“According to many on the left, health insurance companies are sleazy and unethical, making obscene profits by charging high prices to sick people, giving physicians and patients the runaround to avoid paying bills, and rescinding policies just when people who paid in good faith get cancer, while their executives often walk away with millions in compensation.”
The individual state’s Board of Insurance is in charge of regulating the healthcare insurance industry. The stated goal is to protect consumers.
All state boards issue licenses to sell healthcare insurance yearly to healthcare insurers.
Few of the state Boards of Insurance have enforced their own regulations. The state insurance boards could easily refuse to issue a license to a company that doesn’t follow the regulations
Dr. Emanuel takes the healthcare insurance industry’s bottom line literally, while ignoring the financial facts.
“Last year, health insurance companies did rack up big profits, but it turns out that the combined profits of the country’s five largest for-profit health insurance companies —United, WellPoint, Aetna, Humana and Cigna — were $11.7 billion, only 0.5 percent of total health care spending.”
“Even confiscating every penny of those profits would add up to less than half of the cost-saving threshold. And even not-for-profit insurance companies need to have an operating margin — a profit by another name. There just isn’t enough money there to make a dent in health care spending.
The bottom line figure after expenses might be published as only $11.7 billion dollars but the real profits are buried into the profit built into the administrative expenses that do not get added into the bottom line.
An additional 25 percent of consumers in this market are in plans that spend between 25 and 30 cents of every premium dollar on administrative costs.
And in some extreme cases, insurance plans spend more than 50 percent of every premium dollar on administrative costs.
President Obama thinks his law will decrease these expenses. The public has also been lead to believe that Medicare’s administrative overhead is 2.5%. The 2.5% is the overhead to maintain a CMS department outsourcing administration services to the healthcare insurance industry and generating new regulations.
The percentage of overhead has to be higher much higher now with the development of Dr. Berwick’s bloated bureaucracy.
CMS outsources its administrative services to the healthcare insurance industry. The healthcare insurance industry adds an additional 20-30% to the bid price for services claims.
The healthcare insurance industry is required to maintain the Medical-Loss Ratio at 80-85%. Medical Loss Ratio means it has to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement rather than on administrative costs.
Healthcare insurance companies have been permitted, by the government, through the influence of its lobbyists, to shift certain expenses from administrative expenses into the patient care expenses. The result is less money spent on direct patient care.
These expenses are designated as direct patient care expenses. Each expense is a profit center. This profit is not reflected in the healthcare insurance company’s bottom line. These are the reasons the net income figures are bogus.
Aetna made $4.8 billion dollars in profit on Medicare Advantage and Medicare Part D alone two years ago.
I think they are always going to try and find way to go aroudn the system or the law and create loopholes to make it legal for them to do this to us. That figure is insane. If they were less greedy we wouldn’t have the economical problems we have now.
I wonder how many Congressional Representatives and Senators read HR3200. It is amazing that our representatives would permit the federal government to restrict our freedoms so severely.
This morning I received this You Tube from a reader. It describes the restrictions on our freedoms created by President Obama’s healthcare reform plan. The restrictions have not be publicized by the traditional media.
I was reminded of the blog I wrote on July 30,2009. Below is the link to the original bill and a copy of my 2009 blog.
It is easy to forget all the restrictions imposed on Americans’ freedoms by this piece of legislation.
On Thursday, Oct 20, 2011 at 8:52 AM a reader sent this You Tube and comment
"This has to be one of the scariest pieces I've seen. If you have the stomach, take the few minutes to review. Maybe even compare the statements with the actual bill." Here's the link to HR3200:
I have compared the You Tube to the original bill. Obamacare is defective. Americans will not tolerate centralized control over our lives and choices once they understand the concepts in the bill.
President Obama has been effective in manipulating the media to keep Americans in the dark.
The House of Representatives Healthcare Bill is 1018 pages long. Many Representatives and Senators did not read the entire economic stimulus bill because “we did not have time” before we experienced a severe economic recession. They claimed to be saving us from another great depression.
I have read a good portion of HR3200. The provisions are unacceptable and sinister. It represents a complete government takeover of our healthcare system. It is not in the interest of the consumer. It is not in the interest of our precious freedom of choice.
Every Americans, especially our Senators and Representative must know what is actually in the bill before it is passed. President Obama’s generalities do not cover the details of HR 3200.
Mr. Schweikart evaluated 498 of the 1107 page bill. The summary of one half HR3200 is frightening. His summary is a good reference guide to the appreciation of the harshness of the bill. It also explains President Obama’s urgency in getting a bill passed before anyone realizes the implications of the bills contents.
Representatives who vote for this bill should not be reelected. They are not representing their constituents’ rights or protecting their freedoms. Your healthcare, health and freedoms are at stake.
You can check the reviewer’s summary against the actual bill at the link below.
“Take a look at what actually is in the Health Care bill. Obama makes disingenuous comments like "You'll still keep your doctor" or "You'll keep your existing health care."
Pg 22 of the HC Bill mandates the Government will audit books of all employers that self insured. Can you imagine what that will do to small businesses? Everyone will abandon “self insurance” and go on Government insurance. So when Obama says that there will still be private health care, it’s simply a lie: this mandate will force employers to abandon their private plans.
