Combining health insurance and health providers (medical doctors) into one company is a basis for value based medical care

"What many new companies have in common is that they are involved, to varying degrees, in a newer approach to the provision of health known as value-based care. 

It differs from the more widespread fee-for-service model in which medical providers have an incentive to utilize the healthcare system as much as possible because that drives up compensation. 

Value-based care, by contrast, encourages providers to be more proactive in preventing illness because they also benefit from savings. 

It is too early to tell whether that approach will truly benefit patients or just improve the bottom line for providers and insurers.

UnitedHealth, the sprawling conglomerate that includes 60,000 physicians, a pharmacy benefit manager and an insurance business, is furthest along in the transition. Through its medical provider arm, Optum Care, it has been buying multi-specialty physician practices, many of which focus on more proactively managing patients through home, virtual and on-site care. 

The idea, in a nutshell, is to keep people out of the hospital, because that is where the costs are highest. 

Because UnitedHealth also takes on risk through its insurance arm, it stands to gain by driving down the cost of care. 

UnitedHealth on Wednesday announced it will provide analytics to help Walmart clinics deliver value-based care to Medicare patients.

One key aspect of the race to remake healthcare centers on a long overlooked profession: the family doctor. Because America's system rewards more expensive procedures, medical students prefer to become, say, cardiologists or surgeons. That has prompted a nationwide shortage of primary-care doctors. The long waits to see a doctor have led many Americans to completely abandon the relationship with their primary-care physicians, leading to worse health outcomes.

Companies like Amazon, CVS and UnitedHealth have sensed an opportunity in the primary-care crisis. 

Brian Tanquilut, an analyst at Jefferies, says the big investments in value-based care can realign incentives because primary-care doctors at places like One Medical, which Amazon agreed to buy, earn about double what other family doctors make." [1]

1. EXCHANGE --- Heard on the Street: Dr. Amazon Will See You Now --- A crop of upstarts is offering industry giants a chance to buy their way in and disrupt U.S. healthcare

Wainer, David. 

Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 10 Sep 2022: B.12.

Bloga naujiena Airijai - kai kurios ES šalys įgyvendina minimalių mokesčių planą

„Prancūzija, Vokietija ir dar trys Europos Sąjungos šalys teigė, kad jau kitais metais imsis 15% minimalaus mokesčio didelėms įmonėms, nepaisant Vengrijos veto dėl tarptautiniu mastu sutarto plano.

 

    Kadangi kiekviena iš 27 ES valstybių narių turi veto teisę, priimant daugumą mokesčių sprendimų, dėl Vengrijos žingsnio plano įgyvendinimas tapo neįmanomu įgyvendinti viso bloko teisės aktais.

 

    Beveik 140 šalių praėjusiais metais susitarė įvesti 15% minimalų mokestį didelėms įmonėms, atverdamos kelią reikšmingiausiam tarptautinių mokesčių taisyklių persvarstymui per šimtmetį, nustatant žemiausią pelno mokesčio mokėjimą.

 

    Po kelių mėnesių nebuvo padaryta didelė pažanga keičiant nacionalinius įstatymus, kad būtų įgyvendintas mokestis.

 

    Kalbėdamas penktadienį po ES finansų ministrų susitikimo Prahoje, Prancūzijos finansų ministras Bruno Le Maire'as sakė, kad Prancūzija, Vokietija, Nyderlandai, Italija ir Ispanija susitarė pagaliau taikyti mokestį.

 

    „Dabar norime paankstinti ir nuo 2023 m. įvesti minimalų pelno mokestį“, – sakė ponas Le Maire'as. „Mes nelauksime“.

 

    P. Le Maire'as sakė, kad Prancūzija ir jos partneriai svarsto dvi galimybes. Vienas iš jų būtų pradėti specialią ES procedūrą, vadinamą glaudesniu bendradarbiavimu, kuri leistų iniciatyvą įgyvendinti, kai ją remia bent devynios šalys, o prieštaraujančios šalys gali atsisakyti šios priemonės.

 

    Arba penkios šalys ir visi norintys prie jų prisijungti imtųsi vienos ir mokesčių įgyvendinimą koordinuotų pagal vidaus teisės aktus.

 

    „Mes jau seniai pasirašėme minimalų pelno mokestį ir negalime susilaikyti tokiu svarbiu klausimu“, – sakė Nyderlandų finansų ministrė Sigrid Kaag.

