitate a bankruptcy. In these circumstances, a form of business insurance, called key person coverage, is recommended in order to alleviate the potential financial problems resulting from the death of that employee.
The business would purchase and own a life insurance policy on the key person. Upon the death of the employee, the life insurance proceeds could be used to:
Pay off bank loans.
Replace the lost profits of the company.
Establish a reserve for the search, hiring and training of a replacement.
[B] Business Continuation Funding
See the chapters on buy-sell agreements and asset protection planning.
[C] Executive Bonus Plan
An executive bonus plan (or § 162 plan) is an effective way for a company to provide valued, select employees an additional employment benefit. One of the main advantages to an executive bonus plan, when compared to other benefits, is its simplicity. In a typical executive bonus plan, an agreement is made between the employer and employee, whereby the employer agrees to pay for the cost of a life insurance policy, in the form of a bonus, on the life of the employee.
The major benefits of such a plan to the employee are that he or she is the immediate owner of the cash values and the death benefit provided. The only cost to the employee is the payment of income tax on any bonus received. The employer receives a tax deduction for providing the benefit, improves the morale of its selected employees, and can use the plan as a tool to attract additional talent.
[D] Non-Qualified Salary Continuation
Commonly referred to as deferred compensation, this is a legally binding promise by an employer to pay a salary continuation benefit at a specific point in the future, in exchange for the current and continued performance of its employee. These plans are normally used to supplement existing retirement plans.
Although there are different variations of deferred compensation, in a typical deferred compensation agreement, the employer will purchase and own a life insurance policy on the life of the employee. The cash value of the policy grows tax deferred during the employee’s working years. After retirement, these cash values can be withdrawn from the policy to reimburse the company for its after-tax retirement payments to the employee.
Upon the death of the employee, any remaining death benefit would likely be received income tax free by the employer (Alternative Minimum Taxes could apply to any benefit received by certain larger C corporations). The death benefit could then be used to pay any required survivor benefits to the employee’s spouse, or provide partial or total cost recovery to the employer.
In a typical plan, the terms of the agreement are negotiated as to the amount of benefit received by the employee, when retirement benefits can begin, how long retirement benefits will be paid, and if benefits will be provided for death or disability. The business has established what is commonly referred to as “golden handcuffs” for the employee. As a result, the benefit will only be received if the employee continues to work for the company until retirement. If the employee is terminated or quits prior to retirement, the plan would end and no benefits would be payed.
[E] Split Dollar Plans
Split dollar arrangements can be a complicated and confusing concept for even the most experienced insurance professional or financial advisor. This concept is, in its simplest terms, a way for a business to share the cost and benefit of a life insurance policy with a valued employee. In a normal split dollar arrangement, the employee will receive valuable life insurance coverage at little cost to them. The business pays the majority of the premium, but is usually able to recover the entire cost of providing this benefit at termination of employment, death or surrender of the policy.
Following the publication of IRS Notices 2002-8 and 2002-59, there are currently two general approaches to the ownership of business split-dollar life insurance: Employer-owned or Employee-owned.
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[1] Employer-Owned Method
In the employer-owned method the employer is the sole owner of the policy. A written split-dollar agreement usually permits the employee to name the beneficiary for most of the death proceeds. The employer owns all the cash value and has the unfettered right to borrow or withdraw it as necessary. At the end of the formal agreement, the business can generally (1) continue the policy as key person insurance, (2) transfer ownership to the insured and report the cash values as additional income to the insured, (3) sell the policy to the insured, or (4) use a combination of these methods. This is commonly referred to as “rollout.”
Practitioners should be careful not to include rollout language in the split-dollar agreement. The reason the rollout should not be included is that if the parties formally agree that after a specified number of years—or following a specific event—related only to the circumstances surrounding the policy, that the policy will be turned over to the insured, the IRS could declare that the entire transaction was a sham and that its sole purpose was to avoid taxation of the premiums to the employee, generating substantial interest and penalties in addition to the additional taxes due.
