Quite frankly, I think I simply hate all politicians. I fail to understand why anyone chooses a life of public service and then, once elected, spends the rest of thier tenure refusing to serve the public that elected them.
I am currently of the persuasion that most politicians do not run because they want to help people, but because they want the prestige and power. Call me cynical if you like, but the results that we see on Capitol Hill only reinforce my statement.
I have now read *literally* hundreds of FB comments, discussions and blogs about the vote to repeal "Don't Ask, Don't Tell" (DADT). After doing so, I have come to a single conclusion, and I think the conclusion applies to the entire last decade of politics: democrats are blindly blaming republicans and republicans are blindly blaming democrats. The key words in my statement are "blindly" and "blindly." The politics on Capitol Hill have gotten so partisan, that the public has follwed suit. No one even questions 'what' or 'why,' they simply agree with their party's stance on any given subject, no matter how ludicrious.
DADT was the first piece of legislation that Bill Clinton (he was a DEMOCRAT, for those who have forgotten) signed into law. When its popularity waned, he blamed the republicans for fooling him. ok. whatever.
Telling the gays to hush up and stay in the closet was a mistake, and the public at large (not to mention the gay world) listened to all the political talk and bought it anyway, primarily because a democrat told them that it was ok.... So, now here we are, almost 20 years later. The party that liked the legislation is giving lip-service again. the party that didn't like the legislation to begin with is being blamed for not repealing it.
So the question to me is, 'what changed'? The answer is, 'politicians'.
In my cynical little mind, all I can say is this: This whole 'human rights' issue is being used as leverage during a tight mid-term election year. neither side cares about who it affects, or how it affects people, or even if it is constitutional. This is a lip-service power struggle...and BOTH sides are EQUALLY guilty for the repeal legislation failing.
The democrats knew that the legislation would fail. how did they know? because the GOP stated firmly (months ago) that they would NOT vote for any legislation that added to the already soaring, unchecked deficit. The democrats, trying to paint the GOP as the party of "no," tacked DADT onto a financial bill, KNOWING that the GOP would vote against it...even the Republicans who support the repeal voted against it...as did a couple of fiscally conservative democrats. The votes to repeal it EXISTED. EVERYONE knew it. they only needed 1 GOP vote and they had 7. This legislation was tacked onto a financial bill as a parlor trick, in an attempt to dissuade the independents and moderates who are leaning toward voting for the GOP in November. Had the democrats truly cared about this legislation, they would have let it stand alone.
I don't expect the current GOP to be supportive of things like human rights (not since they sold their souls to the religious right)...but I am highly dissapointed that the democrats just used their own constituents as political pawns. Mostly because, IF THIS TRICK FAILS, and the GOP regains control...with some Tea Party-ers in the mix...this legislation will not be able to pass for many years. And that is a tragedy
Thursday, September 23, 2010
Tuesday, August 31, 2010
Virginia, Severability, and the Supreme Court
The Virginia Debacle.
Last week, one of the most important judicial decision of the decade was handed down in Virginia and went virtually un-noticed by the rest of the country.
Virginia is one of the states that is trying the new healthcare law in court. Specifically, they are contesting the thought that the Federal Government has the authority to require a patriot to purchase a product that they don’t want…in this case, health insurance. The fact of the matter is that this will unlikely go to the Supreme Court. The federal court will rule that it IS unconstitutional. The reason is this: the Supreme Court has already argued and ruled this type of requirement ‘unconstitutional’ when a part of the Brady Bill was contested in the late 1980’s. Precedent is already set.
But the fact is, that the states are only sending this through the courts for a single reason: the Healthcare law has no “severability” clause. Most major legislation contains clauses that basically say, ‘if any part of this law is struck down by the courts, the unaffected portions remain law, anyway.’ This was an odd over-sight by the writers of the law. Without severability, if any part of the law is deemed unconstitutional, the entire law could be thrown out. The signers never noticed because, well, they admittedly never read the bill, they just signed it. Since it was passed by reconciliation instead of a vote, it was too late to add it, once it was discovered to be missing.
There are court precedents leaning both ways regarding ‘severability.’ Most often the judgment depends on the effect of the unlawful portion, in regards to the rest of the law. In this case, the portion stating that everyone must purchase insurance seems like a very small part of the law, so it might be overlooked, rather than the cause of declaring the entire law unconstitutional.
I disagree. I believe the requirement to be the hinge upon which the law moves.
