August 15, 2009 Recent News



Obama's flapping lips has him in trouble again.  First it was his shooting from the hip at the Boston police officer.  Next it was his uneducated discussion of primary care physicians getting rich off of tonsil surgery.  Now the seniors are mad at him for his use of the term wasteful in describing the Medicare Advantage plans.  Medicare Advantage has 20% of the Medicare population and these private plans get an extra 14% over traditional Medicare per patient.  This allows the seniors in the program to pay less than those in traditional Medicare but they have more restrictions on physicians and hospitals especially if one gets sick away from home.  The AARP believes it is wasteful to pay the extra money, as do I.

CNN reports that $1.2 TRILLION are wasted each year in health care.  The list includes physicians ordering tests to protect them from liability concerns.  The article quotes a wonk as stating that any test that does not improve the outcome is a waste.  Of course one doesn't know that until one does the test.  The next mentioned is inefficient claims.  This is absolutely true.  The physician must hire extra help and pay extra money for a person do just handle claims inputting.  This is money that might be spent on patient care and is not.  EDs are the next item and it is well known that these are used by both the insured and the non insured as a physician office at a huge waste of money.  Other things on the list are readmissions, medical errors, and of course the highest of all wasters of medical care obesity and smoking.

In a related story, the CBO has sent a letter to Congress on August 7, 2009, stating that preventative care is good but would not only not save money but would increase costs in general although not for one individual who was caught early.  This includes wellness as well as preventative care since if people live longer they will use more federal monies. 

One of the best articles on healthcare I have read is in the August 12, 2009, Wall Street Journal.  It is an opinion piece by John Mackey, the CEO and co-founder of Whole Foods.  He states that Whole Foods has no healthcare problems since they have an employer paid HSA.  He wants the country to move away from more government debt and control.  The points Mr. Mackey makes to get to that goal are
    1. Remove the legal obstacles to HSAs.  Whole Foods pays the cost of the catastrophic plan and $1800 per person into the HSA for all employees working over 30 hours per week.  The employees put in the remainder.  This gives the people control over the spending of their money. 
    2. Equalize tax laws so employee and individual health care purchasers of insurance pay the same.  
    3. Repeal all laws that forbid buying insurance across state lines. 
    4. Repeal government health mandates in order to allow people to buy the insurance they wish and not what some special interest wishes. 
    5. Enact tort reform to get rid of defensive medicine.  
    6. Make costs transparent to allow the consumer to make informed choices.  
    7. Reform Medicare that is currently going bankrupt to give more choices and more importantly more responsibility to recipients. 
    8. Change the tax forms to allow those who wish to make tax deductible donations to help pay for those who are uninsured.  
Mr. Mackey disagrees with those that state healthcare is more of a right than food or shelter.  The latter two are funded by voluntary contributions as should be the former. He states there has never been the history of the country a right to food, shelter or healthcare.  He goes on to state that Canada and the UK also have no right to healthcare.  The people are told what they may receive and when they can receive it.  Currently in Canada there is a wait line for care of 800,000 people and in the UK the line is up to 1.8 million.  This, he says, is from the Investors Business Daily.  Whole Foods employees vote as to what benefits they want funded.  The Whole Food Canadian and UK employees want supplemental health care dollars to spend themselves on their own healthcare since they are happy with government medicine.  Mr. Mackey then ends the article by addressing personal responsibility and the problems with obesity and smoking.  He stresses, to no one's surprise, eating healthy foods.

Compare the above with the article by Shawn Tully, editor at large of CNN Money. She writes about the five freedoms one would lose under the House bill and the Kennedy bill.  The first is the freedom to choose what is in your plan since the plans must include mandated "standard benefit packages."  What is in these packages will not be known until the bills pass.  This is a pig in a poke. The second is community rating.  This makes the young who do not need a lot of coverage pay more and those older who need more pay less. Marxism at its best.  The third is the loss of HSAs which are probably the best insurance program in existence.  This takes away alot of patient choice.  The fourth is the removal of one's choice of keeping your existing health plan.  The reason this is here, even though Obama says it is not true, is over five years the ERISA plans must conform to the standard benefits or go out of business.  If your plan is not ERISA this change comes much sooner.  Therefore watch for significant changes in the first year.  The last is the inability to keep your physician. Under the plan people will need a physician in a "medical home" which is like an HMO.  This physician will control who may or may not get certain tests or see which specialist.  The bills currently allow one to switch to fee for service at any time.  Therefore as long as nothing is wrong it is cheaper to stay with the HMO concept and as soon as something important happens switch to fee for service to get better care.  This would bankrupt the fee for service plans so all that would be left would be the medical home concept. 

The Democrats have begun a smear campaign against insurers.  They are easy to vilify but those in Congress of both parties that have been Insurance Commissioners of their states disagree with the Democrat's latest lampoon.  The insurers are blaming the physicians for high bills.  The bills are immaterial as to what the insurers pay.

The outrage seen at the town meetings shows why Obama wanted passage prior to the August recess.  This healthcare bill is causing more anger and political fervor in people who usually are not politically active.  This is bad for the bill and those who support it unless it is significantly changed.