The death proceeds available to the insured employee’s beneficiary is considered a current and reportable economic benefit (REB), and it is an annually taxable event to the employee. If an individual policy is involved, the REB is calculated by multiplying the face amount times the government’s Table 2004 rates or the insurance company’s alternative term rates, using the insured’s age. If a second-to-die policy is involved, the government’s PS38 rates or the company’s alternative PS38 rates will be used. Any part of the premium actually paid by the employee is used to offset any REB dollar-for-dollar.
[2] Employee-Owned Method
With the employee-owned method, the insured-employee is generally the applicant and owner of the policy. Any premiums paid by the business are deemed to be loans to the employee and the employee reports as income an imputed interest rate on the cumulative amount of loan based on Code § 7872. A collateral assignment is made for the benefit of the business to cover the cumulative loan amount. In some cases, the assignment may allow the assignee to have access to the cash values of the policy by way of a policy loan. This method is unavailable for officers and executives of publicly- held corporations because of the current restrictions on corporate loans (the Sarbanes-Oxley Act of 2002).
The employee-owned method is somewhat similar to the older collateral assignment form of split-dollar. The benefits for the employee are both the ability to control large amounts of death proceeds as well as developing equity in the policy. Whether or not this new method catches on will depend greatly on the imputed interest rate published by the IRS every July. If set low enough, this may be an excellent opportunity for the employee to use inexpensive business dollars to pay for life insurance.
REPORTEDLY FUNDING ANTI-AGEING VENTURES TO CHEAT DEATH
“Not Today – Death”
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By Alma Fabiani
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Jeff Bezos is allegedly investing in Altos Labs, a biological reprogramming tech company currently looking into a variety of methods that could help reverse the ageing process,
Bezos is said to have a fairly long-standing interest in longevity research. But although Altos Labs has so far managed to recruit some impressive names in the biological reprogramming sector, as well as some pretty big investors, its research still needs a lot of work before it can ever be applied to humans.
In this episode the Entrepreneur MD is joined by Dr Robert Pearl, MD, to talk about his latest book Uncaring and the need to stand up against the current healthcare model.
Approximately 250 hospitals across the U.S. are completely or partially physician owned. These physician-owned hospitals (POHs) can offer a variety of services, from general care to specialty services, such as cardiovascular or orthopedic care, known as “focused factories.”
Over the past several decades, healthcare providers and policymakers have claimed that POHs have a negative impact on the healthcare industry, suggesting that: (1) POHs “cherry-pick” the most profitable patients; (2) the quality of care provided at POHs is substandard; and, (3) conflicts of interest exist due to the financial incentive for physician owners to refer patients to their POHs. (Read more…)
The Foot and Ankle Research Consortium, Inc. (FARC) is the leading publisher of Podiatric educational software. Since 1992, we have been producing the most effective and innovative method of preparing for ALL the Podiatry Board Examinations.
This includes: The American Board of Podiatric Surgery, The American Board Of Podiatric Orthopedics and Primary Podiatric Medicine, the American Podiatric Medical Specialties Board, ABLES and the PMLexis. (Now includes the latest information for all Board Re-Certifications).
Uwe Reinhardt PhD was a Princeton Healthcare Economist Who Passed Away in 2017. He Was Possibly the Most Well Known Healthcare Economist in America and Even the World.
A collateralized debt obligation (CDO) is a type of structured asset-backed security (ABS). Originally developed as instruments for the corporate debt markets, after 2002 CDOs became vehicles for refinancing mortgage-backed securities (MBS).
Like other private label securities backed by assets, a CDO can be thought of as a promise to pay investors in a prescribed sequence, based on the cash flow the CDO collects from the pool of bonds or other assets it owns. Distinctively, CDO credit risk is typically assessed based on a probability of default (PD) derived from ratings on those bonds or assets.
A CMO is a debt security backed by mortgages. These mortgage pools are usually separated into different maturity classes called tranches (from the French word for “slice”). The securities were issued by private issuers, as well as the Federal Home Loan Mortgage Corporation (Freddie Mac). As the mortgages were usually government-guaranteed, CMOs usually carried AAA ratings until their current financial meltdown. The early versions of CMOs were known as “plain vanilla,” but recent developments gave us PACs (planned amortization certificates) and TACs (targeted amortization certificates); among too many others. They were all variations on how principal repayments in advance of maturity date were treated.
