hour 1: "Bipartisan Reform Can Prevent Health Care Monopolization" with Dr. Richard Kube MD, Founder/CEO Prairie Spine and Pain Institute
hour 2: "Current Weather/Climate and COP 28" with Dr. Judith Curry



Hour 1: Bipartisan Reform Can Prevent Health Care Monopolization" with Dr. Richard Kube MD, Founder/CEO Prairie Spine and Pain Institute

Richard A. Kube II, MD, FACSS, FAAOS

Dr. Kube is the CEO and Founder of Prairie Spine & Pain Institute. He has served several years on the Coding and Reimbursement Task Force for the International Society for the Advancement of Spine Surgery.

Dr. Richard Kube is an internationally renowned, fellowship-trained spine surgeon known for his advanced spine techniques. He is an expert in advanced spine treatments, including minimally invasive procedures and motion preservation techniques. Also called upon for teaching and speaking engagements, Dr. Kube seeks out new research and education to provide patients with cutting edge treatments, operative and non-operative. He has delivered more than 100 international presentations, including Asia, Europe and North America on his motion preservation techniques.

First surgeon to perform the following procedures:


  • MIS Sacroiliac Joint Fusion Surgery

United States

  • PCM® Cervical disc replacement surgery – post FDA

  • Symmetry Disc replacement procedure – post FDA


  • 2nd Level Cervical Disc Replacement

  • coflex® Interlaminar Stabilization Technology 1st & 2nd Level

Central Illinois

  • Dynesys® LIS Dynamic Stabilization System

  • Minimally invasive lumbar fusion – Outpatient

  • Spectra WaveWriter SCS Long Lasting Pain Relief System

  • Spinal Cord Stimulator (SCS) device – surgical implant

Peoria, Illinois

  • PRESTIGE® Cervical Disc Replacement

Bipartisan Reform Can Prevent Health Care Monopolization |Opinion
Richard A. Kube , CEO and Founder, Prairie Spine & Pain Institute
On 9/14/23 at 11:00 AM EDT
Rising health care costs are a major concern for most Americans. A Pew poll from earlier this year found 64 percent of Americans consider health care affordability a "very big problem in our country today." That includes majorities of both parties—54 percent of Republicans and 73 percent of Democrats. Our country may struggle with division and polarization, but it's clear that health care is an area where bipartisan reform is possible.
One of the key drivers for rising prices is consolidation in the health care market—when a smaller number of providers control a greater share of the overall market. Consolidation leads to less competition and therefore higher prices for consumers.

In recent years, health care markets big and small have become more consolidated. Researchers at the University of California, Berkeley found that from 2010 to 2016 the number of metro areas in the United States with high concentration of primary care providers increased by 85 percent. They also found 65 percent of metro areas were highly concentrated for specialist providers. All the while, the American Medical Association reports record-low numbers of physicians in private practice.

The rise of consolidation and decline of small private practices did not happen by chance. It was the unintended consequence of government policies, such as Medicare's reimbursement rate, which pays large hospitals and hospital systems more than small doctor offices for the same care. This payment differential benefits large hospital systems, which buy up small doctor practices and charge consumers higher prices by simply affixing the company name to an existing facility's front door.

A report from the American Enterprise Institute found that "for a 30-minute office visit, the physician fee schedule payment rate for calendar year 2017 was $109.46 for a new patient, while if delivered in a hospital setting, the total would be 68.5 percent higher or $184.44." This massive difference in reimbursement for the same service not only distorts the market, but, according to the researchers, it is "harmful to patients, who experience higher [Medicare] Part B coinsurance amounts due to bigger bills for the same clinical service."

Consolidation practices increase prices on non-Medicare patients too. The UC Berkeley study found "price increases often exceeding 20 percent" after mergers. A 2023 Harvard/National Bureau of Economic Research study found that "prices paid to health system physicians and hospitals were significantly higher than prices paid to nonsystem physicians." When operating under a hospital logo, physician revenue went up by 26 percent despite providing the same services. To cover that increase in costs, the average American will have to foot the bill through higher co-pays and out-of-pocket expenses, higher insurance premiums, or both.

All of this can be resolved by ending two-tier Medicare reimbursement policies. Instead, the program should implement site-neutral reimbursement payments based on the care provided, not facility location or ownership.

Site-neutral payment would put an end to the unfair policies that promote consolidation and encourage higher prices. Proposals to do so in Congress have support among Republicans and Democrats. Several congressional committees are now debating a health reform package that includes provisions to establish site neutrality in limited circumstances. That would be a vital first step, one which physicians across the country hope will soon expand to other services. After all, what could be more fair than reimbursing providers the same amount for the same service?

In light of the fiscal challenges facing Medicare, including insolvency of its Hospital Insurance Trust Fund, it makes sense to cut program costs and save taxpayers money. The horrors of consolidation over the past decade give even greater urgency to swift action. Health care reform is necessary and, fortunately, reforms like site-neutrality can be simple and bipartisan.

Richard A. Kube II, MD, FACSS, FAAOS is CEO and Founder of Prairie Spine & Pain Institute. He has served several years on the Coding and Reimbursement Task Force for the International Society for the Advancement of Spine Surgery.

Hour 2: "Current Weather/Climate and COP 28" with Dr. Judith Curry  WE THE PEOPLE RADIO

About our Guest Dr. Judith Curry
Dr. Judith Curry is President and co-founder of Climate Forecast Applications Network (CFAN). She is Professor Emerita at the Georgia Institute of Technology, where she served as Chair of Earth and Atmospheric Sciences for 13 years. Her expertise is in climate dynamics, extreme weather, and prediction/predictability. Curry is a Fellow of the American Meteorological Society, the American Association for the Advancement of Science, and the American Geophysical Union.

Following an influential career in academic research and administration, Curry founded CFAN to translate cutting-edge weather and climate research into forecast products and services that support the management of weather and climate risk for public and private sector decision makers. Curry is a leading global thinker on climate change. She is frequently called upon to give U.S. Congressional testimony and serve as an expert witness on matters related to weather and climate. Her influential blog Climate Etc. addresses leading-edge and controversial topics about climate change and the science-policy interface. Her new book Climate Uncertainty and Risk - Rethinking the climate change problem, the risks we are facing, and how we can respond.
Twitter: @curryja
Blog: Climate Etc. judithcurry.com
Climate Forecast Applications Network (CFAN): www.cfanclimate.net
Book: Climate Uncertainty and Risk

World leaders have made a forceful statement that climate change is the greatest challenge facing humanity in the 21st century. However, little progress has been made in implementing policies to address climate change. In Climate Uncertainty and Risk, eminent climate scientist Judith Curry shows how we can break this gridlock. This book helps us rethink the climate change problem, the risks we are facing and how we can respond to these challenges. Understanding the deep uncertainty surrounding the climate change problem helps us to better assess the risks. This book shows how uncertainty and disagreement can be part of the decision-making process. It provides a road map for formulating pragmatic solutions. Climate Uncertainty and Risk is essential reading for those concerned about the environment, professionals dealing with climate change and our national leaders.


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