By example: let’s say that the court rules that the federal government can’t force its patriots to purchase insurance (as the Supreme Court has already ruled). Once this is applied, we return to the thought of people only having insurance if they want it. The problem is that this undermines many other parts of the law in substantial ways. The biggest and most obvious are the ‘pre-existing condition’ clause and the ‘high risk pools.’ The high risk pools are designed to spread the cost of higher-risk insurees across the lower-risk insurees’ premiums…much the way no-fault insurance works. It doesn’t matter whether you have a good driving record or a bad driving record, everyone pays the same premium.. Couple that with the fact that companies will HAVE to immediately insure people, regardless of pre-existing condition, and here’s what has the potential to happen:
Citizen A chooses not to pay $300/month in premiums for 20 years because he is young and healthy. Rather, he pays out-of-pocket for a routine exam every now and then. One day, he gets sick and goes to his doctor who tells him that he has terminal cancer. Citizen A walks down to his insurance agent and buys insurance. Since there is no waiting period and no pre-existing clause, he is, BY LAW, allowed to do this. The company, BY LAW, has to insure him. He has paid no money into a risk-pool, but BY LAW has the right to take out as much as is deemed necessary for treatment.
Ultimately, this is like being allowed to drive without car insurance, but having a law stating that you can buy insurance after an accident…and they HAVE to cover you.
This will bankrupt every insurance company in a matter of months.
Now my cynical side comes out. Isn’t this what the government really wanted (and proposed) to begin with? To eliminate the insurance companies and force everyone to have government-run insurance? The framers of this law were not stupid…they knew the consequences. That is why, there is a $5 Billion dollar reserve to set up the public insurance option that was reportedly not in the bill. (I know this because, unlike most of congress, I actually READ all 2026 pages of the bill before it was signed into law.)
Every single person in this country, regardless of their stance on healthcare reform, had better understand how this first-level ruling in Virginia will affect them. If this portion of the law is thrown out without the whole law, in a matter of months (of the law taking full effect), Billion-dollar industries will fold, unemploying hundreds of thousands of people, further devastating banks and Wall St.
Someone better get a grip on this law and start directing it before it drags us all into bankruptcy…without any insurance at all.
Last week, one of the most important judicial decision of the decade was handed down in Virginia and went virtually un-noticed by the rest of the country.
Virginia is one of the states that is trying the new healthcare law in court. Specifically, they are contesting the thought that the Federal Government has the authority to require a patriot to purchase a product that they don’t want…in this case, health insurance. The fact of the matter is that this will unlikely go to the Supreme Court. The federal court will rule that it IS unconstitutional. The reason is this: the Supreme Court has already argued and ruled this type of requirement ‘unconstitutional’ when a part of the Brady Bill was contested in the late 1980’s. Precedent is already set.
But the fact is, that the states are only sending this through the courts for a single reason: the Healthcare law has no “severability” clause. Most major legislation contains clauses that basically say, ‘if any part of this law is struck down by the courts, the unaffected portions remain law, anyway.’ This was an odd over-sight by the writers of the law. Without severability, if any part of the law is deemed unconstitutional, the entire law could be thrown out. The signers never noticed because, well, they admittedly never read the bill, they just signed it. Since it was passed by reconciliation instead of a vote, it was too late to add it, once it was discovered to be missing.
There are court precedents leaning both ways regarding ‘severability.’ Most often the judgment depends on the effect of the unlawful portion, in regards to the rest of the law. In this case, the portion stating that everyone must purchase insurance seems like a very small part of the law, so it might be overlooked, rather than the cause of declaring the entire law unconstitutional.
I disagree. I believe the requirement to be the hinge upon which the law moves.
By example: let’s say that the court rules that the federal government can’t force its patriots to purchase insurance (as the Supreme Court has already ruled). Once this is applied, we return to the thought of people only having insurance if they want it. The problem is that this undermines many other parts of the law in substantial ways. The biggest and most obvious are the ‘pre-existing condition’ clause and the ‘high risk pools.’ The high risk pools are designed to spread the cost of higher-risk insurees across the lower-risk insurees’ premiums…much the way no-fault insurance works. It doesn’t matter whether you have a good driving record or a bad driving record, everyone pays the same premium.
Citizen A chooses not to pay $300/month in premiums for 20 years because he is young and healthy. Rather, he pays out-of-pocket for a routine exam every now and then. One day, he gets sick and goes to his doctor who tells him that he has terminal cancer. Citizen A walks down to his insurance agent and buys insurance. Since there is no waiting period and no pre-existing clause, he is, BY LAW, allowed to do this. The company, BY LAW, has to insure him. He has paid no money into a risk-pool, but BY LAW has the right to take out as much as is deemed necessary for treatment.
Ultimately, this is like being allowed to drive without car insurance, but having a law stating that you can buy insurance after an accident…and they HAVE to cover you.
This will bankrupt every insurance company in a matter of months.
