Adams Actuarial LLC

06/05/2026

In the United States, a little more than a third of physicians are primary care physicians with the other two-thirds being specialist physicians. In other developed countries between half and two thirds of physicians are primary care physicians. The shortage of primary care physicians (P*Ps) in the US causes a few problems. If a patient with minor health issues cannot get an appointment with a P*P for a couple weeks then they may end up in the emergency room and the cost may be 10 or more times what it would be at the P*P office. Also, P*Ps coordinate care for a patient, thus reducing the number of duplicative and other unnecessary services. P*Ps also provide valuable preventive care which reduces overall health care costs and increases quality of care and quality of life.
The overabundance of specialist physicians in certain specialties also causes an increase in the number of unnecessary services performed. Remembering that physician offices are businesses, there may be a tendency to increase the number of services in these specialties to improve financial stability. Specialists earn in excess of $400,000 per year while P*Ps generally make less than $300,000 per year.
The additional income that a specialist physician earns means that there is substantial incentive for aspiring physicians to study to become specialists and not P*Ps. Part of the reason is that tuition is so high and the aspiring physicians need to take out a substantial amount of loans to get through college. Becoming a specialist allows them to pay off these loans much quicker than if they became a P*P. There have been significant efforts to provide grants to students who study to become P*Ps to help pay for their tuition but there needs to be much more attention paid to this problem.
Additionally, even aside from the tuition, the substantially larger income for specialists draws more aspiring physicians into becoming specialists. Provider fees need to be increased for P*Ps and fees need to be reduced for those specialists who work in a specialist category where there is an overabundance of specialists. Studies need to be done periodically to determine which categories need more physicians and which categories have too many physicians.
.

06/03/2026

I have gone back and forth regarding whether advertising should be allowed for health care entities. As always, I will start with pharmaceutical manufacturers. One good point brought up by supporters of this advertising is that it educates the patients as to what drugs are available and what they do, in theory. Unfortunately, these ads do more harm than good. Often these drug ads do not even tell you what the drug does. I have seen studies that show that 50% of all drugs prescribed are not necessary and these ads are a major reason why. Patients see these ads and decide that they cannot live without these drugs. The patient then goes into the doctor and demands the drug. In the doctor's mind, the doctor has a choice. The doctor thinks that he or she has to prescribe the drug or lose the patient to the doctor down the street who will prescribe the drug. The result is that these ads, which are supposed to educate, are actually causing an uneducated patient to get a drug that they may not need. The resulting side effects of this drug that the patient may not need may decrease health status, quality of care, and quality of life while increasing costs due to the cost of the drug and treatment of the side effects. The best place for the patient to be educated about possible drug treatments is through their doctor, not a misleading advertisement.
i also see no need for advertising for other providers. There are enough quality rankings of hospitals, doctors and other providers and other information available from the governments, the Internet, and employers that advertising would just be an additional cost to an already overburdened health care system.
Likewise, there is enough information available about health care payers that advertising is not necessary. Information is available from doctor's offices, the Internet, employers, health advocates, brokers, and government sources. Especially bothersome to me is the naming of sports stadiums after insurance companies. This is a wasteful additional cost added to our already overburdened health care system.
.