Pg 30 Sec 123 of HC bill – a Government committee will decide what treatments/benefits a person may receive.
Pg 29 lines 4-16 in the HC bill – YOUR HEALTHCARE WILL BE RATIONED!President Obama has been saying healthcare is to be rationed all along in code.
Pg 42 of HC Bill – The Health Choices Commissioner will choose your HC Benefits for you. You will have no choice!
Pg 50 Section 152 in HC bill – HC will be provided to ALL non US citizens, illegal or otherwise.
Pg 58 HC Bill – Government will have real-time access to individual’s finances and a National ID Healthcard will be issued! Government has real-time access to your tax return presently and means test Medicare recipients’ premiums
Pg 59 HC Bill lines 21-24 Government will have direct access to your bank accts for election funds transfer. A further impingement on freedom and privacy.
Pg 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions & community organizations (read: ACORN).
Pg 72 Lines 8-14 Government will create an HC Exchange to bring private HC plans under Government control.
Pg 84 Sec 203 HC bill – Government mandates ALL benefit packages for private HC plans in the Exchange.
Pg 85 Line 7 HC Bill – Specifics of Benefit Levels for Plans = The Government will ration your Healthcare!
Pg 91 Lines 4-7 HC Bill – Government mandates linguistic appropriate services. Example – Translation for illegal aliens.
Pg 95 HC Bill Lines 8-18 The Government will use groups, i.e. ACORN & AmeriCorps, to sign up individuals for Government HC plan.
Pg 85 Line 7 HC Bill – Specifics of Benefit Levels for Plans. AARP members – your Health care WILL be rationed.
Pg 102 Lines 12-18 HC Bill – Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice.
Pg 124 lines 24-25 HC No company can sue Government on price fixing. No "judicial review" against Government Monopoly.
Pg 127 Lines 1-16 HC Bill – Doctors/ AMA – The Government will tell YOU what you can earn.
Pg 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE.
Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families.
Pg 149 Lines 16-24 ANY Employer with payroll $400k & above who does not provide public option pays 8% tax on all payroll.
Pg 150 Lines 9-13 Businesses with payroll between $251k & $400k who don’t provide public option will pay 2-6% tax on all payroll.
Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable HC according to Government will be taxed 2.5% of income.
Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.)
Pg 195 HC Bill -officers & employees of HC Admin (the GOVERNMENT) will have access to ALL Americans’ finances and personal records. Big brother will be watching your every move.
Pg 203 Line 14-15 HC – "The tax imposed under this section shall not be treated as tax" Yes, it says that.
Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid. Seniors, low income, poor affected. Kill off the poor and elderly.
Pg 241 Line 6-8 HC Bill – Doctors – doesn’t matter what specialty – will all be paid the same.
Pg 253 Line 10-18 Government sets value of Doctor’s time, professional judgment, etc. Literally, value of humans.
Pg 265 Sec 1131Government mandates & controls productivity for private HC industries.
Pg 268 Sec 1141 Federal Government regulates rental & purchase of power driven wheelchairs.
Pg 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!
Pg 280 Sec 1151 The Government will penalize hospitals for what Government deems preventable readmissions.
Pg 298 Lines 9-11 Doctors who treat a patient during initial admission that results in a readmission – Government will penalize you.
Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.
Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion – Government will mandate hospitals cannot expand.
Pg 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!
Pg 335 L 16-25 Pg 336-339 – Government mandates establishment of outcome-based measures which of course forces health care rationing.
Pg 341 Lines 3-9 Government has authority to disqualify Medicare Adv Plans, HMOs, etc., forcing people into Government plan.
Pg 354 Sec 1177 – Government will RESTRICT enrollment of Special needs people!
Pg 379 Sec 1191 Government creates more bureaucracy – Telehealth Advisory Committee. Healthcare by phone.
Pg 425 Lines 4-12 Government mandates Advance Care Planning Consultations. Think Senior Citizens end of life prodding.
Pg 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of attorney. Mandatory!
Pg 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in how to die. EVERYONE on Social Security, (will include all Senior Citizens and SSI people) will go to MANDATORY counseling every 5 years to learn and to choose from ways to end your suffering (and your life). Health care will be denied based on age. 500 Billion will be cut from Seniors healthcare. The only way for that to happen is to drastically cut health care, the oldest and the sickest will be cut first. Paying for your own care will not be an option.
Pg 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.
Pg 429 Lines 1-9 An "advanced care planning consultant" will be used frequently as patients’ health deteriorates.
Pg 429 Lines 10-12 "advanced care consultation" may include an ORDER for end of life plans. AN ORDER from the Government to end a life!
Pg 429 Lines 13-25 – The Government will specify which Doctors can write an end of life order.
Pg 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life.
Pg 469 – Community Based Home Medical Services/Non profit orgs. (ACORN Medical Services here?)
Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORGANIZATION. 1 monthly payment to a community-based organization. (Like ACORN)
Pg 489 Sec 1308 The Government will cover Marriage & Family therapy. Which means they will insert Government into our marriages.
Pg 494-498 Government will cover Mental Health Services including defining, creating, rationing those services. You’d better speak up now before you are on the "advanced care consultation" list.