Now my cynical side comes out. Isn’t this what the government really wanted (and proposed) to begin with? To eliminate the insurance companies and force everyone to have government-run insurance? The framers of this law were not stupid…they knew the consequences. That is why, there is a $5 Billion dollar reserve to set up the public insurance option that was reportedly not in the bill. (I know this because, unlike most of congress, I actually READ all 2026 pages of the bill before it was signed into law.)
Every single person in this country, regardless of their stance on healthcare reform, had better understand how this first-level ruling in Virginia will affect them. If this portion of the law is thrown out without the whole law, in a matter of months (of the law taking full effect), Billion-dollar industries will fold, unemploying hundreds of thousands of people, further devastating banks and Wall St.
Someone better get a grip on this law and start directing it before it drags us all into bankruptcy…without any insurance at all.
Thursday, August 12, 2010
Sharing the Pie.
This week, a friend of mine reminded me of a quote that Michelle Obama made about 2 years ago. She said, "...the truth is, in order to get things like universal healthcare and a revamped education system, then someone is going to have to give up a piece of their pie so that someone else can have more."
It was not a new quote to me at all, but it has been plaguing me all week. What if I don't want to give up my "piece of the pie"? Who is the government to tell me that I HAVE to? Seriously, what right do our own *elected* officials have to tell me that I have to give more of my money to fund programs that I don't believe in? The government is supposed to work for us. I don't get to walk up to my boss and tell them how much they are going to pay me...that's just not the way the world works. Yet, we allow the government to work this way.
Naturally, I have a solution *grins* or two:
The first one goes like this: figure out how much of our tax money actually goes to fund the federal programs outlined by the constitution (3 branches of govt, interstate commerce, protection of borders). Make those our taxes. By *super* rough calculations, this should cut everyone's federal tax bill by about 60%. Since everyone now has an additional 40% of their *previous* tax dollars, they can contribute to the social programs of their choosing...or not, if they so choose. It would be interesting to see where people would give if it were their CHOICE, rather than having it just taken away from them and allocated as the government sees fit. My guess is that most of the welfare programs that reward people for laziness would be gone. What Americans appear to have forgotten is that the government can't give you anything that it hasn't first taken away from someone else. Why is that even legal, much less expected?
The truth is that it would never work because everyone would just spend *their* money on the things that *they* think are important...kind of like it were their own money to begin with.....
??
Yeah.
Anyway, here is my second option.
On every tax form, there is an allocation table. everyone who pays taxes gets to choose *where* their tax money goes....sort of like donating money to a charitable organization.... After the expenses outlined in the constitution are paid, the money is distributed according to each person's allocation table. Then, each program has to live within it's budget. The power and accountability returns to the people instead of the establishment
The money that I earn is *mine.* Seriously, why does the government have the right to take it from me and do things with it that I oppose?
It was not a new quote to me at all, but it has been plaguing me all week. What if I don't want to give up my "piece of the pie"? Who is the government to tell me that I HAVE to? Seriously, what right do our own *elected* officials have to tell me that I have to give more of my money to fund programs that I don't believe in? The government is supposed to work for us. I don't get to walk up to my boss and tell them how much they are going to pay me...that's just not the way the world works. Yet, we allow the government to work this way.
Naturally, I have a solution *grins* or two:
The first one goes like this: figure out how much of our tax money actually goes to fund the federal programs outlined by the constitution (3 branches of govt, interstate commerce, protection of borders). Make those our taxes. By *super* rough calculations, this should cut everyone's federal tax bill by about 60%. Since everyone now has an additional 40% of their *previous* tax dollars, they can contribute to the social programs of their choosing...or not, if they so choose. It would be interesting to see where people would give if it were their CHOICE, rather than having it just taken away from them and allocated as the government sees fit. My guess is that most of the welfare programs that reward people for laziness would be gone. What Americans appear to have forgotten is that the government can't give you anything that it hasn't first taken away from someone else. Why is that even legal, much less expected?
The truth is that it would never work because everyone would just spend *their* money on the things that *they* think are important...kind of like it were their own money to begin with.....
??
Yeah.
Anyway, here is my second option.
On every tax form, there is an allocation table. everyone who pays taxes gets to choose *where* their tax money goes....sort of like donating money to a charitable organization.... After the expenses outlined in the constitution are paid, the money is distributed according to each person's allocation table. Then, each program has to live within it's budget. The power and accountability returns to the people instead of the establishment
The money that I earn is *mine.* Seriously, why does the government have the right to take it from me and do things with it that I oppose?
Monday, July 19, 2010
New Subject
You want a rant? THIS is going to be a rant!