06/02/2026

Prescription drugs is a common topic in my posts on how to fix our broken health care system. The main reason for this is that the issues brought up about prescription drugs are often a microcosm of issues that are occurring in other sectors of our health care system. So the following article discusses controlling payments per prescription but similar issues exist in other areas, such as anesthesiology and emergency room. There are many nuances to the prescription drug issue that are not present in other areas and some of these will be discussed in this article.
currently drug prices in the United States are double the prices for these same drugs in other countries. The reason is that the US is the only country that has no control over drug prices. The problem mainly exists for drugs that are under patent and have no competition, called single source brand drugs. Since the drug has no competition then there is no limit on what the pharmaceutical manufacturer can charge. Once drugs come off patent then they will likely have competition and that will bring the price down significantly. Something needs to be done to control single source brand prices and also to control prices for other drugs that have extremely high prices for other reasons. Note that this article targets the prices set by the pharmaceutical manufacturer, where I believe that most of the problem exists, and does not discuss the impact of the middlemen even though there are areas for improvement there.
one thing to remember is that substantially reducing prescription drug prices will not reduce funds necessary for drug research. Instead, it will substantially reduce what I call pharmacy manufacturer marketing costs. These include television ads, advertisements in periodicals, payments to politicians designed to tip laws in favor of pharmaceutical manufacturers, payments to medical universities designed to influence prescribing habits of future doctors, and other payments designed to influence the system.
currently, for the most part, Payers, such as insurance companies, agree to buy drugs from pharmaceutical manufacturers at a percent discount off charges. There is often no restriction on the amount that the pharmaceutical manufacturer can charge. This leads to the astronomical drug prices that we have today.
Any attempt to lower drug prices needs to include private insurance and not just government programs. Historically cost reduction legislation has only included reductions in payments for government programs. As a result, the cost reductions for government programs were then passed on as cost increases to commercial insurers. Commercial insurers do not have a whole lot of leverage in negotiations with providers, which is why providers are so afraid of a single payer health care system.
Pharmaceutical manufacturers obviously can make a profit at much lower prices than what they charge in the US as they would not sell their drugs overseas at such low prices if they could not.
The use of an index of prices used by other countries is a good method of setting drug prices. A board can alsn be set up that would help in the process of setting prescription drug prices for all Payers, government and commercial.
Again there are many ways to accomplish the task but somehow there needs to be controls on how much pharmaceutical manufacturers can charge for its drugs.

06/01/2026

I am including Universal Health Care in the category of changes that can be done immediately since the Affordable Care Act as it was first passed went a long way to get health insurance to millions more Americans than had it before. In order to get enough votes to get it passed, states were not required to opt in to the Medicaid portion of the bill and many opted not to. This framework can be used and updated to provide coverage for many of the 8.3% of Americans who do not currently have coverage.
This health care system should be available for persons who do not have access to affordable health care coverage through any other means. All employers who do not offer affordable health care should be required to pay an amount that goes towards covering health care costs in this system. The rest should be funded by the government.
Member contributions should vary by income brackets with the brackets being small enough that members should not be put in the position where they have to turn down raises because the raise is not large enough to offset the increase in member contributions for the health benefit.
The overall quality of life, quality of care, health status, and productivity will significantly increase for those who would then be able to get health care coverage. This would mean more people in the work force.
The additional cost would be partially offset by a healthier population with a reduction in health issues that could be prevented or whose symptoms could be lessened. This could include a reduction in some very costly and serious health issues. Additionally, people who do not have health coverage often go to the emergency room since states often require the emergency room to treat them and get payment from bad debt and charity pools. Claims in the emergency room tend to be very expensive as compared to the same treatment at other sites.
.

05/29/2026

For the next several days I will be posting a series of articles on changes that should be made to our health care system. Keep in mind that there is no "correct" solution that will make everybody happy. There is also no Silver Bullet, just a lot of hard work and a lot of changes. Our health care system is over 17% of our economy and making changes can be very complex. Having said that, there are many changes that can be done quickly and many changes that will take years or decades to implement. I will discuss 3 changes in each category.
Immediate changes:
1. Universal health care.
2. Index prescription drug payments to indices based on payment indexes used by other developed countries.
3. Ban most advertising by health care providers.
Long term changes:
1. Remodel provider payment system.
2. Change distribution of physician specialties to improve quality of care and reduce costs.
3. Implement programs that increase health status, quality of care, quality of life, and productivity while keeping members out of the hospital.

05/28/2026

05/28/2026

This is unacceptable. This will increase emergency room usage since that is the only place that many uninsured persons can get treatment. The extremely high costs at ERs means that Bad Debt and Charity Pools will have to pay the providers for services that the uninsured incur. There is little savings here, just a large drop in the quality of care, quality of life, health status, and productivity. This is the main reason that the US ranks towards the bottom of most rankings of the health care systems of developed countries.
.

05/28/2026

05/26/2026

The health care sector has been the fastest growing sector of our economy for many decades.

05/25/2026