Much of the anger is at both the monetary and the "death conferences."  The latter is easily fixed, take it out of the bill.  Advance directives have been around for many years and have been moderately successful.  Physicians are not lawyers and can not discuss many end of life items with seniors.  The discussion should have happened many years prior with the person and the family.   The monetary problem is much harder to cure.  The final bill must not only pay for the people without insurance but must also actually decrease spending and decrease the deficit.  The bill can not cover the higher earning income people in the House proposal.  It must be truthful and not a spin like the Democrats did when the CBO said that the House bill would increase the debt by $246 Billion.  The only way debt can be reduced is by less spending on hospital, pharmacy and physician payments.  This may be done by charging seniors that can afford it to pay for some Medicare services and higher payments for pharmaceuticals.  This will mean a means test, something the pols have been loathe to do in the past.  

Obama has foot in mouth disease.  He is either the shoot from the hip without thinking person or he is relying on idiots to feed him information.  He has made several really stupid blunders from talking about a police situation which he knew nothing about to multiple gaffs on money spent for healthcare.  His latest was how much money a surgeon made on a foot amputation.  He stated they get $30,000 to $50,000.  The reality is the payment is between $700 to $1140.  The total cost including the hospitalization and rehab might be that much but not the surgical fee as he said.  The health community is beginning to call him the "idiot in chief."

Hidden in the House bill is a nugget of payment to states that pass legislation to make sure there is prompt and fair resolution of med mal disputes, encourage disclosure of healthcare events, have affordable med mal insurance, early offers of restitution and have certificates of merit.  This would not put any caps on attorney fees or damages.  This would not stop defensive medicine.  This would not allow mea culpas.  This would not allow guidelines to be used as a defense.  This would not do anything but the AMA is all for it.  This is one of the reasons the AMA does not speak for American medicine.  What could work are medical courts, disclosure and offer and safe harbors.  The latter may get rid of some of the defensive medicine.  The trial lawyers have the Dems in their pocket so no caps can be on the table.

The Republic of Massachusetts continues to have monetary problems due to the attempt to insure all.  Now that the recession has it full blast, more people are unemployed and needing unemployment health benefits the Republic does not have the funds to pay.  They are going after the employers, who are already paying significant money to the health system, for more taxes to help the unemployed.  This has always been a state job in all other states but not in the Republic.  The employers pay a tax to support this and it has not been raised since 1990.  There was not a tax on employers then to support the state general medical plan. Now they have a double whammy.   

Kaiser has been named by Obama as one of the places to be emulated. Kaiser just announced it continues to lose members, albeit small numbers.  Their operating profit was down 18% over a year earlier.  These numbers do not include the for profit Permanente Medical Group that contracts to care for Kaiser HMO patients in Kaiser hospitals.

Following the above announcement, Kaiser then stated it was cutting 1800 jobs in the California branches.  These will be the on-call and temps.  No union people or physicians will be let go. 

Remember when Obama went to the Cleveland Clinic to show America what a great place it was.  Well the Cleveland Clinic is now billing patients a facility fee to see their physicians in the Clinic facilities.  The charge is up to $55 per visit and they are justifying it because they have to be accredited and physician offices don't.  There was a prior class action law suit against Virginia Mason and the University of Washington for charging facility fees and not disclosing them to patients in advance.  This resulted in massive refunds.  The Cleveland Clinic learned from this and has notified patients in advance.

Obama also wants to emulate France in our healthcare system.  The front page of the Wall Street Journal tells of the problems confronting France.  Monetary problems are closing hospitals or departments of hospitals. The French government is attempting to reign in costs by putting in co-pays.  Each French person funds the healthcare in proportion to their income and they have universal coverage.  The French now spend 11% of their GNP on healthcare but their medical fund has been in the red since 1989 and the red ink is growing.  A major difference between Obamacare and the French system is that physicians may order any test or therapy without government interference in any way.  Obama wants rationing by guidelines.  About 90% of the French have voluntary private health plans as well as the government plans.  The government health plan has huge clout so keeps physician fees artificially low.  A visit (consultation) is about $32.  Recently France put in an HMO type system where all people must have a central MD who can control consultations by specialists.  The people may still go to other physicians but will pay 70% of the bill instead of 30%.  The French are also changing their state run hospitals to fee for service so they can get a better handle on individual charges.  

A group of physician specialists have formed the Access to Medical Imaging Coalition to protest the proposed CMS changes to in office medical imaging.  The Coalition has had over 70 bipartisan House members sign a letter to Sebelius to protest the proposed changes.  A different group, the Coalition to Protect Senior Care persuaded over 100 House and Senate members to write to Sebelius to protest cuts for providers of nursing care.

In an article in the New York Times physician charges were vilified.  The charges were the high one sent to insurers who don't pay them anyway.  Patients who do get stuck with paying the bills are those who hate their insurers or their in-network physicians who are sub standard but will work for less money or those who have no insurance.  Those usually work out a price prior to any care.  I have very little sympathy for those in networks because it is cheap.  They got what they paid for.


  DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.