Politics and Medicine Blog

Pay Attention to Massachusetts

2010-04-28T12:14:00.001-04:00

All we have to do is look at the state of Massachusetts and the current insurance industry crisis there to find what will soon be coming to the rest of the United States. As reported in the Wall Street Journal, Massachusetts Governor Deval Patrick decided to impose restrictions on insurance premiums last week to curb costs. Because this resulted in the inability of the major insurance companies to raise premiums appropriately, many of the companies in the state (who are all nonprofit) decided to stop issuing new policies. In response to this, state officials have ordered the insurance companies to continue to offer quotes to the public. We should look at this simply for what it is. This is the government encroaching into the private industry to dictate how private companies conduct their business.

This is a gross over extension of government power into the private sector. Unfortunately, the model of Massachusetts universal care is very similar to the plan that will soon be imposed on many American

citizens by the recent health care bill. The Massachusetts model has also grossly underestimated their plan in terms of cost. There are several estimations that the cost of universal coverage in Massachusetts is 3 times greater than what was originally estimated. Despite the success of covering 98% of people in the state, the costs are something that have been and will be restrictive for the state moving forward. The not for profit insurance organizations are feeling the effects of this bill and are even discussing solvency in response to the inability to increase their premiums. This is what soon will be the model if President Obama and the Democrats in Congress have their way. We need to see that this coarse intrusion of government into private industry is something that we simply cannot stand for in this country and will not accept. The fact that this is happening in Massachusetts is proof that it will happen nationwide if this health care bill is allowed to proceed.

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Reform 2010: A Positive Outlook

2010-04-28T12:13:00.001-04:00

What seems like a neverending story, its finally a done deal. Obama finally got his healthcare reform past but there is going to be great up roar about the constituitionality of the this passage and you can count on a fight. Although this bill is not perfect, it has a lot of useful options and seems appropriate to take a step back and look what this bill has to offer.
Medicare:
- Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
- Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.

Medicaid:
- Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.
- Requires states to expand Medicaid to include childless adults starting in 2014.
- Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.
- Illegal immigrants are not eligible for Medicaid.

Insurance Reforms:
- Six months after enactment, insurance companies could no longer denying children coverage based on a preexisting condition.
- Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
- Insurance companies must allow children to stay on their parent's insurance plans until their 26th birthday.

Abortion:

- The bill segregates private insurance premium funds from taxpayer funds. Individuals would have to pay for abortion coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds.

- No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.

**Separately, anti-abortion Democrats worked out language with the White House on an executive order that would state that no federal funds can be used to pay for abortions except in the case of rape, incest or health of the mother. (Read more here)

Individual Mandate:
- In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people. This is similar to having car insurance, and buying insurance is required because driving is considered to be a privalege. Having the best access to health care should be considered a privalege and buying insurance should be a requirement.

Employer Mandate:

- Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.

Immigration:

- Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money.

Summary:

On a seperate note payment for this bill is that of shifting costs and less actual savings. They plan on covering 30 million more Americans and dumping them into a pool of people who's inurance pays so poorly that nobody will see them. Walgreens has even quit filling their presciptions in Washington. Medicaid paid 72% of Medicare rates in 2008, which is substantially lower than private insurance pays. All this does is create an even bigger pool of people whom will continue to get poorer and more scarce healthcare than originally desired. The cuts in payments to physicians from Medicare and Medicaid are being slashed again and soon nobody is going to see them. Working for free isn't a healthcare initiative. This does not provide them the access they need. Cost shifting is not the approach, its a poor effort to address the real problem with medicaid and medicare. And once again they failed to address the 21% medicare cuts that are planned to hit again. They are just hiding billions of dollars and sweeping them under the rug for some one else to deal with.

When it comes down to it this bill has some great focus. The question that remains though is, can they deliver. Government is notorious for making empty promises and their historical lack of follow through and lack luster production is one major reason the people don't want them to be involved.

Further Reading
Health Care Reform Bill Summary: A Look At What's in the Bill
Twenty-six Lies About H.R. 3200

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By: Dr. Travis Smith

Walk the walk

2009-12-16T15:07:00.002-05:00

One has to wonder about the rationale behind the current administration's economic policies. The White House says they are pro growth on the economy; however, their actions are currently speaking louder than their words. They claim to want to help small businesses; however, they will not clearly define the rules by which they must play. Small businesses will find it difficult to expand when they don't know if they will be hit in the future with new taxes and regulations. In the midst of healthcare reform and cap and trade legislation, there could be a myriad of new taxes and fines that will sack the economy and, most importantly, small businesses. The Federal Reserve has continued to let the value of the dollar slide which will invariably lead to inflation. The anticipated announcement today that Bernanke and company will maintain the federal funds rate and discount window at the current low levels shows us that it is targeting the unemployment numbers. While this is important, the Fed’s inability to tighten the money supply could easily lead to asset bubbles as we are seeing in the increasing price of gold and crude oil. They seem to be forgetting that an increase in commodity prices is, in fact, a tax on the people through higher gas prices, etc. that will stifle economic growth.