A decentralized autonomous organization (DAO), sometimes called a decentralized autonomous corporation (DAC), is an organization represented by rules encoded as a computer program that is transparent, controlled by the organization members and not influenced by a central government. A DAO’s financial transaction record and program rules are maintained on a blockchain. The precise legal status of this type of business organization is unclear.
A well-known example, intended for venture capital funding, was The DAO, which launched with $150 million in crowdfunding in June 2016, and was nearly immediately hacked and drained of US$50 million in cryptocurrency. The hack was reversed in the following weeks, and the money restored, via a hard fork of the Ethereum blockchain: the Ethereum miners and clients switched to the new fork.
Being an entrepreneur is not necessarily easy, and many people that try to become entrepreneurs wind up failing. It’s important to recognize the risk of failure before you decide to walk down this path. Being an entrepreneur is very rewarding, and you can find success if you can do things right.
Keep reading to learn about common entrepreneurial mistakes that you can avoid to give yourself a better chance of realizing your entrepreneurial goals.
A Ponzi scheme (/ˈpɒnzi/, Italian: [ˈpontsi]) is a form of fraud that lures investors and pays profits to earlier investors with funds from more recent investors. Recall Bernie Madoff.
The scheme leads victims to believe that profits are coming from legitimate business activity (e.g., product sales or successful investments), and they remain unaware that other investors are the source of funds. A Ponzi scheme can maintain the illusion of a sustainable business as long as new investors contribute new funds, and as long as most of the investors do not demand full repayment and still believe in the non-existent assets they are purported to own.
A pyramid scheme is a business model that recruits members via a promise of payments or services for enrolling others into the scheme, rather than supplying investments or sale of products. As recruiting multiplies, recruiting becomes quickly impossible, and most members are unable to profit; as such, pyramid schemes are unsustainable and often illegal.
DEFINITION: Stablecoins are blockchain-based digital currencies that have been created with the aim to have a stable value. Stablecoins achieve price-stability through various different methods such as a peg against a fiat currency or a commodity, through collateralization against other cryptocurrencies or through algorithmic coin supply management.
Every stable coin includes a specific set of mechanisms that mostly behave in the same way. In general, stable coins keep collateral of the asset and manage the supply. In this way, they incentivize the market, which allows trade of the coin for no more or less than $1.
A stable coin can be considered the best depending on several factors: It should be stable. PAX is one the most stable stablecoin. It should be liquid and available on most exchanges. It should be backed by FIAT. PAX is 100% collateralized in US bank accounts. It should be regulated. It should be redeemable.
A cap on how much the US government can borrow to finance its operations.
It was introduced during World War I so that Congress wouldn’t have to approve every bond issuance by the Treasury Department as it had done previously—freeing up more time for name-calling.
The debt ceiling has been suspended dozens of times over the years, including 3x during the Trump administration.
Without suspending the debt ceiling, the US wouldn’t be able to borrow money to pay its bills—and things would get ugly if that happened. The federal government would have to slash spending for programs like Medicaid, local governments would find it harder to borrow, and financial markets could go haywire.
In short, a failure to act would “produce widespread economic catastrophe,” Treasury Secretary Janet Yellen wrote in the Wall Street Journal.
Important note: The debt ceiling doesn’t account for new spending, like the $3.5 trillion proposal the Democrats have on the table. Instead, it’s about spending Congress has already authorized, such as paying out Social Security. Over the years, the debt ceiling has become a “political weapon,” according to the AP, as each party tries to blame the other for their spending habits and for heaping more debt on the US.
World Gratitude Day is a timely opportunity to give your employees their deserved props—beyond an ordinary thumbs-up emoji. And, how you celebrate the day is limited only by your imagination.
Some people write thank you notes to those they appreciate. Some make a point of having “gratitude dinners” with family members. And others start a gratitude journal in which they record what they’re grateful for.
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We’re all human, and at Workhuman, they get that. Workhuman’s employee recognition solution, Social Recognition, helps foster employee appreciation—something that strengthens teams, reduces turnovers, and drives business forward.
Yep, a little “Thank you” goes a long way.