I absolutely came unglued this morning on my way to work. Something that I already knew suddenly stop and go, WHAT?!? The construction workers working on I-290 are on strke. What I suddenly noticed this morning...or paid attention to, for the first time time in 112 days...was the signage that lets all the motorists know that the project is funded by the "Community Re-investment Act of 2009." You remember this...the government gave away $589B of our tax money (that's $4,496 per taxpayer, if you're one to do the math) to projects and pork-barrels in an attempt to jump-start the economy. I *still* say that giving each taxpayer that amount in a refund check would have cost the same amount, except that the money *actually* would have been spent jump-starting the economy....but I digress....
In Chicago, hundreds of millions of it are being spent to repave the least needy expressway that we have. What suddenly pushed me over the edge is this. Here are hundreds of workers who were, because of the recession, assumedly unemployed. So, their company is given hundreds of millions of dollars to put them back to work and what do they do? work? be happy to have a job? no...they STRIKE. Now, at this point, I honestly want to go get every one of them a nice big glass of shut-the-hell-up. Pick up your shovel, quit crying like a school-girl and go earn your paycheck. Because, quite frankly, there are hundreds of thousands of Americans who would take your job in a heartbeat if it were offered to them...not to mention, Arizona would *happily* ship out their illegal immigrants that the Federal Government is so gung-ho on protecting at the costs of its own citizens.
Now, before I get pegged as anti-union, let me tell you that I am not anti- or pro- anything when it comes to labor. I believe that investors (business owners) have a right to get a return on their investment, and I believe that a worker has the right to be compensated for their efforts. An imbalance of power on *either* side is equally destructive.
I just don't understand the need to push...in this economy...for anything more than is being offered. Most of us have gotten little or no raise in the past 2 years. Many of us have actually taken pay cuts. I hope that these lazy workers are replaced and unemployed. See how well THAT pays....
I absolutely came unglued this morning on my way to work. Something that I already knew suddenly stop and go, WHAT?!? The construction workers working on I-290 are on strke. What I suddenly noticed this morning...or paid attention to, for the first time time in 112 days...was the signage that lets all the motorists know that the project is funded by the "Community Re-investment Act of 2009." You remember this...the government gave away $589B of our tax money (that's $4,496 per taxpayer, if you're one to do the math) to projects and pork-barrels in an attempt to jump-start the economy. I *still* say that giving each taxpayer that amount in a refund check would have cost the same amount, except that the money *actually* would have been spent jump-starting the economy....but I digress....
In Chicago, hundreds of millions of it are being spent to repave the least needy expressway that we have. What suddenly pushed me over the edge is this. Here are hundreds of workers who were, because of the recession, assumedly unemployed. So, their company is given hundreds of millions of dollars to put them back to work and what do they do? work? be happy to have a job? no...they STRIKE. Now, at this point, I honestly want to go get every one of them a nice big glass of shut-the-hell-up. Pick up your shovel, quit crying like a school-girl and go earn your paycheck. Because, quite frankly, there are hundreds of thousands of Americans who would take your job in a heartbeat if it were offered to them...not to mention, Arizona would *happily* ship out their illegal immigrants that the Federal Government is so gung-ho on protecting at the costs of its own citizens.
Now, before I get pegged as anti-union, let me tell you that I am not anti- or pro- anything when it comes to labor. I believe that investors (business owners) have a right to get a return on their investment, and I believe that a worker has the right to be compensated for their efforts. An imbalance of power on *either* side is equally destructive.
I just don't understand the need to push...in this economy...for anything more than is being offered. Most of us have gotten little or no raise in the past 2 years. Many of us have actually taken pay cuts. I hope that these lazy workers are replaced and unemployed. See how well THAT pays....
Wednesday, June 30, 2010
Back to Being Me, Part 4
To continue my thoughts about healthcare:
Why the new healthcare law will fail miserably (part 4):
1. It totally fails to address the real problems in the US healthcare system.
a. Over-indulgence by the insurance companies.
b. Unsustainable growth (in this case, by Universal Coverage).
c. No tort-reform on law suits.
(read prior posts to catch up on these points)
d. No accountability for the Publically Insured.
One point that has been relatively untouched by the media and the discussion groups that I have seen is the differences in responsibility and accountability between privately and publically insured patients.
My insurance has a co-pay and a deductible. I can look at two different physicians or two different tests (as courses of action) and I have to decide which is best for me medically, but I ALSO have to consider which is best for me financially. I will have to pay 20% of the bill, so there is a substantial difference between a Physician who charges $100 for an office visit -vs- one who charges $600. Or there is a tremendous difference between an Ultrasound which costs $600 -vs- the MRI that costs $6,000. I am forced to weigh the potential benefits as compared to the out-of-pocket expense. i.e. the MRI may not statistically provide better information.