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Bye Bye Public Option

2009-08-18T15:30:00.003-04:00

Over the past few months President Obama has been pushing health care reform and attempting to persuade the public to join in favor of a public option. He believes that this public option will create honesty among the private sector and push health care costs in the other direction. With this debate, there has arisen the public's fight against this plan for one plain reason: we don't want any more government control.

There is no question that people around the country, including all Republicans, want health care reform. The path to achieving it is something that people can't agree on. The problem that Obama is facing is a similar one that President Clinton faced when he attempted this change. The similarities being the Democrats have control of the House, Senate, White House and insist on jamming reform down our throats before anyone can digest it. Another big problem that stands in the way of health care in the near future is that Obama and his administration have stuck their nose the auto industry, banking industry, energy industry, and now the health care industry. This is a big problem for many Americans because they do not want more government control in their lives. That is what it boils down too.

Its no surprise to me that reform has once again not gone in favor of the Democrats. It seems everytime they have the opportunity for change they mess it up. Maybe things would have been different if Obama had stayed out of Wall Street or not given all of those bailouts. With that being said, I also believe that if the bill wasnt 1000 plus pages long and somebody would have read it then maybe some Americans would have jumped on board with Obama and his public option. Should he have waited another year or so before introducing this? Probabaly yes, this would have given people time to sift through the smoke and digest it and people would have forgotten about the government take over of 2009. Now the only thing left is hope for public non profit co-op plans. This plan will also not go down without of fight. Good luck President Obama.

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By Dr. Smith

Obama's War On Healthcare

2009-07-22T19:56:00.003-04:00

With the passage of a health care bill through the House this week, we are moving closer than we ever have to massive health care reform in this country. However, the reality of this bill is that it will not only become a back door to the socialization of health care in the United States, but it will leave the entire American public on the hook to pay for it, especially the “rich” and the elderly. It is a massive trillion dollar package that will threaten to destroy our economy and quality health care as we know it.

The statistic that is constantly thrown around by proponents of this package is that there are 47 million uninsured people in the United States. Sounds like a lot doesn’t it? Well, the truth is there are very good reasons why there are that many uninsured. According the U.S. Department of Health and Human Services, 27% of the uninsured have incomes that are greater than 300% of the poverty line. These people should usually find insurance affordable. However, for whatever reason, they chose not to have it. Furthermore, 21% of the uninsured are illegal immigrants. These people have already broken the law just by being here, so it is unreasonable to think that the American people should have to pay for them. There is also a certain segment of the uninsured that qualify for assistance programs, however, they are just not signed up. So, the number of 47 million is really a large overestimation. See the report here.

The 1,018 page bill that Democrats pushed through the week includes a variety of changes. The largest of these is arguably a government health insurance plan that is apparently needed to “compete” with private insurers. First of all, since when have we needed the government to stimulate competition? The reality of this provision is that it is intended to eventually convert everyone onto the public option and create a single payer system. Don’t believe this is the case? A report on Investor’s Business Daily found that on page 16 of this bill, there is a provision making individual private insurance illegal in some instances. For example, those who currently have private insurance will not be able to change it. Also, if one chooses to leave their current job to work for themselves, they will not be allowed to buy a private plan. See the article here. It is estimated by the U.S. National Institute of Health that about one fifth of the population experiences a change in their insurance every year. So, by this standard, it wouldn’t take more than 5 or 6 years before we would all be enrolled in the public option, effectively socialized medicine.

This plan would be a disaster for the economy, healthcare providers, and patients. In the current economic environment, it would not seem prudent to pass a trillion dollar package that will be paid for by increased taxes. It is pure common sense that increasing taxes in a recession is counterproductive. About half of the bill will be paid for by increasing taxes on households making more than $350,000, $500,000, and $1,000,000 by 1%, 2%, and 3% respectively. These rates would likely increase as more funds are needed in the future. The estimated cost of 1 trillion dollars is most likely a large underestimation for this bill. In Massachusetts, where a universal health care plan is already in effect, they have more than doubled the estimated cost. The notion that we should tax the highest earners in the middle of a recession defies logic. These are the people we need right now to expand their businesses, start new businesses, and hire new workers. Most people are not employed by those who are low on the income scale. They are employed by those who have successfully earned a larger income and consequently need other workers to expand their venture. The entrepreneur and small business owner are the backbone of this economy and should not be left out in the cold by this bill. After all, small businesses make up 60 to 80 percent of the jobs in this country. Conversely, the government makes up less than 8 percent. The balance of the bill is supposed to be paid for by savings from Medicare and Medicaid, which are already incredibly underfunded. For the government to reap savings from Medicare and Medicaid, they could do either two things. The first would be to cut reimbursement rates to healthcare providers even further. The second would be to cut the coverage to their clients and ration care for people currently under these programs. The latter is what is being done in Massachusetts. They are planning to cut tens of thousands legal, taxpaying immigrants out of the program. If we enact the former and cut reimbursement rates, fewer doctors than ever will accept these programs or, if we are forced to accept them, doctors will flock from the profession. If they cut and ration coverage from Medicare and Medicaid, sick people will not get the care they need. Sounds like bad situation either way.