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AUTUMNAL EQUINOX 2021
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Today, in 2021, the autumnal equinox will also take place at 3:21 p.m. EDT and marks the moment the sun’s rays are shining directly on the equator. It’s called the equinox because daytime and nighttime are equal lengths. The winter solstice, which occurs on Dec. 21, will be the shortest day of the year and marks the start of winter.
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If you’re a physician looking to get ahead on planning for retirement, you’re likely familiar with individual retirement accounts, or IRAs. An IRA is a tax-advantaged vehicle that helps you grow your retirement savings. Roth IRAs are particularly attractive, because you don’t pay taxes on withdrawals in retirement.
There’s one problem: you can’t contribute to a Roth IRA directly if you make above a certain income. A backdoor IRA, though, can solve your problem by allowing you to convert a traditional IRA into a Roth.
Here’s how it works:
First, place your contribution in a traditional IRA—which has no income limits.
Then, move the money into a Roth IRA using a Roth conversion.
But make sure you understand the tax consequences before using this strategy.
The mega backdoor Roth allows you to put up to $38,500 in a Roth IRA or Roth 401(k) in 2021, on top of the regular contribution limits for those accounts. If you have a Roth 401(k) at work (and the plan allows for the mega option as described below), generally you can choose whether the final destination of your mega contributions is the Roth 401(k) or a Roth IRA. If your employer offers only a traditional 401(k), then your mega contributions would end up in a Roth IRA.
Here’s a quick summary of what you need to have in place for the ideal mega backdoor Roth strategy:
A 401(k) plan that allows “after-tax contributions.” After-tax contributions are a separate bucket of money from your traditional and Roth 401(k) contributions. About 43% of 401(k) plans allow after-tax contributions, according to a 2017 survey of large and midsize employers by consulting firm Willis Towers Watson.
Your employer offers either in-service distributions to a Roth IRA — that is, you can take money out of the 401(k) plan while you’re still working at the company — or lets you move money from the after-tax portion of your plan into the Roth 401(k) part of the plan. If you’re not sure, ask your human resources department or plan administrator.
You’ve got money left over to save, even after maxing out your regular 401(k) and Roth IRA contributions.
Dr. David Edward Marcinko MBA CMP® enjoys personal coaching and public speaking and gives as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.
These have included lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.
His talks and podcasts tend to be engaging, iconoclastic, and humorous. His most popular presentations include a diverse variety of topics and typically include those in all iMBA, Inc’s textbooks, handbooks, white-papers and most topics covered on this blog.
It is not uncommon for practicing physicians to have more than a dozen separate insurance policies to protect their medical practice and personal assets. Yet, most doctors understand very little about their policies.BOOK REVIR
Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™explains to physicians and insurance professionals the background, theory, and practicalities of medical risk management, asset protection methods, and insurance planning.
The book presents information in a manner that is convenient and highly useful for busy medical practitioners. It discusses the medical records revolution and addresses concerns regarding cloud computing, data security, and technological threats.
The book covers modern health law and policy, including fraud and abuse, workplace-violence, Medicare compliance, HIPAA regulations, AR protection strategies with internal controls, P4P and value based care, insurance and reputation management, and how the ARA legislation is impacting physician practices. It also includes case models and examples that provide you with a real-world understanding of how to recognize and reduce personal and medical practice risks.
With time at a premium for all, and so much information packed into one well-organized resource, this book is a must-read for every physician and financial advisor that serves the health care sector. The book will help physicians make better decisions about the risks they face and will help financial advisors improve the value they provide to their clients who are doctors.
The New York Times Posted an Article Explaining Hospital Prices for Patients on Private Insurance Plans Such as Blue Cross, United Healthcare, Cigna and Aetna.
Do your children have income-generating assets in a custodial account?
If so, be sure you understand the so-called kiddie tax.
This law was passed to discourage wealthier individuals from transferring assets to their children to take advantage of their lower tax rates. The kiddie tax has seen many iterations but current rules tax a minor child’s unearned income—including capital gains distributions, dividends, and interest income—at the parents’ tax rate if it exceeds the annual limit ($2,200 in 2021).
The tax applies to dependent children under the age of 18 at the end of the tax year (or full-time students younger than 24) and works like this:
The first $1,100 of unearned income is covered by the kiddie tax’s standard deduction, so it isn’t taxed.