The same is not true for Public Aid. At *best* most PA plans have a flat co-pay per visit. So, if one doc charges $100 for the office visit and recommends a $600 ultrasound, there is no reason for the publically insured patient to choose that route over the $600 office visit and $6,000 MRI, because there is no vested financial interest on the part of the patient. They pay the same amount (usually nothing).
It is a fact that fewer publically insured patients maintain a Primary Care Provider and get regular preventive care. It is also a fact that more publically insured patients use the Emergency Room as a Primary Care Facility. The reason is not a stretch. There is no financial deterent to someone who pays for no part of the visit. I look at paying 20% of a $200 office visit as a far superior choice to paying 20% of a $2,000 ER visit. If there is no financial accountability, why would anyone care?
Unfortunately, the new healthcare law ceases to address this, very real, problem. I work at an inner-city hospital, where 8 or 10 hour ER waits are standard. Most inner-city ER's run less than 20% privately insured. Additionally, it is estimated that less than 50% of these ER visits are actually emergent. The ER's are plugged up with people who choose to use them rather than to establish care with a PCP. It is my experience, that when these patients are stabalized and set up with a PCP, the vast majority of them will NEVER keep the PCP appointment. In clinics that I have managed, Publically Insured "New" patients have almost a 40% no-show rate...over 400% more likely to No-Show than a Privately Insured "New" patient.
How will universal insurance affect this kind of situation? I think our best indicator would be to look at Massachusetts, since it is the only state that already mandates Health Insurance. In MA: preventive visits are down, ER visits are up. Ironically, the ER visits are not up solely because of Publically insured...they are also flooded with Privately Insured patients who can not get in to see a PCP, because the PCP offices are backed up for MONTHS due to the mandatory, unsustainable growth (see previous post). This has now given Massachusetts the distinction of having:
1 the slowest care in the country,
2 the highest percentage of ER visits, and
3 the most expensive healthcare in the US. Look these stats up on the internet, they're scary.
Thankfully, the rest of the country will soon be modelled after MA, so they won't be alone.
I have yet to see the positive side of this law....
Why the new healthcare law will fail miserably (part 4):
1. It totally fails to address the real problems in the US healthcare system.
a. Over-indulgence by the insurance companies.
b. Unsustainable growth (in this case, by Universal Coverage).
c. No tort-reform on law suits.
(read prior posts to catch up on these points)
d. No accountability for the Publically Insured.
One point that has been relatively untouched by the media and the discussion groups that I have seen is the differences in responsibility and accountability between privately and publically insured patients.
My insurance has a co-pay and a deductible. I can look at two different physicians or two different tests (as courses of action) and I have to decide which is best for me medically, but I ALSO have to consider which is best for me financially. I will have to pay 20% of the bill, so there is a substantial difference between a Physician who charges $100 for an office visit -vs- one who charges $600. Or there is a tremendous difference between an Ultrasound which costs $600 -vs- the MRI that costs $6,000. I am forced to weigh the potential benefits as compared to the out-of-pocket expense. i.e. the MRI may not statistically provide better information.
The same is not true for Public Aid. At *best* most PA plans have a flat co-pay per visit. So, if one doc charges $100 for the office visit and recommends a $600 ultrasound, there is no reason for the publically insured patient to choose that route over the $600 office visit and $6,000 MRI, because there is no vested financial interest on the part of the patient. They pay the same amount (usually nothing).
It is a fact that fewer publically insured patients maintain a Primary Care Provider and get regular preventive care. It is also a fact that more publically insured patients use the Emergency Room as a Primary Care Facility. The reason is not a stretch. There is no financial deterent to someone who pays for no part of the visit. I look at paying 20% of a $200 office visit as a far superior choice to paying 20% of a $2,000 ER visit. If there is no financial accountability, why would anyone care?
Unfortunately, the new healthcare law ceases to address this, very real, problem. I work at an inner-city hospital, where 8 or 10 hour ER waits are standard. Most inner-city ER's run less than 20% privately insured. Additionally, it is estimated that less than 50% of these ER visits are actually emergent. The ER's are plugged up with people who choose to use them rather than to establish care with a PCP. It is my experience, that when these patients are stabalized and set up with a PCP, the vast majority of them will NEVER keep the PCP appointment. In clinics that I have managed, Publically Insured "New" patients have almost a 40% no-show rate...over 400% more likely to No-Show than a Privately Insured "New" patient.
How will universal insurance affect this kind of situation? I think our best indicator would be to look at Massachusetts, since it is the only state that already mandates Health Insurance. In MA: preventive visits are down, ER visits are up. Ironically, the ER visits are not up solely because of Publically insured...they are also flooded with Privately Insured patients who can not get in to see a PCP, because the PCP offices are backed up for MONTHS due to the mandatory, unsustainable growth (see previous post). This has now given Massachusetts the distinction of having:
1 the slowest care in the country,
2 the highest percentage of ER visits, and
3 the most expensive healthcare in the US. Look these stats up on the internet, they're scary.