 

    Vengrijos pozicija sukėlė nusivylimą didžiosioms Europos valstybėms, kurios yra entuziastingiausios naujojo mokesčio šalininkės. Tai taip pat naujausias pavyzdys, kai Vengrija trukdo priimti ES sprendimus.

 

    Vengrija savo parlamente priėmė rezoliuciją, kuria nepritaria minimaliam mokesčiui. Jos vyriausybė tvirtina, kad dėl neapibrėžtumo dėl Europos ekonomikos perspektyvų po sankcijų Rusijai dabar netinkamas laikas didinti mokesčius.

 

    Anksčiau Lenkija prieštaravo įvairiais motyvais, tačiau šių metų pradžioje savo pasipriešinimą atšaukė.

 

    JAV minimalių mokesčių planas susidūrė su kliūtimis Kongrese.

 

    Bideno administracijos pareigūnai planavo panaudoti demokratinius fiskalinius įstatymus, kad priimtų praėjusiais metais JAV sudarytą susitarimą, tačiau tai nepavyko. Dabar administracija tikisi, kad kitos šalys pirmiausia įsives mokesčius ir galiausiai kartu patrauks JAV.

 

    Tai gali būti sudėtinga, jei respublikonai, nepritariantys didesniems mokesčiams, lapkritį perimtų Senato kontrolę.

 

    JAV pagal rugpjūtį pasirašytą įstatymą kai kurioms didelėms įmonėms priėmė kitokį 15% mokestį. Dar neaišku, kaip tas mokestis sąveikautų su mokesčiais kitur." [1]

1. World News: Some EU Countries Move Ahead With Minimum-Tax Plan
Norman, Laurence. 
Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 10 Sep 2022: A.9.

Bad news for Ireland: Some EU Countries Move Ahead With Minimum-Tax Plan

"France, Germany and three other European Union countries said they would press ahead with the implementation of a 15% minimum tax on large companies as soon as next year, despite a veto by Hungary on the internationally agreed plan.

Since each of the EU's 27 member states holds a veto over most tax decisions, Hungary's move has made bloc wide legislation to implement the plan impossible.

Nearly 140 countries agreed last year to impose a 15% minimum tax on large companies, paving the way for the most significant overhaul of international tax rules in a century by placing a floor under corporate tax payments.

Months later, there has been little progress on changing national laws to implement the tax.

Speaking Friday after a meeting of EU finance ministers in Prague, French Finance Minister Bruno Le Maire said France, Germany, the Netherlands, Italy and Spain had agreed to press ahead with the tax.

"Now we want to advance and put in place as soon as 2023 the minimum corporation tax," Mr. Le Maire said. "We will not wait."

Mr. Le Maire said France and its partners are weighing two options. One would be to trigger a special EU procedure called enhanced cooperation, which allows an initiative to go ahead when it has the support of at least nine countries, while those opposed can sit the measure out.

Alternatively, the five countries and any who wished to join them would go it alone and coordinate the implementation of the tax through domestic legislation.

"We have signed off on the corporate minimum tax quite a while ago, and we can't be held back on such an important issue," said Dutch Finance Minister Sigrid Kaag.

Hungary's stance has been a source of frustration for the big European nations that are the most enthusiastic supporters of the new tax. It is also the latest example of Hungary standing in the way of EU decisions.

Hungary passed a resolution in its Parliament opposing the minimum tax. Its government argues that the uncertainty about Europe's economic outlook following sanctions on Russia makes it a bad time to raise taxes.

Previously, Poland had objected on different grounds, but reversed its opposition earlier this year.

In the U.S., the minimum tax plan has hit obstacles in Congress.

Biden administration officials had planned to use Democratic fiscal legislation to enact the U.S. piece of the deal struck last year, but that failed. Now the administration is hoping other nations will implement the tax first, eventually pulling the U.S. alongside.

That could be challenging if Republicans opposed to higher taxes win control of the Senate in November.

The U.S. has adopted a different 15% tax on some large companies as part of a law signed in August. It isn't yet certain how that tax would interact with taxes elsewhere." [1]

1. World News: Some EU Countries Move Ahead With Minimum-Tax Plan
Norman, Laurence. 
Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 10 Sep 2022: A.9.