It gets worse: the Health Care Reform bill that is now about to come up for a vote will absolutely eliminate private health care options. Do not kid yourself: They are going to say that they aren't going to interfere with your right to go to your "own doctor" or have your own "private health insurance." But there won't be non-government doctors or private health insurance if the government mandates them out of existence.
Even still, I hear people who want to "get past all this partisanship." Sorry, but GROW UP.
Our system from the beginning has pitted one group against another out of fear of the very giant government that is metastasizing before our eyes. James Madison didn't like "parties" or "factions," but he finally admitted that they were absolutely necessary to fragment power.
For our system to work there has to be a clear choice, not a mushy middle, because the mushy middle always, always, always gravitates left. There is a "presumption of power" on the left –conservatives, by nature, do not like government, don't trust it, and do not want to use it to advance their ends, which they see as advanced through liberty, individual achievement, and entrepreneurship.
It is hard to read H3200 and comprehend its implications. However, a careful reading leads me to similar conclusions to those of Mr. Schweikart.
Do you think your representatives have studied the bill? If they have and vote for it they should lose your vote. If they have not read it and vote on party lines they should lose your vote.
This bill is not going to Repair the Healthcare System. It will make the healthcare system more complex, restrict access to care, restrict the delivery of care, ration care, limit freedom of choice, and increase the deficit.
Let your Senators and Representatives know the proposals are unacceptable. Write, fax, call, email, twitter. Tell them:
“We do not want the government to control our lives. We want affordable, universal healthcare coverage that does not limit access to care. We want control over our healthcare dollars. We do not want government to control our lives and our money.”
We all agree the healthcare system is dysfunctional. As Obamacare works its way toward full implementation the dysfunction has intensified and healthcare costs have increased. It is important for all of us to recognize why Obamacare is a disaster.
Obamacare will not only destroy our healthcare system. More importantly It will destroy our freedoms.
On October 19th 2011, President Obama said his administration has done everything correctly. It just hasn’t worked out yet.
Does anyone believe him?
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
I received the following comment from a reader. The comment is sincere, honest and heart felt. The dysfunction in the healthcare system affected his mother and father.
This is a blind spot for you and a blog that comes across as defensive versus simply acknowledging the role the Physician must play in reducing excess utilization. “
There is no question that physicians’ delivery of medical care can be ineffective and dysfunctional creating waste.
It does not follow that physicians are the primary source of waste. Physicians are convenient targets for causing the majority of the waste in the healthcare system because the medical interface is between physicians and patients.
Sometimes patients have a horrible experience interacting with the healthcare system.
It is difficult for a sick person to navigate the healthcare system. When a person is sick they realize how inefficient the system is.
I have tried to emphasize how all the stakeholders’ incentives are misaligned. The results is this dysfunction. Physicians’ incentives are created by government, healthcare insurance industry and hospital systems rules and regulations.
I am not interested in making excuses for some physicians’ poor behavior. I am more interested in making the public aware of every stakeholder’s role in our dysfunctional healthcare system.
“Either you have never had someone in your family who’s been referred around the system with no significant benefit or your Endo experience is what you apply to the rest of healthcare delivery.”
“Either way, you accept no responsibility for Physician intervention to reduce consumption of healthcare and all the data says you’re not being objective. There are many reasons Physicians don’t intervene to reduce consumption but to imply it’s only a small amount of $ isn’t being honest.”
I have tried to point out some of the major reasons for physician dysfunction.
h. Decrease in effectiveness in reproducible laboratory results and procedure results lead to retesting to make the correct diagnosis.
What can seem like piling on of procedures to a patient and his family might not be a quest for dollars but a quest for a correct diagnosis.
In most cases the dollars do not go into the ordering physician’s pocket.
This is the reason the healthcare system must be consumer driven. It would incentivize patients to challenge physicians who are spending the the consumers money. The system should not be government or healthcare insurance industry driven. Patients must own their healthcare dollars. Patients must be involved in understanding the physician’s thinking.
“My mom was referred around the system for tests, specialist visits etc. for 6 years with a very clear set of symptoms until my sister diagnosed her through web based research with a Histamine allergy/reaction. Why in the world with classic symptoms that are available on the web would she simply be handed off Dr. to Dr. to duplicate tests over and over again yielding no care plan or plan to narrow the diagnoses?”
“ The answer is EVERY activity, every visit, every test, every procedure generated revenue for the providers. My sister is a real estate broker not a Dr.”
I cannot address this problem with the data provided. Maybe your mother went to the wrong physicians.
A Histamine reaction is are usually an epiphenomenon. The reactions are usually secondary to an underlying stimulant. Sometimes the underlying stimulant is a disease that can be deadly. If diagnosed the underlying diseases can be cured. Many time the cause is benign. Perhaps this could explain her physicians difficulty in diagnosis.
“My Dad was diagnosed with lung cancer in 1995. He had a lobe removed and recovered for a great year in 1996. In Nov 1996 he was diagnosed with brain mets (what were his chances for survival at that point? No one ever talked to the family.)
“They did brain surgery, radiation and rehab and 6 weeks later the cancer was back in the same location in the brain. Now what were my Dad’s chances for survival? No one ever mentioned palliative care or that my Dad was going to die barring a miracle. Instead, another brain surgery was scheduled by the surgeon, then more radiation until my Dad’s brain was fried and he stroked.”