The next $1,100 is taxed at the child’s marginal tax rate.
Anything above $2,200 is taxed at the parents’ marginal tax rate.
So – If your child also has earned income, say from a summer job or legitimate work in your medical office or practice, the rules become more complicated.
Former: CEO and Founder Superior Consultant Company, Inc. [SUPC-NASD]
EDITOR’S NOTE:I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.
-Dr. David E. Marcinko MBA CMP®
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By Richard Helppie
Today for your consideration – How to fix the healthcare financing methods in the United States?
I use the term “methods” because calling what we do now a “system” is inaccurate. I also focus on healthcare financing, because in terms of healthcare delivery, there is no better place in the world than the USA in terms of supply and innovation for medical diagnosis and treatment. Similarly, I use the term healthcare financing to differentiate from healthcare insurance – because insurance without supply is an empty promise.
This is a straightforward, 4-part plan. It is uniquely American and will at last extend coverage to every US citizen while not hampering the innovation and robust supply that we have today. As this is about a Common Bridge and not about ideology or dogma, there will no doubt be aspects of this proposal that every individual will have difficulty with. However, on balance, I believe it is the most fair and equitable way to resolve the impasse on healthcare funding . . . .
Let me start in an area sure to raise the ire of a few. And that is, we have to start with eliminating the methods that are in place today. The first is the outdated notion that healthcare insurance is tied to one’s work, and the second is that there are overlapping and competing tax-supported bureaucracies to administer that area of healthcare finance.
Step 1 is to break the link between employment and health insurance. Fastest way to do that is simply tax the cost of benefits for the compensation that it is. This is how company cars, big life insurance policies and other fringe benefits were trimmed. Eliminating the tax-favored treatment of employer-provided healthcare is the single most important change that should be made.
Yes, you will hear arguments that this is an efficient market with satisfied customers. However, upon examination, it is highly risky, unfair, and frankly out of step with today’s job market.
Employer provided health insurance is an artifact from the 1940’s as an answer to wage freezes – an employer could not give a wage increase, but could offer benefits that weren’t taxed. It makes no sense today for a variety of reasons. Here are a few:
1. Its patently unfair. Two people living in the same apartment building, each making the same income and each have employer provided health insurance. Chris in unit 21 has a generous health plan that would be worth $25,000 each year. Pays zero tax on that compensation. Pat, in unit 42 has a skimpy plan with a narrow network, big deductibles and hefty co-pays. The play is worth $9,000 each year. Pat pays zero tax.
3. The insurance pools kick out the aged. Once one becomes too old to work, they are out of the employer plan and on to the retirement plan or over to the taxpayers (Medicare).
4. The structure is a bad fit. Health insurance and healthy living are longitudinal needs over a long period of time. In a time when people change careers and jobs frequently, or are in the gig economy, they are not any one place long enough for the insurance to work like insurance.
5. Creates perverse incentives. The incentives are weighted to have employers not have their work force meet the standards of employees so they don’t have to pay for the health insurance. Witness latest news in California with Uber and Lyft.
6. Incentives to deny claims abound. There is little incentive to serve the subscriber/patient since the likelihood the employer will shop the plan or the employee will change jobs means that stringing out a claim approval is a profitable exercise.
7. Employers have difficulty as purchasers. An employer large enough to supply health insurance has a diverse set of health insurance needs in their work force. They pay a lot of money and their work force is still not 100% happy.
Net of it, health insurance tied to work has outlived its usefulness. Time to end the tax-favored treatment of employer-based insurance. If an employer wants to provide health insurance, they can do it, but the value of that insurance is reflected in the taxable W-2 wages – now Pat and Chris will be treated equally.
Step 2 is to consolidate the multiple tax-supported bureaus that supply healthcare. Relieve the citizens from having to prove they are old enough, disabled enough, impoverished enough, young enough. Combine Medicare, Medicaid, CHIP, Tricare and even possibly the VA into a single bureaucracy. Every American Citizen gets this broad coverage at some level. Everyone pays something into the system – start at $20 a year, and then perhaps an income-adjusted escalator that would charge the most wealthy up to $75,000. Collect the money with a line on Form 1040.