The results of wild capitalism greed: the landscape of Lithuania and people's living conditions are definitely not changing for the better

"Environmentalists are worried about the changes in the landscape of Lithuania: it used to resemble a mosaic, but now it is turning into a whole, uniform area of ​​land, similar to steppes. 

 

The report on the state of the environment prepared by the European Environment Agency indicates that one of the main reasons for the loss of biodiversity and the breakdown of ecosystems in Europe is an excessively intensive agricultural activity, reports the Ministry of the Environment.

 

 Due to it, the diversity of the landscape in agro-ecosystems is also disappearing, and the barrier functions of ecological compensation are weakening. At the same time, the quality of the soil deteriorates, as mechanical erosion of the fertile soil layer increases due to plowing in the hilly landscape, there is a risk of wind caused erosion, as well as erosion caused by water.

 

As in many other regions of the EU, the areas of fields sown with monocultures are expanding in Lithuania, and meadows are being plowed up. 

 

Streams straightened during the Soviet era (more than 90% of natural water courses were changed) and their valleys and vegetation were not given the opportunity to return to a more natural state, because the aim is to constantly renew the melioration systems.

 

The areas of perennial meadows are rapidly decreasing in Lithuania: in 2015 668 thousand ha. of them were declared, and in 2021 - only 601 thousand ha. Meadows are turned into arable land. And when natural meadows are plowed, ecological relationships formed over decades are destroyed, sensitive and rare species that have established themselves in highly specialized ecological niches disappear, natural habitats of wild pollinators and enemies of plant pests are lost.

 

 The condition of meadow habitats is also deteriorating. According to the Habitats Directive 2019 report, there is not a single type of meadow habitat of European Community importance in Lithuania, whose conservation status would be assessed as favorable. This is also caused by the abandonment of meadows, then they are covered with bushes and trees, they are no longer suitable for many species of insects and birds typical of meadows, the species composition of the habitats changes, and they degrade. Therefore, extensive grazing or mowing is necessary to maintain natural grassland habitats.

 

One of the widely used indicators of the biodiversity status of agricultural land is the rural bird population index. The last report prepared by Lithuanian ornithologists shows that in 2016-2018 during the period, the populations of even 10 bird species decreased, one increased and three more remained stable. Of course, the impoverished landscape is not the only reason, but it certainly contributes to the loss of bird species common to the rural landscape.

 

 In the national landscape management plan in Lithuania, 4 problematic environmental landscape areas have been identified, which cover about 17 percent of territories of the country. Most of them are located in agricultural areas - this is the major part of Suvalkija, the whole of Northern Lithuania, the lower Nemunas and separate parts of the Central Lithuanian Plain. 

 

The most impoverished, ecologically inferior areas of the natural framework are concentrated in these areas, as well as water bodies squeezed by arable fields. In them, soil erosion must be better managed, landscape mosaicism must be increased, only well-thought-out renovation of drainage systems based on modern solutions should be carried out. Special attention should be paid to the restoration of natural watercourses.

 

For degraded areas of the agricultural landscape, where agricultural land accounts for more than 80 percent from the area of ​​the entire territory, and where there are negative changes in the state of soil, surface and underground water, biological diversity, the aforementioned document proposes means of spontaneous or artificial restoration.

 

 In the highlands, in order to restore eroded soils, the conversion of arable to non-arable agriculture is proposed, the use of soil-improving measures that enrich the organic matter of the soil is encouraged, and the areas of meadows and pastures are expanded. In the plains, where wind erosion is relevant, it is proposed to divide the monoculture fields into smaller ones, increase the areas of perennial meadows, plant trees - protective strips of the fields.

 

Restoration of landscape elements is a long-term work. It is very important to educate farmers on what kind of economic activity contributes to the preservation of the landscape, and to increase their environmental awareness. If you start applying measures to improve the landscape earlier, you will win because favorable conditions for farming will be created sooner. In addition, the quality and aesthetic appearance of the living environment of farmers and their families will improve.

 

In the new financial period of the Common Agricultural Policy, Lithuania will especially promote the preservation and restoration of landscape elements. For this, the Lithuanian Agriculture and Rural Development 2023-2027 the strategic plan envisages the preparation of eco-schemes, with the help of which farmers will be rewarded for nature-friendly farming focused on improving the environment and landscape."