“Now, if you think that surgeon isn’t part of the problem, that generating revenue with activity isn’t rampant in our healthcare system, then I simply don’t give your blog much credibility because clearly it is and it must be addressed not by outsiders, but by Physicians.”
I disagree with the PCPs. Patients and their families should be the captain of the healthcare team. The Primary Care Physicians should coordinate care and follow the will of patients and their family. Primary care physicians should be the coach of the healthcare team. .
“These aren’t isolated cases of excess utilization, they are the norm. If Dr.’s aren’t proactively part of fixing it, then care will be rationed. If consumers get control of their own healthcare dollars it would be the single biggest hit to revenue for all providers that could possibly take place (I support consumers armed with info making decisions).”
I do not think it would decrease physician revenue significantly. I think it would decrease waiting times to see a physician and decrease delays in treatment.
The major cause of excess utilization is the lack of tort reform and the resulting defensive medicine. Consumers must drive physicians to communicate effectively or move on to another physician.
President Obama has refused to recognize tort reform as an issue.
The healthcare insurance industry’s control of the healthcare dollar would vanish utilizing my concept of the Ideal Medical Saving Account. It would reduce costs by the 30-60% the healthcare insurance industry takes off the top for first dollar coverage. It would make consumers wise spenders.
“In the meantime, the fee for activity system we have now doesn’t work for anyone except industry, insurance companies and providers who do expensive things. The patients and doctors whose expertise requires cognitive time with patients have all been shortchanged on this journey to where we are today”.
This is precisely why we have to have a consumer driven healthcare system. Consumers must control their healthcare dollars and be individually responsible for their treatment decisions.
“Sorry, you’ve touched a nerve.” Sincerely your
The same blog hit a nerve in another reader. He wrote:
“This piece made me think of an old verse that states the case of the physicians pretty well:”
I'm not allowed to run the train The whistle I can't blow… I'm not allowed to say how far The railroad cars can go. I'm not allowed to shoot off steam, Nor even clang the bell… But let the damn train jump the track And see who catches Hell!
It is easy to see the elephant from one point of view. Incentives have to be aligned. The healthcare system must be realigned to the patients’ point of view.
President Obama and Dr. Don Berwick think they are seeing the problems from the patients’ point of view. They feel the government has to dictate care.
They are creating a system so bureaucratic and complex that they will blow up the healthcare system. They will make the system more dysfunctional and more costly.
A reader responded to my last blog, Why ACOs Will Fail, with the following comment.
"Stan
Let's keep our objections as simple as possible, so we can explain them better. The ACO's are a form of capitation. Why should doctors be at any financial risk for performing a service that the government and the public feel is absolutely necessary?
Sincerely
R.M. M.D."
The point I made was that the only way to repair the healthcare system is if patients are responsible for their healthcare dollars and for the maintenance of their health. Patients with the appropriate education with will force the healthcare system to be competitive (Consumer Driven Healthcare).
It is naïve to assume that physicians and hospital systems are interested in taking risks for patients’ behavior.
HHS head,Kathleen Sibelius, does not think I am correct according to hernews release;
“Changing the way we pay hospitals will improve the quality of care for seniors and save money for all of us,”
The sites in the pilot have not achieved the level of saving to share with Medicare.
CMS hopes 75 to 150 groups will apply and qualify as an ACO. The startup investment and first-year operating expense for a participant in the Shared Savings Program is estimated by CMS to be about $1.75 million per ACO. Many say this estimate is low.
CEO of the large hospital systems and group practices are starting to understand the financial trap ACO’s represent.
“They’re very detailed, and somewhat prescriptive, although there’s a mention that if there’s an alternate idea, and you can show how your proposed alternative meets these goals, they would consider it.”
The Geisinger Health System, one of the 10 Physician Group
Practice demonstration sites plans to stay with the PGP model for another two years, especially since the new rules for the second portion of that program were just released.
Dr. Graf also notes that some organizations will have to endure a
25% withhold, which means that in order to make sure new ACOs
are able to manage any losses, they’ll retain one-quarter of shared
savings. “To the extent you’re a startup ACO, you have to put in
costs now, presumably something to improve the care that you’re
delivering on both the quality and cost side. You incur costs on
Day 1”.
Dr. Graf explains: “Let’s say that in the first year, you qualify for
shared savings of $2 million. [CMS says] we’ll pay you $1.5 million
and we’ll retain half a million in case in the second year you have
$300,000 of losses, which will come out of the $500,000.”
CEOs are realizing that an effective plan must include smaller organizations. Local markets must be represented because all medical care is local. The hospital system CEOs also are beginning to recognize that patients must be central to determining their own healthcare needs. Consumers must be responsible for their own care for a healthcare system to be effective.
Craig Samitt, MD, president and CEO of Dean Health System in Madison, WI. says,
“There are many complexities and process-based requirement in ACO s.”
Large investments will be needed for most organizations to be high-performing ACOs”
Some don’t think ACOs equitable or practical. ACOs will not
know which Medicare beneficiaries they will be judged on until at
least a year after the program is under way.
Many have expressed concern that there just isn’t enough time between now and Jan. 1 for the final regulations to come out. There is not enough time for them to apply and be approved. It will be impossible for them to have all the pieces in place for a highly functioning ACO.