We don’t need to look any further than Medicare, Medicaid, and the Veterans Affairs health care system for a model of what our current system will morph into under this bill. Medicare and Medicaid are extremely in debt and have massive amounts of unfunded IOU’s. If the entire nation were on a system like this, the government would have no choice but to raise taxes higher on just about everyone. In the VA system, I recently had a patient who just got on the waiting list for a shoulder replacement. His estimated wait time? Two and half years. Welcome to the world of government medicine.

The reality is that this program is being hurried through Congress under the disguise of a reform. They are hoping that by calling the government insurance a “public option” it will achieve better public support. The name implies we will have a choice but clearly we will not.

The implementation of government medicine will, most importantly, decrease the quality of the care that patient’s receive. There are a certain number of doctors and providers available to treat patients now. That same number of providers will soon be asked to care for millions more. It stands to logic that rationing of our healthcare resources will be their answer to this inevitable problem. It will also not be economically feasible to care for that many people under a government plan as there is no incentive for cost savings. No consideration will be given to healthcare savings since everything will either be paid for by the government or insurance companies. Therefore, further rationing or wildly increased tax rates will be rampant.

If this is not the answer than what is? Reform on many different levels would provide an overall healthier healthcare system. Tort reform and limiting the payment for pain and suffering awards in frivolous law suits against healthcare providers would have a large effect. These cases should be reviewed by an independent panel of board certified physicians that have no monetary connection to the case. After it is deemed that a healthcare provider deviated from the acceptable standard of care, then the case would be allowed to proceed. Also, the tax treatment of current health benefits needs to be altered. Currently, the health benefits that one receives from their employer are not taxed. However, if an individual goes out and buys the same policy on their own, they do not receive the same tax benefits. Allowing the same tax benefits to individuals would allow more people to get in the market for health insurance and would end the dependence of people on their employer for healthcare. Portability of health insurance is another major issue in this country. Currently, a person may not buy insurance from a company in another state. If the trade barriers were brought down between states (such barriers are unconstitutional to begin with) there would be a much larger market for people to choose from. A larger market means companies must compete more for consumer’s business. More competition means lower prices and more affordable premiums. If more competition is what the government says we need, than this is the way to do it. An added benefit could come in the way of increased use of health savings accounts. These are a good option for some patients as they include a tax free savings account that is coupled with a high deductible catastrophic health insurance plan. This means that routine medical care would come out of the tax exempt savings account and would be owned by the individual. Being owned by the individual means there would also be incentive for cost savings. Currently, there is no incentive to reduce cost because everything is paid for by a third party, the insurance company or the government. This would give people a stake in their healthcare and encourage preventative treatment. They, or their employer, could make tax free contributions each year toward health expenses. They would be free to see what doctors they choose and go to any hospital they desire, thus increasing competition further. The unused funds would roll over year after year and could be withdrawn for a reason other than healthcare after being taxed as income. If a severe illness or catastrophic event happens, the aforementioned insurance plan would come into effect after a deductible is met. This account would not be for everyone and has its flaws as does every plan, however, it should be recognized as a legitimate option and treated as such under law. In addition, instead of getting more people on Medicaid, an alternative would be to give tax credits or income subsidies to those with lower incomes so they could purchase their own private insurance.

While these are just a few options, it is clear that a government health insurance plan is not the answer to healthcare reform. Click here to get the contact information for your Congressman and voice your opinion.

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Another Approach at Achieving Reform

2009-06-25T16:33:00.001-04:00

As the health care reform debate hits full speed, it seems lawmakers can’t agree on anything. What has been compromised on is that health care for Americans needs to cover more people and the overall cost needs to be dramatically reduced. What hasn't been agreed on is the correct path to achieve these goals.

Obama and colleagues are in favor of a public option or a co op plan that will achieve lower costs and expand coverage. The problem is that he will only cover 16 million or 1/3 of the uninsured and if you break it down it’s very expensive per person. This adds up to 10,000 dollars per person per year which is almost twice the amount of the current person pays, around $6,000. This plan is a wasted expenditure and the wrong way to approach this problem.

