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Universal
Health Care
Commentary
Recently, the CEO of a major California health plan came out in favor of universal health care. A recent op-piece in the San Francisco Chronicle also recommends universal health care. The writer believes health care is a right and not a privilege. I believe all agree with that statement, but is it a right for all to receive the same healthcare? Should some receive better health care than others depending on their ability to pay? Should all get the same car or be able to get the one they can afford? Twenty years ago all received health care but some either by choice or lack of insurance went to county hospitals. These hospitals are often the best in the area for trauma and social services. They have medical students and residents. They have academic attending physicians who are usually affiliated with medical schools. Now the county system is dead or dying except in areas where the States either create road blocks or do not provide adequate funding for Medicaid patients to see private physicians. In these areas the county system continues to thrive. I did my training at Cook County Hospital. My wife had explicit instructions that if I was ever in an accident or had something serious I was to be taken to Cook. Yes, I had insurance and Cook County was farther from my apartment in Chicago but they had the only trauma center in the country and always had residents available in all specialties with immediate consultative abilities with attendings. The closer and nicer private hospitals had no in-house physicians except for the emergency room and many physicians lived up to a hour away. This is not true where I currently live. There is a trauma center and hospital three minutes from my house. Another major hospital is 10 minutes away. The local county hospital, where I worked and taught, has been relegated to a jail ward and those patients who opt for the very inexpensive and restrictive HMO that only allows care at that hospital and via their resident physicians. Although it is the newest hospital in the area, it is no longer a place that offers first class care. Their institution is geared to family practice training only. If it affiliated closely with a medical school in all fields and allowed those residents and medical students to rotate through with medical school attendings, it could become an excellent hospital. Do we need universal health care? I believe the answer is no. I believe we need a good second tier of medicine that may even give better care in some areas of medicine than the top tier.
While I'm on my soap box, we also do not
need the VA system. This expensive drain on medical resources should be
closed and all those with true service connected disabilities should be given
free Medicare and free prescription coverage with the ability to go to any
provider. The remainder of the veteran population, including me, should
not be given free or even the current low cost care.
Top
There has been no significant reduction in medical errors since the disputed IOM report several years ago. In a recent New England Journal report about 35% of the physicians polled and 42% of the public polled had experienced a medical mistake themselves. The study stated that the best way to reduce mistakes were using systemic methods and not focusing on individuals. However, only 23% of physicians felt that computer hospital ordering systems were very effective in reducing errors.
The JCAHO inspected Palm Beach Gardens Medical Center in Florida after their rash of infection problems. The Joint found no infection control problems were now occurring. This Tenet hospital and multiple others have received or will receive targeted inspections. Top
Sutter Health in California, a 26 unit hospital system, is faring well. They received revenue of $3.6 billion and made $186 million for an operating margin of 5.1%. They have learned how to deal with insurers. The contract covers all the hospitals or none. If the insurers don't contract with Sutter they may lose the only hospitals in the area and also the physicians in the 501 (c)(3) foundations. Top
Yep, it's here. The promised Medicare reduction of an additional 4.4% to fee for service Medicare physicians is upon the industry. This makes a total of 10% in two years. It seems ridiculous for providers to continue to accept more Medicare patients and lose money on each one. I, as a retired private practice urologist who treated a large amount of Medicare patients, would hate to be faced with the reductions in payment from all sources and the increasing overhead. I would think that those providers that can retire, will.
In Pinellas County, Florida most physicians will stop accepting new Medicare patients. If this holds throughout the country, the Medicare program could be in trouble over the next several years. This also affects TRICARE, the military insurance program who may not have enough money to continue operations.
California, due to the mismanagement by the legislature and the Governor, has a major budget shortfall. In order to make up some of the money they are going after the poor, non-voters. There may be a 10% reduction in pay to providers who care for Medicaid patients and fewer people being allowed to get on the Medicaid roles. This means fewer physicians and nursing homes that will accept Medicaid patients and more problems for the state. The good news is that these poor people don't vote. Top
The Red Cross is in trouble again. They have been accused of unsafe medical practices. This organization which provides 45% of the blood products in the country was accused by the FDA of not fixing the problems that have plagued them for at least 10 years. The federal organization accused the Red Cross of teaching employees to lie and falsify information in safety processes. They also accepted blood from people they knew were not to be donors. Last year the FDA went to court for a contempt citation against the Red Cross for the past ten years of safety violations. This is now in negotiations for a settlement. How do you settle a poor record of safety and for lying? Top
The Bankruptcy Court has approved the liquidation of the Health Plan of the Redwoods defunct HMO. They owe $37 million to hospitals, physicians and others. They will pay between 23 to 27 cents on each dollar owed. These paltry sums will not be paid until December 2003.
Blue Cross has left CalOptima, a company that disburses government funds to physicians for Medicaid patients. Blue Cross had 30,000 patients under the plan and was paid a fee per member per month. The 30,000 members will now have to find a new health insurance company.