Chris Van Gorder president and CEO of Scripps Health expressed that concern, among others. “The government is trying to put a politically correct managed care
system of healthcare together requiring the hospitals or the ACO to assume both financial and quality responsibility for patients without even letting them know who those patients are prospectively.”
Chris Van Gorder says “he’ll hold his system back from applying for
Medicare ACO status unless the regulations undergo significant
change.” “Frankly, I was surprised. I thought there would be more
carrots, not so much stick.”
He emphasized that rather than this flawed ACO model, CMS would get better results by expanding bundled payment incentives to include hospital care. “That will get faster and maybe better results than by trying to push the ACO too fast.”
He also says that “he was quite surprised the regulations
impose a penalty for lack of performance on cost controls “right
at the beginning of this grand experiment. That was expected
over time, but [not] for a startup program that is extremely
complicated and far-reaching. One would have thought the
feds would have done all they could to attract and incentivize
healthcare providers and suppliers to take this risk.”
That sentiment was echoed by Richard A. Hachten II, president
and chief executive officer of Alegent Health in Omaha, NE.
“It’s appropriate that we’re going to be managing people’s
health differently going forward; it’s the financial risk part of it
and not being able to do that as effectively as one could if you
knew which patients you were working with, and could do a more
effective job in coaching the use of healthcare resources,” he says.
“So we think there’s a significant amount of unmanageable risk
built into the way it’s set up currently.”
Jay Cohen, MD, executive chairman of Monarch Healthcare in Orange County, CA says;
The negatives on the flip side outweigh the positives in the proposed regulations, and may prevent his organization from opting to be an ACO. “The way the proposed regulations are written will not work.”
George Halvorson, chairman and chief executive officer of
Kaiser Foundation Health Plan and Kaiser Foundation Hospitals,
which has 8.8 million members nationally, says his system does
not plan to apply and will stay with prepaid Medicare Advantage.
Kaiser, he says, already has a much more advanced team approach to care that goes beyond the four walls of the system. “We’re already there and we’re giving great care. We’re cutting the number of heart attacks in half; we’re cutting the number of broken bones in half.”
There you have it. “The Art Of War”. The healthcare organizations Dr. Donald Berwick was depending on are not going to show up to his ACO party.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Please let me know if you’re looking for a writer for your blog. You have some really good articles and I believe I would be a good asset. If you ever want to take some of the load off, I’d love to write some articles for your blog in exchange for a link back to mine. Please send me an email if interested. Cheers!
President Obama finally admitted that we are at war with terrorists. He said there are problems in the massive intelligence bureaucracy.
It “failed to connect the dots of intelligence.” If the agencies were coordinated Umar Farouk Abdulmutallab, a known terrorist, who paid cash for his ticket, did not carry luggage and did not have a proper visa would not have been permitted to board the plane to Detroit on Christmas Day.
It was not a failure to connect the dots. There are systems defects in the bureaucracy. The intramural politics of bureaucracies prevents important information from moving up the food chain.
Robert Baer makes this point clear in his book “See No Evil 1988”. The CIA does not have agents in the field that understand local politics.
“Because his account of how we have no assets that are useful against terrorism. There are four other stories within this excellent book, all dealing with infirmed bureaucracies.”
The administration’s response to the potential terrorist attack demonstrates Robert Baer point.
“The National Counterterrorism Center’s NCTC and CIA—have a role to play in conducting (and a responsibility to carry out) all-source analysis to identify operatives and uncover specific plots like the attempted December 25 attack. . . .”
The agencies were not coordinated and missed the obvious terrorist.
How does this relate to the Healthcare Reform debate?
The Democrats in congress and President Obama’s administration are about to pass a terrible healthcare reform bill. The bill misses the obvious. An example of an ineffective bureaucratic agency is the Healthy People Project
The goal of healthcare reform should be to help Americans receive effective healthcare. I have contended that increasing bureaucracy and the cost of maintaining a bureaucracy does not deliver better healthcare or make Americans healthier. President Obama’s healthcare bill expands government bureaucracy.
Real cultural changes in eating and self responsibility,
Real enforceable food production legislation,
Real tort reform,
Real healthcare insurance reform,
Real chronic disease management systems education for both physicians and patients.
These real changes will help decrease the cost of medical care.
Unfortunately none of these changes are in President Obama’s healthcare reform bill. Instead there are 118 new boards, commissions, and programs doing its thing to generate reports and pilot studies.
Atul Gawande in a recent New Yorker article pointed out that President Obama’s healthcare reform bill offers pilot studies.
“So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.
Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude.”
“There are more obese Americans than a decade ago and not fewer. We eat more salt and fat, not less. More of us have high blood pressure and diabetes. More of our children have untreated tooth decay, obesity and diabetes.”
The lack of control of these diseases result in their complications.
"We need to strike a balance of setting targets that are achievable and also ask the country to reach," said Dr. Howard Koh, the federal health official who oversees the Healthy People project. "That’s a balance that’s sometimes a challenge to strike."
After more than 30 years, the goals aren’t well known to the public and only a modest number have been met.
“About 41 percent of the 1990 measurable goals were achieved. For the 2000 goals, it was just 24 percent. Worse, the nation actually retreated from about 23 percent of the goals.”
I would say this expensive bureaucratic pilot study was a failure.