I have not done the exact math. However, removing the process to prove eligibility and having one versus many bureaucracies has to generate savings. Are you a US Citizen? Yes, then here is your base insurance. Like every other nationalized system, one can expect longer waits, fewer referrals to a specialist, and less innovation. These centralized systems all squeeze supply of healthcare services to keep their spend down. The reports extolling their efficiencies come from the people whose livelihoods depend on the centralized system. However, at least everyone gets something. And, for life threatening health conditions, by and large the centralized systems do a decent job. With everyone covered, the fear of medical bankruptcy evaporates. The fear of being out of work and losing healthcare when one needs it most is gone.
So if you are a free market absolutist, then the reduction of vast bureaucracies should be attractive – no need for eligibility requirements (old enough, etc.) and a single administration which is both more efficient, more equitable (everyone gets the same thing). And there remains a private market (more on this in step 3) For those who detest private insurance companies a portion of that market just went away. There is less incentive to purchase a private plan. And for everyone’s sense of fairness, the national plan is funded on ability to pay. Bearing in mind that everyone has to pay something. Less bureaucracies. Everyone in it together. Funded on ability to pay.
Step 3 is to allow and even encourage a robust market for health insurance above and beyond the national plan – If people want to purchase more health insurance, then they have the ability to do so. Which increases supply, relieves burden on the tax-supported system, aligns the US with other countries, provides an alternative to medical tourism (and the associated health spend in our country) and offers a bit of competition to the otherwise monopolistic government plan.
Its not a new concept, in many respects it is like the widely popular Medigap plans that supplement what Medicare does not cover.
No one is forced to make that purchase. Other counties’ experience shows that those who choose to purchase private coverage over and above a national plan often cite faster access, more choice, innovation, or services outside the universal system, e.g., a woman who chooses to have mammography at an early age or with more frequency than the national plan might allow. If the insurance provider can offer a good value to the price, then they will sell insurance. If they can deliver that value for more than their costs, then they create a profit. Owners of the company, who risk their capital in creating the business may earn a return.
For those of you who favor a free market, the choices are available. There will be necessary regulation to prevent discrimination on genetics, pre-existing conditions, and the like. Buy the type of plan that makes you feel secure – just as one purchases automobile and life insurance.For those who are supremely confident in the absolute performance of a centralized system to support 300+ million Americans in the way each would want, they should like this plan as well – because if the national plan is meeting all needs and no one wants perhaps faster services, then few will purchase the private insurance and the issuers will not have a business. Free choice. More health insurance for those who want it. Competition keeps both national and private plans seeking to better themselves.
Step 4 would be to Permit Access to Medicare Part D to every US Citizen, Immediately
One of the bright spots in the US Healthcare Financing Method is Medicare Part D, which provides prescription drug coverage to seniors. It is running at 95% subscriber satisfaction and about 40% below cost projections.
Subscribers choose from a wide variety of plans offered by private insurance companies. There are differences in formularies, co-pays, deductibles and premiums.
So there you have it, a four part plan that would maintain or increase the supply of healthcare services, universal insurance coverage, market competition, and lower costs. Its not perfect but I believe a vast improvement over what exists today. To recap:
1. Break the link between employment and healthcare insurance coverage, by taxing the benefits as the compensation they are.
2. Establish a single, universal plan that covers all US citizens paid for via personal income taxes on an ability-to-pay basis. Eliminate all the other tax-funded plans in favor of this new one.
3. For those who want it, private, supplemental insurance to the national system, ala major industrialized nations.
4. Open Medicare Part D (prescription drugs) to every US citizen. Today.
Markets: While yesterday was somewhat of a snoozefest on Wall Street, today should be more interesting. In a quarterly event known as “quadruple witching,” stock options, index options, stock futures, and index futures all expire on the same day, which can produce fireworks.
The phrase quadruple witching brings to mind stories that begin, “It was a dark and stormy night…” or folkloric visions of witches flying chaotically on broomsticks across the brightness of a moon.