Kaiser Permanente has decided to cut back on payments to insurance brokers. The brokers will now be paid on a flat fee per member per month. They used to get a percent of premiums and of course more per person if the premiums increased.
Texas HMOs are drying up. The enrollments are down 8% in 2001 and 11% in the first half of 2002. This is a drop of 720,000 enrollees in the past two years. To add to their misery the cost of care continues to increase. This means the cost to the enrollees that remain will increase dramatically, leading to more disenrollment.
Florida never wants to be left out. Their HMOs have lost 6.6% in the first half of 2002. The is the same as a loss of 451,000 enrollees. Most of the loss is in the commercial side but there were significant decreases in the Medicare HMO market as well. Top
A North Palm Springs, Florida internist and gastroenterologist as well as a popular radio physician has put in a waiver for all his patients not to sue him for any reason. Why, you ask? In insurance went from $12,000 to $60,000. He dropped his coverage and instituted this new policy. If the patient will not sign it, the patient is out. The personal injury attorneys state the waiver is not legal. This is probably true but the physician will get rid of many potentially litigious patients.
Lee County, Florida trauma center will stay in business for another year. The voters decided against an increased tax to pay for the unit but private contributions and a loan from the county commissioners will keep it afloat for one year. Lee County still must work out a long term plan. They lost on a sales tax increase and will now try a property tax.
Texas is now being hit with less physicians due to high malpractice costs. The legislature is being lobbied for tort reform.
There are some people that probably don't have enough sense to walk and chew gum. One of those is the Pennsylvania Secretary of the Commonwealth, C. Michael Weaver. He not only does not have a first name but wrote a letter to physicians reminding them of their duty to their patients and not to abandon their patients. The ding dong also offered a not so veiled threat that their license may be removed if they abandon their patients. This does not encompass retirement, leaving practice for another state, not taking new patients or trimming your practice by not doing OB or other high risk procedures. It's hard to believe but the outgoing Governor actually backed the Secretary and tried to put a spin on it by stating "the letter was simply to make sure that all doctors follow the proper protocols to make sure their patients have adequate coverage."
TopThe usual fight between hospitals attempting to get enough money to care for patients and the MCOs who want to continue to get their profits and stay in business by charging as low a fee as possible to the companies is in full swing. Throughout the country there are multiple hospitals and MCOs dropping each other due to lack of agreement over costs and payments. In the Bay Area, the premier Children's Hospital in Oakland has dropped Blue Shield. This accounts for about 5% of their admissions. The children will now have to cross the Bay Bridge to San Francisco or go 30 miles to Stanford. In deference to Blue Shield, Children's wanted enough money to cover their employees insurances. This doesn't seem right.
The People's Republic of Massachusetts Blue Cross and Blue Shield are going to give their providers bonuses. These bonuses will be for costs not quality. These payments would be to individuals and to groups who "beat the trend." The insurer uses the term "high performing" as if it is something to be proud of. It ain't necessarily so. "High performing" has nothing to do with good medicine and only with less costs. The insurer states it will base the rewards on quality, patient satisfaction and cost. In reality if patients stay with the insurer and don't switch and the physicians reduce the insurers cost so the insurer can make more, they will get their bonus. Quality is only an add-on with no significant benefit. Since there is only a finite amount of money the bonus money will come from physicians that do not toe the line on costs but attempt to practice quality medicine. This is the same BS as the California insurers have begun to institute.
In an interesting statistic physicians in the US averaged 13.1 managed care plans per physician and 90% belong to some managed care organization.
In the mid 1990s HMOs screwed themselves by instituting "drive by deliveries." They only allowed one night stays for routine deliveries. This raised such a ruckus that there were state and national legislation against the programs. There is now a study financed by Harvard Pilgrim HMO that states this would have been a safe procedure. The caveat is that there would need to have been follow up home visits. This would cost money and it is questionable if it would have been done in all instances. The study is based on the number of ED visits for the babies during the drive by era and after. Top
As everybody knows by now smallpox is back in the news after no cases in many many years. There are two known areas where smallpox is till being kept, US and Russia. The President has ordered all military to have smallpox inoculations and in fact had one himself. He also has asked that healthcare workers be vaccinated. To date, two major hospitals have come out against the mandate. Grady in Atlanta and Philadelphia's Children state they will not go along with the program. Their reasons were germane. The cowpox virus which is used in the vaccinations may be spread to immune compromised patients. It would be prudent to give the workers a week or so off after the vaccination to prevent this from happening. This would be devastating to hospitals. The other reason is liability. In an unfunded mandate, the feds have said to do this but have not taken any responsibility for the complications that might come from this program. In the risk assessment the hospitals believe there is greater risk of spread of cowpox and other complications than a risk of a biologic attack. Top
As I am sure all know CMS has put the new 4.4% Medicare fee for service fee reduction into place. This should reduce the number of physicians taking new Medicare patients. Top
ArchiveDISCLAIMER: 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.