By George W. Chapman
Over the past five national elections, healthcare costs have been in the public’s top 5 concerns. The only notable legislation in the past 20 years to control costs is the 2010 Affordable Care Act which capped insurance profits, did away with pre-existing conditions, established a marketplace for individuals and tax subsidies based on income. While laudable, it did little to lower costs per se. Try as they will, lowering costs for everyone is a fool’s errand. Why? Our healthcare industry/market is way too complicated, diverse and concentrated. It’s really like herding cats. Efforts to control costs are met with strong parochial resistance. Strategies to control costs don’t work across the board when confronted with disparate plans like Medicare, Medicaid, hundreds of commercial plans, self-insured plans, disability, Workers Comp, etc. So when it comes to lowering costs or premiums, it’s pretty much up to the individual plans to do so… but only for their members. All 350 million of us need to be “in the same boat” before any serious cost control can be effective. Medicare for All for example. But with our country split 50/50 politically it probably will be very political. But that’s how it is in all countries with universal coverage. Yet, all countries with universal coverage have way lower costs than the good ol’ USA.
Prior Authorizations
As previously discussed, prior authorization is the No. 1 headache for patients and physicians alike. Recently, several well publicized deaths have caused several states to pass legislation allowing physicians and their patients to pursue alternative medical treatment to that approved by the insurer, especially when it costs about the same or less. This eliminates having to go through the lengthy prior approval process all over again which has resulted in care delayed which has resulted in deaths, As of this writing in mid–April, NYS has not passed such legislation. NYS allows patients to seek and receive alternative treatment but does not require the insurer to pay even when they approved another treatment.
MD Visas
To protect American–born workers, the Trump administration increased the H1-B application fee for foreign–born workers from $2,000–$5,000 to $100,000. This includes physicians. After backlash from hospitals — most of which employ sorely needed foreign-born staff — the administration agreed to consider lowering the fee for physicians back to the $5,000 range. Rather than doing that, new H1-B applications are being “slow walked,” adding to the headaches of hospital executives trying to serve their communities. These visas are good for five, six years. We are experiencing a physician shortage which is expected to peak in 2030. Physicians here on H1-B visas do not deprive American–born docs of jobs.
Mark Cuban
The former principal owner of the Dallas Mavericks basketball franchise, star on TV’s “Shark Tank” and cofounder of Cost Plus Drugs is actively supporting a bipartisan bill sponsored by Elizabeth Warren and Josh Hawley. The senate bill would dismantle huge vertically integrated healthcare conglomerates like UnitedHealth Group, composed of insurance, pharmacy benefit managers and physician groups. Cuban vociferously supports the Break Up Big Medicine Act which accuses these conglomerates of controlling pricing, steering patients within their systems and reducing competition.
Guests Who Never Leave
We’ve all experienced it—whether it’s relatives staying just a little too long or a party that clearly ended hours ago. Please, just leave. But did you have to sue them in order to get them to depart? The Tallahassee Memorial Hospital did. Successfully treated and discharged in early October 2025, this patient refused to go home. Cajoling by hospital staff, friends, relatives and even attorneys didn’t work. The hospital needed the bed, staff and the resources. So having failed to get her to leave voluntarily, the hospital was forced to sue. The suit was finally dropped when she left in late March. She was there for six months. While a somewhat amusing story, patients like these only serve to aggravate already cash-stressed bottom lines, overworked staff and scarce supplies. Let us all be sure to show some respect and appreciation when the “party” is over.
Medicare
When you reach 65 and it’s time to enroll, traditional Medicare is the default choice. In other words, if you do not select an advantage plan you are automatically enrolled in traditional Medicare which does not include the bells and whistles of any advantage plan. Right now, about half of Medicare eligibles, 30 million, have opted for an advantage plan administered by a commercial insurer. CMS is currently considering making Advantage plans the default choice, meaning if you don’t select traditional Medicare you automatically are enrolled into an advantage plan and will be required to select one. CMS believes competition is healthy. Meanwhile, another CMS committee is looking to make recommendation to make advantage plan.
Happy Birthday
Or is it? Every time we celebrate one, we are a year older…chronologically. But not biologically or “epigenetically.” Your inherited genetics, lifestyle habits and medical history determine whether you are older or younger epigenetically. Epigenetic clocks measure changes to our DNA at the molecular level so scientists can determine how we are aging. There are epigenetic test kits available online in the $300 to $500 range. It is a rapidly growing futuristic industry. One point twenty-eight billion was spent in 2024 with a projected $3 billion by 2033. If you’re curious about your epigenetic age, some of the available test kits are PhenoAge, GrimAge, DunedinPACE, and Horvath Clock. Experts say these products are still in early stages of development so that should be taken into consideration when purchasing.
George W. Chapman is a retired healthcare business consultant who worked exclusively with physicians, hospitals and healthcare organizations. He used to operate GW Chapman Consulting based in Syracuse.