In the context of investing, quadruple witching also refers to possible chaos but chaos in the financial markets. Such chaos can erupt due to four different types of contracts on financial assets expiring on the same day. The quadruple witching hour is the last hour of the trading session on that day. The question is whether investors can make abnormally robust profits on quadruple witching days due to market fluctuations.
What Is Quadruple Witching?
Quadruple witching refers to four days during the calendar year when the contracts on four different kinds of financial assets expire. The days are the third Friday of March, June, September and December. The assets on which the contracts expire on that day are stock options, single stock futures, stock index futures and stock index options. Options contracts also expire monthly. Futures contracts expire quarterly.
Because all four types of contracts expire on the same day, the quadruple witching day usually sees a heavier volume of trading. This is why the reference to chaos is made about this witching day. Market volume is increased partly due to offsetting trades that are made automatically. Volume on quadruple witching days has increased roughly two-thirds of the time since 2005.
Recent Quadruple Witching Expiration Day
On June 18, 2021, a quadruple witching day, a near-record volume of single-stock equity options was set to expire at the end of the day in the amount of $818 billion. As a result, a near-record of single stock open interest of about $3 trillion stood on June 18, 2021. Open interest refers to how many contracts are open during any given point during the day. It is an important metric for traders to watch since a large amount of open interest can move the value of the underlying stock.
AMERICAN DEPOSITORY RECEIPT (ADR) = A receipt evidencing shares of a foreign corporation held on deposit or under the control of a U. S. banking institution; it is used to facilitate transactions and expedite transfer of beneficial ownership for a foreign security in the U.S. Everything is done in dollars and the ADR holder doesn’t have voting rights; essentially the same as an American Depository Share (ADS).
A Standard & Poor’s Depositary Receipt, or SPDR, is a type of exchange traded fund that began trading on the American Stock Exchange (AMEX) in 1993 when State Street Global Advisors’ investment management group first issued shares of the SPDR 500 Trust (SPY).
Taking a distribution from a tax qualified retirement plan, such as a 401(k), prior to age 59 1/2 is generally subject to a 10 percent early withdrawal tax penalty.
However, the IRS rule of 55 may allow you to receive a distribution after attaining age 55 (and before age 59 1/2 ) without triggering the early penalty if your plan provides for such distributions.
The distribution would still be subject to an income tax withholding rate of 20 percent, however. (If it turns out that 20 percent is more than you owe based on your total taxable income, you will get a refund after filing your yearly tax return.)
Elizabeth Holmes has no idea how much damage she has done with Theranos. As I often wrote, for digital technologies to gain ground and become part of our everyday lives, we need not only technological solutions but a cultural paradigm shift. Holmes rolled a massive rock in front of it.
Similarly, Facebook’s data privacy practices do not increase people’s confidence in the company’s products. All the scandals that have surrounded the social network could backfire when Facebook wants to step into healthcare – and this is exactly what we wrote about in our latest article, Is There A Place For Facebook In Healthcare? In it, we looked at what Facebook currently does in medicine and evaluated whether those are viable ways to follow in the future.
Take care, Berci Bertalan Meskó, MDPhD The Medical Futurist
Culture is a factor to consider with healthcare. Depending on the culture they may seek alternative treatment such as homeopathic and treatment they have been raised with in their country Some cultures will get medications from their country because they believe in their medical system more then what is offered.
BY IHME
***
Dr. Joseph L. Dieleman, Associate Professor in the Department of Health Metric Sciences at the University of Washington, is the lead author of the study “US Health Care Spending by Race and Ethnicity, 2002-2016,” published August 17, 2021 in the Journal of the American Medical Association
DEFINITION: The PPI is a group of indexes that measure the change, over time, in the prices received by domestic producers of goods and services. It measures price changes from the perspective of the seller rather than the consumer, as with the CPI. The CPI would include imported goods, while the PPI is relevant to U.S. producers, and therefore would not include imports.
The PPI measures over 10,000 products and services. It reports the price changes prior to the retail level. This information is useful to the government in formulating fiscal and monetary policies. The data gathered from the PPI is often used in escalating purchase and sales contracts. That is the dollar amount to be paid at some time in the future.
NOTE: Long-term managed medical care contracts of the future will seek escalation clauses for increases in prices.
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