Healthy People 2010 called for the percentage of adults who are obese to drop to 15 percent. In 2000, 25% of all adults were obese. Now, about 34 percent of adults are obese. Twenty eight percent of Americans had hypertension in 2000. Today 29% of Adult Americans have hypertension. The Projects goal was to reduce hypertension to 16%.
“To many health officials, simply making progress is a victory. An analysis of 635 of the nearly 1,000 targets for the past decade shows only 117 goals have been met. But progress was made toward another 332. In other words, there was improvement in 70 percent of the measures.
"That’s evidence of a healthier nation," Koh said.”
You have got to be kidding!! Is this what we want from President Obama’s Healthcare Reform bill, 118 new bureaucratic agencies? There is something wrong here.
…and we won’t be getting any healther over the next decade. While the ‘reform’ will increase access, a worthy objective, it is otherwise promoting stagnation or actually reversing progress. Where is the cost control in the pending legislation? Will Medicare recipients be content with less care? Will physicians still see Medicare patients with continued erosion in reimbursement, or should we cut these patients loose like the Mayo Clinic’s Arizona satellite? Will defensive medicine ebb in the absence of tort reform? Will the public’s appetite for expensive medical technology disappear? Will medical quality improve? If it does, it will be in spite of health care ‘reform’. I think that as the public grasps what awaits them,which may take time, that there will be a backlash. My summary is that this will all cost much more than they say and deliver much less than they promise. http://www.MDWhistleblower.blogspot.com
Congress is trying to figure out how to generate increased tax revenue to pay for the healthcare reform plan. The popular press has not discussed the congressional proposals for raising taxes
Congress is going to raise taxes for healthcare reform. The President has not opposed the notion. No one is talking about the real issues. The real issue is to fix the defects in the healthcare system effectively.
Can Americans trust politicians? Americans want universal healthcare, affordable healthcare coverage, access to care and an increase in quality of care. President Obama’s generality promises this. He never goes into the details.
“Senate negotiators had been considering a tax on some employer-provided health benefits.”
The Democrats are trying to figure out who to tax first to cover the 1.5-3.5 trillion dollar deficit that will be created by President Obama’s healthcare reform plan. They have decided to tax the “rich.”
Taxing the rich has not worked in the past for many reasons. The house proposal presently is a surcharge on the rich in addition to raising the tax rate to 39%.
“The House Ways and Means Committee was said to be nearing agreement on an income tax surcharge of 2 percent or more on Americans with the highest incomes – those earning more than $250,000. The surtax would rise for those earning $500,000 and rise again for those earning more than $1 million.”
Tax the rich to help the poor. The rich usually disappear as a taxable entity when this occurs.
One commenter said;
“ Look, the "Rich" don’t pay taxes. The Kennedys don’t pay taxes. Their money is in offshore trusts. George Soris doesn’t pay taxes. Al Gore is making bazillions off his energy soapbox but he’s not paying taxes. This will all come out of the hides of the middle class, until we have meaningful tax reform.”
The Senate and the House are now fighting over which tax increases should be incorporated into the healthcare bill. I suspect the public will become aware of the tax increases after they are passed.
“A proposed sales tax on sodas and other sugary drinks and a new payroll tax of 0.3 percent to be paid by employees and employers was in favor last week but has gone underground for now.”
There are lots of ideas on how to increase taxes to pay for President Obama’s healthcare reform plan.
“The Senate seemed to be narrowing their focus on a plan that would tax only the most generous employer-provided health plans – those worth $25,000 or more a year – as well as a modified limit on tax deductions proposed by Obama.”
Democrats’ mode of operation is first spend and then tax. I believe all large employers will have their employees buy insurance through the public option. The penalty will cost less than providing healthcare insurance
“Senators are also considering a plan to apply the Medicare payroll tax of 1.45 percent to nonwage income like dividends and capital gains.”
Congress seems to be doing everything in its power to decrease investment incentives in the name of healthcare reform without even realizing what they are doing. Investment incentives have made America strong.
“One tax increase would bar drug companies from deducting the cost of advertisements as a business expense on their corporate tax returns.”
If congress wanted to fix the healthcare system and lower costs they would restrict direct to public advertising completely.
“Another would end a tax break for healthcare flexible spending accounts.”
Democrats in congress are going to increase taxes in multiple ways to pay for President Obama’s healthcare reform.
“Senators don’t like to raise revenues,’’ Baucus said, using a euphemism for tax increases.
The White House has not expressed a position on the surtax, but lawmakers said they had heard no objections so far.
It seems to me the Democrats have not learned anything in the last 50 years.
They have not learned that :
Entitlements are bottomless pits.
The public does not like bottomless pits because it leads to tax increases.
Increasing tax leads to a decrease in economic growth by decreasing innovation and risk taking.
Government’s role should be to make rules that level the playing field for all the stakeholders and then get out of the way. (Adam Smith)
I believe the Democrats are heading for another 1994 congressional debacle without the Republicans doing one smart thing. The Obama healthcare plan is doing nothing to improve in the healthcare system. Congress is going to pass a bill that spends a lot of money and accomplishes nothing
The Obama method lets others do his dirty work. He makes sure it is what he approves as he stays on the high road.