Thankfully, the rest of the country will soon be modelled after MA, so they won't be alone.
I have yet to see the positive side of this law....
Friday, June 18, 2010
Back to Being Me, part 3
To continue my thoughts about healthcare:
Why the new healthcare law will fail miserably (part 3):
1. It totally fails to address the real problems in the US healthcare system.
a. Over-indulgence by the insurance companies.
b. Unsustainable growth (in this case, by Universal Coverage).
(read prior posts to catch up on these points)
c. no tort-reform on law suits.
When President Obama gave his healthcare pitch to congress (and the nation), he had only a few points that made both sides of the aisle applaud. the biggest was the promise that there would be reform on malpractice insurance and lawsuits (tort reform). If anyone notices, this never made it into the law. Now, let's not be critical of Mr Obama. He truly did want to know if the healthcare system had a problem with frivolous lawsuits. He wanted to know so badly that he tasked his Secretary of Health and Human Services, Kathleen Sebelius, to find out for him. She said that frivolous lawsuits probably only cost insurance companies about 5 billion dollars a year...not enough to be worried about. Ultimately, she said that tort reform/lawsuits aren't a problem. I was PERSONALLY relieved to hear her unbiased opinion. Oh, as a sidenote, prior to being the Secretary of Health and Human Services for Obama, Sebelius served as executive director and CHIEF LOBBYIST for the Kansas Trial Lawyers Association. So naturally, she is impartial to matters concerning lawsuits/lawyers.
First off, I don't find a 5 billion dollar savings to be something that is just brushed aside.
Secondly, there is no way to put a price tag on the cost of frivilous lawsuits because they cause reactions that are not measurable. For instance, they are the driving force behind "defensive medicine." For those not in healthcare, "defensive medicine" is when a Physician orders every possible test available, despite a lack of clear medical necessity, because they are afraid of getting sued if they miss something...even if the patient had no indications/symptoms. Thousands of times every day, an expensive MRI is ordered, when its likelihood of showing anything more than an Ultrasound, is statistically insignificant. Physician documentation and language has changed from "evaluate for symptomatic XXXX" to "rule out XXXX." That may seem like an insignificant change, but it costs patients millions (and probably billions) of dollars every year in additional co-pays and out-of-pocket expense. The end result is NOT the hope of finding some undiagnosed illness...it's the ability to sway a jury, in a court of law, to view the physician as someone who did everything possible...even beyond "standards of practice." And I won't even get into the fact that if an insurance company denies a medically indicated test it's the doctor who gets sued if there is a bad outcome....
Thirdly, is the fact that the original 5B in savings doesn't factor in the steady increases in malpractice insurance. I think that very few people have any idea what it would be like to be forced to make a split-second, life-and-death decision based on: limited current patient information, no comprehensive medical history, and no background of events...and know that if you're wrong, you could be sued and lose everything. So, many types of practices pay hundreds of thousands of dollars per physician, per year in malpractice insurance. And who pays for that? The doctor? you and I both know that it is passed on to the patient in higher costs. And again (referring back to my previous posts), the ones who truly pay for it the most are the uninsured.
There needs to be tort reform. There needs to be regulated price caps for insurance, and there needs to be lawsuit caps on liability. $10M won't bring gramma back. yes, her death may have been unfortunate. yes, given the situation her death might have been post-poned. but $10M? It doesn't bring her back. It doesn't make the pain go away. All it does is drive up costs for everyone...and encourage frivolous lawsuits from everyone on the planet who lost a loved one...regardless of circumstance. And those lawsuits cost money, even if the healthcare provider is proven to be not-at-fault.
If we want true reform on the lawsuits, there is one simple way to reform it. Make one tiny law: if you lose a lawsuit, you have to pay for the defendent's legal fees and damages. Frivolotry, thinks twice.
It seems that this entire law does nothing but give more power and less regulation to the insurance companies...while doing nothing for the patient or the provider.
Why the new healthcare law will fail miserably (part 3):
1. It totally fails to address the real problems in the US healthcare system.
a. Over-indulgence by the insurance companies.
b. Unsustainable growth (in this case, by Universal Coverage).
(read prior posts to catch up on these points)
c. no tort-reform on law suits.