The problem with calculating the number of people covered under a public plan is a confusing one. Seeing how out of 48 million currently uninsured, two thirds or 16 million of theses are currently eligible for current government assistance like Medicaid, 12 million are illegal immigrants and the rest, roughly 18 million are offered insurance through their employer but refuse to purchase it because of its high cost.

It seems more approachable and less invasive to assist those whom are eligible for assistance get coverage and find a way to subsidize insurance premiums to those who are spending more than 10% of their income on health insurance. These approaches confront a much agreed on problem of covering those uninsured without creating another inefficient government entity while not further bankrupting the system.

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AMA Should Take Stronger Stance

2009-06-18T00:28:00.001-04:00

In President Obama's address to the AMA yesterday, he laid out some basic framework for the health care overhall he is undertaking in his still very young term. As part of his reform, one of his key considerations is a public insurance option in addition to the many private insurance options. The AMA has long been considered a conservative organization and fundamentally opposed to a socialized or universal payer system. While Obama is not directly proposing either of these options, he is laying the groundwork for a state controlled health care system. Many would argue that a public option in a private market is simply a back door way to socialize medicine, much the same way the TARP funds were a back door way for government to intervene in the banking sector.

Unforunately, the AMA did not take a firm stance against this public insurance option and remained cautious. They, of course, did not specifically endorse a public option but they did not close the door on it. This is something they should have done to show that we will not tolerate any slide toward a state contolled system. Honestly, does any really believe that a public option will not attempt to push the private sector out of the health care industry? Any does anyone seriously believe they could even accomplish this goal efficiently? All one needs to do is take a look at the fiscally disaterous public options now available to specific populations, Medicare and Medicaid, to see this is not a vaible option. More and more doctors are deciding not to accept Medicare and Medicaid because reimbursements are declining and it is not financially efficient to do so. This problem will be expontenially compounded under a public option available to the general public.

Overall, the public insurance option is not a feasible plan in many aspects. This author believes the AMA should take a stronger stance against this proposition and let the administration know where we stand. There are many other health care reform changes that would provide better care for patients, lower costs, and be acceptable for physicians. These will be outlined in later posts.

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Reforming Medical Malpractice

2009-06-16T20:33:00.001-04:00

Reforming the medical system is going to require more than one approach. It is going to have to play to both sides of fence. One side is the patient, allowing coverage to include more people at a more cost effective rate and the other side is for physicians. Its too bad for them because one of biggest topics they want addressed is medical malpractice reform and nobody is talking about doing anything.

Obama, as well as Ted Kennedy and Max Baucus, have not indicated that they are going to tackle capping malpractice payouts this time around. They site that this plays little part in the economics of health care spending and that it takes away patient's rights. According to a January 2006 report prepared by PricewaterhouseCoopers LLP for the insurers’ group America’s Health Insurance Plans, it showed that 10% of health care spending goes toward medical malpractice. This is in the form of gigantic payouts and unnecessary tests ordered in fear of getting sued. To say that lawsuits aren't a major factor in tests that are ordered would be a total fallacy.

It has also been suggested that medical malpractice is just a drop in the bucket in health care spending, but I argue that 10% of a 2 trillion dollar a year industry costs about 200 billion. Over ten years that is the estimated cost of the entire health care reform being proposed by Kennedy and Baucus. I hope that in the coming weeks someone can tune in Mr. Obama, break him away from his trial lawyer buddies and tell him how important this issue is for entire field of medicine. It will help curb costs and improve health care efficiency around the board.

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Obama's AMA Trip

2009-06-16T00:00:00.001-04:00

President Obama laid out his floor plan to the AMA this morning. His reform platform has goals to reach coverage for millions of more Americans over the next few years in an attempt to spread the insurance liability. His approach is also tackles what he calls "inefficient medicine" or "wasteful spending" on items such as "EKG's" and "CT scans." He goes on to say that tests like this are often uneccessary and physicians are ordering them because he thinks doctors are getting kick backs for ordering them. I am not sure where he is recieving this information, but its far from the truth.

Doctor's order tests like EKG's and CT scans routinely for certain life threatening reasons and they are very neccessary, but there are times that you could probably get away with not ordering one because the odds are that the patient is fine. It is under those circumstances that lawyers jump right into our minds. Even if there was a 999 in 1000 chance that an EKG would most likely be normal, it is that one which ends up costing millions of dollars. Nothing in medicine is 100% and its for that reason that there are going to always be wasteful tests and procedures.

Obama either doesn't understand this yet or he doesn't care because it keeps his fellow lawyers in business. Either way it is on him to tackle reform with extreme liability and malpractice reform. If the government wants to stick their nose in this, they need to address that situation first. He needs to not only protect the people but also the physicians against this intrusion upon medical decision making.

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