Obama’s chief of staff, Rahm Emanuel, who visited the Capitol twice this week to discuss healthcare proposals with House Democrats.
He said the president would prefer that money to pay for the legislation come from within the healthcare system.
But unlike a tax on employer-provided benefits, which Obama opposed during the presidential campaign, a tax on the wealthy would be in keeping with his promise not to raise taxes on Americans earning less than $250,000 a year.
America’s healthcare system’s costs are going to escalate with Obama’s healthcare plan just as they have in Massachusetts. The President will be forced to raise taxes even further.
I am afraid this will not stimulate a faltering economy. It will make it worse. With increasing taxes we will all be on the way toward working for the government.
Move On.org ability to social network is legend. MoveOn.org acted immediately with a call to action as soon as it was obvious that the healthcare insurance industry was going to attack President Obama’s healthcare plan. Its plan is to attack the healthcare insurance industry
Blue Cross Blue Shield is trying to kill "a key plank in Obama’s reform platform." So we’re trying to raise $150,000 in two days to fight back. Can you chip in $35 right now?
Breaking news on health care: The Washington Post is now reporting that insurance giant Blue Cross Blue Shield "is putting the finishing touches on a public message campaign aimed at killing a key plank in Obama’s reform platform."1
The Huffington Post sums it up as "Insurers Planning on Double-Crossing Obama."2
MoveOn.org drew the line in the sand before the healthcare insurance industry using old media tactics finished its storyboard.
“We knew the insurance companies would eventually turn on the president, but this is much sooner than expected. And they’re targeting the public health insurance option—the crucial piece that will help cover everyone. So we’re immediately launching a rapid-response campaign to go toe-to-toe with Blue Cross Blue Shield and win quality health care for all Americans.”
MoveOn.org makes the point that the insurance companies turned on the President. It has prepared a rapid-response to help the President get his healthcare reform package passed in 2009.
“We need to raise $150,000 in the next two days. It’s a lot, but we’ll need every penny to take on Goliath. We’ll run ads, hold events, and work like crazy to get the real truth out to voters. AND we’ll keep the pressure on Congress to make sure they don’t get bullied into gutting the president’s plan to guarantee health care coverage for everyone. Can you chip in $35 right now to make it happen?”
MoveOn.org’s message is clear. It is asking people to send money to prevent the healthcare insurance industry from destroying a key provision, (“National Insurance Exchange”) in the President’s healthcare reform plan. President Obama’s healthcare reform plan claims it will provide a public health insurance plan option that will not subsidize neither healthcare Insurance companies CEO’s salaries nor stockholders profits therefore reducing healthcare costs.
MoveOn.org ignores the fact that our country presently cannot afford the costs of Medicare . Expanding Medicare will be a disaster.
“If we had the choice of a public plan, private insurers would have to lower rates and improve quality to compete, so they’re dead set against it. Today’s news just confirms that fact.”
You bet the healthcare insurance industry is dead set against his plan. However the healthcare insurance industry is the administrative service provider for government operated healthcare plans. Everyone will move to the public plan. The healthcare insurance industry will make a greater profit because everyone will be insured. The process of setting price will be in the hands of the healthcare insurance industry.
There will be not improvement in access to care or quality of care because the incentives in the healthcare system will not be changed.
“In the past, Blue Cross Blue Shield has been sued for underpaying doctors and fined for refusing to cover necessary medical treatments for their customers.3 Now, with what watchdog group Media Matters calls a "desperate attempt to deceive,"4 they’ve gone one step too far.”
The healthcare insurance industry has killed the goose that laid its golden egg. It is impossible for consumers or physicians to sue the government. The government will be forced to underpay physicians as well as restrict access to necessary medical treatment.
The debate is not a debate on Repairing the Healthcare System. It is a debate between the government and the healthcare insurance industry about who controls the healthcare dollar
MoveOn raised $270,000 in 24 hours surpassing the goal of $150,000. The message is loud and clear. Consumers are mad as hell and they do not want to take it any more.
“Dear MoveOn member,
Amazing! After news broke of Blue Cross Blue Shield’s new campaign to defeat Obama’s health care plan, MoveOn members responded in a huge way. Together, we smashed our goal and raised $270,000 in just one day. (Thanks!)”
Move on.org will not stop there and set a new goal of $350,000 for the next 24 hours.
“If we can hit this mark, we’ll send a strong message to the entire industry that if they start trying to block Obama’s key health care proposal to cover everyone, we’ll be ready to fight back—hard.”
This is too much for Harry and Louise to take on. When consumers realize that President Obama’s plan will not work they will demand control of their healthcare dollars.
There are three take home points.
1. The old media will not work.
2. People power using the new media is very powerful
My 50th Columbia College reunion is coming up in June . I volunteered to be on the Jubilee Reunion committee. As a member of the reunion committee I developed a social network for Columbia College CC’59 using Ning. I like Ning’s founder Marc Andreesen’s mind. I was curious to see if a social network would work with 70 year old Columbia College graduates. We all need social networks because we are all social beings whether we admit it or not. .
The network works. I have reconnected with college friends I have not seen in 50 years. One connection was with one of my medical school roommates.