When President Obama gave his healthcare pitch to congress (and the nation), he had only a few points that made both sides of the aisle applaud. the biggest was the promise that there would be reform on malpractice insurance and lawsuits (tort reform). If anyone notices, this never made it into the law. Now, let's not be critical of Mr Obama. He truly did want to know if the healthcare system had a problem with frivolous lawsuits. He wanted to know so badly that he tasked his Secretary of Health and Human Services, Kathleen Sebelius, to find out for him. She said that frivolous lawsuits probably only cost insurance companies about 5 billion dollars a year...not enough to be worried about. Ultimately, she said that tort reform/lawsuits aren't a problem. I was PERSONALLY relieved to hear her unbiased opinion. Oh, as a sidenote, prior to being the Secretary of Health and Human Services for Obama, Sebelius served as executive director and CHIEF LOBBYIST for the Kansas Trial Lawyers Association. So naturally, she is impartial to matters concerning lawsuits/lawyers.
First off, I don't find a 5 billion dollar savings to be something that is just brushed aside.
Secondly, there is no way to put a price tag on the cost of frivilous lawsuits because they cause reactions that are not measurable. For instance, they are the driving force behind "defensive medicine." For those not in healthcare, "defensive medicine" is when a Physician orders every possible test available, despite a lack of clear medical necessity, because they are afraid of getting sued if they miss something...even if the patient had no indications/symptoms. Thousands of times every day, an expensive MRI is ordered, when its likelihood of showing anything more than an Ultrasound, is statistically insignificant. Physician documentation and language has changed from "evaluate for symptomatic XXXX" to "rule out XXXX." That may seem like an insignificant change, but it costs patients millions (and probably billions) of dollars every year in additional co-pays and out-of-pocket expense. The end result is NOT the hope of finding some undiagnosed illness...it's the ability to sway a jury, in a court of law, to view the physician as someone who did everything possible...even beyond "standards of practice." And I won't even get into the fact that if an insurance company denies a medically indicated test it's the doctor who gets sued if there is a bad outcome....
Thirdly, is the fact that the original 5B in savings doesn't factor in the steady increases in malpractice insurance. I think that very few people have any idea what it would be like to be forced to make a split-second, life-and-death decision based on: limited current patient information, no comprehensive medical history, and no background of events...and know that if you're wrong, you could be sued and lose everything. So, many types of practices pay hundreds of thousands of dollars per physician, per year in malpractice insurance. And who pays for that? The doctor? you and I both know that it is passed on to the patient in higher costs. And again (referring back to my previous posts), the ones who truly pay for it the most are the uninsured.
There needs to be tort reform. There needs to be regulated price caps for insurance, and there needs to be lawsuit caps on liability. $10M won't bring gramma back. yes, her death may have been unfortunate. yes, given the situation her death might have been post-poned. but $10M? It doesn't bring her back. It doesn't make the pain go away. All it does is drive up costs for everyone...and encourage frivolous lawsuits from everyone on the planet who lost a loved one...regardless of circumstance. And those lawsuits cost money, even if the healthcare provider is proven to be not-at-fault.
If we want true reform on the lawsuits, there is one simple way to reform it. Make one tiny law: if you lose a lawsuit, you have to pay for the defendent's legal fees and damages. Frivolotry, thinks twice.
It seems that this entire law does nothing but give more power and less regulation to the insurance companies...while doing nothing for the patient or the provider.
Thursday, June 17, 2010
Back to Being Me, Part 2
To continue my thought that was so rudely interrupted by the oil spill:
Why the new healthcare law will fail miserably (part 2):
1. It totally fails to address the real problems in the US healthcare system.
a. Over-indulgence by the insurance companies. (see previous post before continuing)
b. Unsustainable growth (in this case, by Universal Coverage).
Several years ago, I was managing a sub/sandwich shop. We expanded to a new location because business was good. The new location was huge and nice, all new equipment, all new staff, etc. On our 5th day in business, the owner showed up and announced that he had put an advertisement in the local paper, to print on Friday. What he failed to tell us was that the print ad was a buy one, get one free. When Friday night rolled around, the shop was swamped. We didn't have enough staff, the staff that we did have was under-trained and unprepared, and worst of all, there wasn't enough product. It was a fiasco. The horrible service that night did irrepairable damage to the store's future business. It was labelled as 'slow,' 'inefficient,' and 'inaccurate.' And all were true for the same reason: demand flooded supply.
Now, back in 2010, we understand the lesson, but fail to make the application to healthcare. If there are suddenly 30,000,000 more 'customers,' we have a huge and sudden problem. There are not enough docs to go around. There are not enough exam rooms. The clinics are understaffed. In a normal, supply-vs-demand, free-market world, the demand rises slowly and supply follows. Unsustainable growth in patients requires sudden growth in facilities and providers. We will see niether of those.