He invited me to visit him when I was in L.A.(Santa Monica) . I went to Los Angeles two days before my weekend with Brad to renew our friendship. The first challenge was getting to his house and then getting into his house. The taxi dropped me off a block from his house because a gate closed off his street. I snuck through the gate
Marty is a psychiatrist. He sees patients in his house. He office layout is the same as HBO’s program “In Treatment”. I arrived early and figured he would be busy with a patient. I was sure he would leave a window open to climb in just as he did in our basement apartment in medical school. Lucky for me I arrived during his lunch break . He has two Great Danes. Each one is bigger and heavier that I am. If I climbed through the window I would have been the Great Danes’ lunch.
Marty and I had a simple lunch and talked non-stop. He cancelled his patients for the rest of the day. We were off to his gym. I jog daily. I never used an elliptical machine although Cecelia has tried to convince me to try it. Marty insisted I use it because then we could talk side by side. After 15 minutes my quadriceps were on fire. When I got off the machine (after 35 minutes), I could hardly stand up. It felt seasick for the next hour.
In our gym clothes we went galley hopping at Bergamot Station in Santa Monica. When we got back to his home he asked me to help him walk his Great Danes.
I am not a dog lover. The dog I was walking almost dislocated my shoulder. It was less than an enjoyable experience.
Marty has not changed one bit in 50 years. I would bet most of us haven’t changed much.
With my thighs still hurting I ended up running 4 miles to the Santa Monica Pier by myself the next morning. My run to the Pier was too much. My thighs were really hurting now. I had to run walk or crawl to get back since I had no money.
Marty and Francine took me for a surprise lunch of Hebrew National Hot Dogs at Costco I love Costco. The three of us went shopping and spent an hour buying things they did not need.
They do not take reservations. However, Marty using his best psychiatric skills and charm talked them into giving us a reservation for 7 pm. Brad and John were stuck in traffic. Brad twittered me their problem. We gave up our table and walked on the beach until they showed up. Welcome to L.A.The meal was great and the look of the place was authentic hippy.
On Friday morning we went to the L.A . Museum of Art . The museum architecture is hodge podge. I think L.A. county should have blown up the original build before adding on. The exhibits were fair.
Thank you Marty and Francine for showing me the Los Angeles I had never seen before. And finally thank you Marc Andreesen for Ning and reconnecting me to Marty.
After I wrote the article about consumer driven healthcare a Washington lobbyist said to me; “ many people in Washington do not think that the Massachusetts healthcare plan has failed. In fact President Obama and many congressmen think the Massachusetts plan should be the model for the federal government’s healthcare reform plan.”
This is difficult for me to believe. The Massachusetts healthcare reform plan fails all five criteria the Institute of Medicine’s use to define an effective healthcare plan. The plan not only fails all five criteria for healthcare reform, it has encountered obscene cost overruns.
The Massachusetts healthcare reform plan flunks by all five criteria.
Universal healthcare coverage : The state still has more than 200,000 citizens without coverage. The number is rising as a result of increasing unemployment.
2 . Continuous coverage: Coverage is not continuous if individuals lose their jobs. The healthcare insurance premiums have risen. Small businesses can not afford to cover employees. It is less expensive to pay the state imposed penalty tax.
3. Affordable for individuals and families: Individuals and families cannot afford coverage.
“For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications. “
4.Affordable to Society : The original budget for the Commonwealth Care subsidized program was $387 million dollars. It almost doubled in the first year to $630 million dollars. The estimated cost in 2009 is $1.3 billion dollars. Massachusetts has already received a federal government bailout of $2 billion dollars for healthcare. These cost increases are not sustainable nor affordable to society.
5.Access to high-quality care for everyone : High deductible plans are cheaper but the deductibles are so high many consumers can not afford care when they are sick. Much of the population is under insured. The goal is to assure affordable healthcare insurance while providing quality care.
If the plan flunks all five Institute of Medicine criteria how can policy makers in Washington think it is a success? They are deceiving themselves and the public. Why bother study the effectiveness of the plan when you can believe in the buzz?
There are other issues that compound the failure. They include local political issues of power.
1. “Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals.
2. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world.
3. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.”
President Obama , please be aware of the unintended consequences of Tom Daschle’s healthcare plan. Throwing money at defective and unsustainable systems will not work. It will fail no matter how much plan is intellectualized by healthcare policy wonks at thirty thousand feet above reality.
Some think the Medicare model meets the Institute of Medicine’s five criteria for healthcare reform. They are convinced Medicare for all is the answer.
They argue;“Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country.
Medicare does satisfy the first three criteria. It insures everyone over 65 regardless of preexisting illness. It provides access to care and not tied to a job.
However, it has not be affordable to every senior. High deductibles, massive copayments and services approved and therefore billable but not covered must be taken into account when deciding on Medicare’s affordability for seniors on a fixed income. Medicare Part D (drug coverage) has failed to be affordable from the onset. The premiums have tripled in the last 2 years.
The only system that will repair the healthcare system is a system in which consumers control their initial healthcare dollars and is taught to be responsible for their health maintenance. .
President Obama, you should take a hard look at the ideal Medical Savings Account option to control costs and improve the health of America.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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EMR • November 22, 2011
I think they are always going to try and find way to go aroudn the system or the law and create loopholes to make it legal for them to do this to us. That figure is insane. If they were less greedy we wouldn’t have the economical problems we have now.