Polls among medical students and early-practicing Primary Physicians are all reporting that less people plan to be practicing primary medicine next year than this year...and the trend is sharply downward for every foreseeable year. The reasons? Over-worked and under-reimbursed. The only way that supply catches up with demand is when there is incentive for growth. Half of the previously-uninsured people, entering the healthcare realm, will be on public insurance. The reimbursement from state aid is as low as 6 cents on the dollar; substantially less than it costs to actually see the patient. *And no one seems to be asking the question about where the states are going to get the money to 'insure' the 15M people. That money is not addressed in the healthcare law, it is laid on the already-cash-strapped states to fund for themselves.*
The point is...it's hard to recruit doctors who will not make any money or build clinics that will operate in the red. The options are few, but here is what is being talked about in the healthcare circles that I am in:
1. limiting the number of patients seen...all walk-in clinics, first come, first serve. This is known in the European/Canadian healthcare system as 'rationing'
2. having advanced practice nurses doing the work of primary care physicians. This is also known as 'reducing quality.'
BOTH of these were warned about, but the government ignored the warnings.
3. charging people a 'retainer fee' in order to have a primary care physician (this is already done in Massachusetts...it had to be done as soon as the state passed their mandatory coverage law).
or the most frightening, and yet most realistic:
4. Hospitals/clinics/physicians opting OUT of the federal/state programs. They simply don't contract with the government. They pay higher taxes, but they are not obligated to provide care for Medcicare/Medicaid patients. They close their Emergency Rooms, and only accept clinically-referred patients to their inpatient units. This is already happening all over the country, in response to the new law. And think about this: the places that are already caring for the non/under-insured patients will close their doors to both. The bill may provide more people with insurance...but end up PROVIDING CARE TO FEWER!
This law will collapse on itself because it fails to understand one of the simplest laws of business...supply and demand.
Why the new healthcare law will fail miserably (part 2):
1. It totally fails to address the real problems in the US healthcare system.
a. Over-indulgence by the insurance companies. (see previous post before continuing)
b. Unsustainable growth (in this case, by Universal Coverage).
Several years ago, I was managing a sub/sandwich shop. We expanded to a new location because business was good. The new location was huge and nice, all new equipment, all new staff, etc. On our 5th day in business, the owner showed up and announced that he had put an advertisement in the local paper, to print on Friday. What he failed to tell us was that the print ad was a buy one, get one free. When Friday night rolled around, the shop was swamped. We didn't have enough staff, the staff that we did have was under-trained and unprepared, and worst of all, there wasn't enough product. It was a fiasco. The horrible service that night did irrepairable damage to the store's future business. It was labelled as 'slow,' 'inefficient,' and 'inaccurate.' And all were true for the same reason: demand flooded supply.
Now, back in 2010, we understand the lesson, but fail to make the application to healthcare. If there are suddenly 30,000,000 more 'customers,' we have a huge and sudden problem. There are not enough docs to go around. There are not enough exam rooms. The clinics are understaffed. In a normal, supply-vs-demand, free-market world, the demand rises slowly and supply follows. Unsustainable growth in patients requires sudden growth in facilities and providers. We will see niether of those.
Polls among medical students and early-practicing Primary Physicians are all reporting that less people plan to be practicing primary medicine next year than this year...and the trend is sharply downward for every foreseeable year. The reasons? Over-worked and under-reimbursed. The only way that supply catches up with demand is when there is incentive for growth. Half of the previously-uninsured people, entering the healthcare realm, will be on public insurance. The reimbursement from state aid is as low as 6 cents on the dollar; substantially less than it costs to actually see the patient. *And no one seems to be asking the question about where the states are going to get the money to 'insure' the 15M people. That money is not addressed in the healthcare law, it is laid on the already-cash-strapped states to fund for themselves.*
The point is...it's hard to recruit doctors who will not make any money or build clinics that will operate in the red. The options are few, but here is what is being talked about in the healthcare circles that I am in:
1. limiting the number of patients seen...all walk-in clinics, first come, first serve. This is known in the European/Canadian healthcare system as 'rationing'
2. having advanced practice nurses doing the work of primary care physicians. This is also known as 'reducing quality.'
BOTH of these were warned about, but the government ignored the warnings.
3. charging people a 'retainer fee' in order to have a primary care physician (this is already done in Massachusetts...it had to be done as soon as the state passed their mandatory coverage law).
or the most frightening, and yet most realistic:
4. Hospitals/clinics/physicians opting OUT of the federal/state programs. They simply don't contract with the government. They pay higher taxes, but they are not obligated to provide care for Medcicare/Medicaid patients. They close their Emergency Rooms, and only accept clinically-referred patients to their inpatient units. This is already happening all over the country, in response to the new law. And think about this: the places that are already caring for the non/under-insured patients will close their doors to both. The bill may provide more people with insurance...but end up PROVIDING CARE TO FEWER!
This law will collapse on itself because it fails to understand one of the simplest laws of business...supply and demand.
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