Physicians News Health news for doctors and patients.
The big news affecting all of healthcare is the subject of reform. Today, President Obama will speak at the AMA Convention to garner support for his proposals. Physicians News will cover much of his discussion, reform proposals and reaction from different sources with different viewpoints. If you would like to add your point of view, send a comment to this post and we’ll add to the national dialogue.
Breaking News
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The funny (actually Sad) thing is… these entitled victims, without previously purchasing healthcare insurance, and who would rather drive a Benz, Lexus and live in a shack etc… NEVER have or had intentions to purchase Medical insurance…. and now….. the working tax payers have(forced) to support their entitlement to basically free Med benefits. So just another step in supporting, Pro Creating bad work habits, laziness and propagating bad gene pools. If this was 100 years ago, these entitled, non working, non tax paying and yes Voters (should not have the right to vote if you do not pay taxes or collect from a social program) these victims would either starve and die or get off their butts and do something for themselves and families. So Yes… let’s punish the working, educated, self driven, contributing citizens, tax payers and make them pay some more. Great reward program for the invalids of America… Thanks again Obama and staff. Voters should = Tax Payers and Exclude anyone collecting from a social program.
The same tactic used to win the election again. Gain support from the many, who have less and take from those who have more. He got support of primary care docs, ie the AMA and pitted them against the relatively few who chose long difficult residencies, high stress, odd hour, high liability exposure medical careers (Surgeons, Anesthesiologists etc). We’re going to fix this all by giving primary care folks more income and “save money” by paying less to the “greedy” specialists, who drive up costs, and, by the way, taxing the crap out of their income they have. Well, as someone who spent many extra years of training and now sweats through long complicated surgeries on the sick elderly for about $80/hour, I’m soon done. Yes, the rate of “reimbursement” for Medicare is about $20 per unit (15 minutes of time). Anesthesiologists got royally screwed when they calculated the relative value scale, and even the Government admits it. Most specialties collect 80-90% of insurance rates for Medicare patients, we get about 33%. My income has stagnated or gone down in the last 15 years while the cost of living here has skyrocketed. I can no longer affort my mortgage payment, in addition to college tuition. I pulled my other kids from private schools (thank God we have good public schools here) and we essentially quit the country club. We can’t afford a vacation this year. So someone please tell me why I’m still staying up all night taking care of laboring patients, busting my ass to keep old sick people alive while they have their hips replaced? My family and I no longer can enjoy any of the benefits I thought I secured while spending my 20’s studying and working while all my friends played. When I am forced to sell this house (the value of which just got crushed), I’m done in Medicine. Yeah, you’ll have insurance, you just won’t have the quality people you have now taking care of you. Have your primary care doctor or Michael Jackson’s doctor push your Propofol. I’ll be working on a dive boat in the Caribbean.
Basic healthcare such as immunizations, preventive medicine, diagnosis and medical treatment of diabetes, hypertension and numerous other diseases should be a right of all our citizens and could easily be paid for without a huge increase in federal debt. However, advanced medical treatment such as transplants, coronary by-pass surgery and many others is simply too expensive for society to provide free for “everyone”. The sooner we establish a two-tiered system of care, the sooner we can bring rationality back to medical care. Rationing may be a bad word now but better that physicians do the rationing than let politicians make the choices based on political contributions, getting out the vote, nepotism and bribery.
Another fact of healthcare is that practicing physicians have almost no voice in medical education. Medical schools are run by insulated academic specialists who indoctrinate students in expensive secondary and tertiary care but abandon the basics such as cleaning ears, physical examination, stopping nosebleeds and treating colds. Little wonder that we have to import primary care doctors from abroad.
Oh, and yes there are a lot of great plans on this site, but interestingly, there are no MDs at the table helping to formulate plans about healthcare, I guess we are not needed when the objective is to lower cost, lower quality of care, designate new taxes and bankrupt private insurance. They have a better track record.
believe it or not there are MDs out there in favor of these plans. I find it saddening. Obama is trying to generate a type of “class” warfare among MDs to support his plan, getting the primary cares to become hateful of specialists who earn more, to earn support when he cuts their reimbursement. But not far behind that are the cuts to primary care,(the majority of physicians and where money is spent). The head of the AMA already make a 180 degree turn in favor of Obama’s plan. I don’t know who greased his wheels, but its obvious what happened. We need leader of physician organizations who represent us, not slimy backpedaling hypocrites.
This site needs to limit the number of characters permitted in the comment section. For those writers whose passion requires more than two paragraphs – get politically active and be part of the change, ranting on a website won’t get it done.
I am stunned that the major networks will not carry comments in response to the Obama healthcare proposal. I suggest that we all boycott the mainstream media stations, notify and boycott their advertisers and be certain to let them know that we are displeased with their unjournalistic, one-sided coverage of this matter which affects the entire populice. Once it passes, there will not be any recourse or turning back. We must be called to action and not just complain and be led as lambs to the demise of a wonderful healthcare system that may require some minor tweaking to make even better.
Tell Obama he can see the patients himself. I quit.
This is in answer to Dr. Jean-Pierre Forage M.D.
I like your plan, it is simple, no new bureaucracy required to run it and we can help these patients, the earlier the better.
I would sign up for it.
Karola F. White, M.D.
I am a one MD child psychiatric practice in urban area, now 4 1/2 years out of Residency and after almost 2 years working in the hospital now in private practice. My experience is that the cost of running my business is rising, while the reimbursements are falling and soon Psychiatry as a whole will be “Medicine for the rich” only. I believe in the old fashioned medication and therapy approach, which is proving to be very effective to get patients better and keep them to stay healthy, but a tightrope dance between paying my bills and bankruptcy. I see 85 % military families due to feeling strongly about supporting our troops and their families. This is not easy. I already had to give up all Medicaid patients, after I incurred more debt than I got reimbursed, which I am struggling to pay off at this time.
It all summons up that the way to save money in medical care is to hold patients responsible for their health, instead of taking health for granted. Patients that have an interest in their health seem to listen better, follow instructions and come to appointments to prevent problems instead of waiting until there is a crisis. Life insurances have different rates for smokers and non-smokers, high risk takers and low risk people and give benefits for healthy lifestyles. If insurance companies would reward non-smokers, healthy lifestyles and people who get regular checkups it would save money. In psychiatry specifically, having the ability to go and see a psychiatrist prevents suicide, alcohol and drug abuse and chronic health and mental problems due to psychiatric illness of any kind. Blue Cross Blue Shield does not even allow psychiatric care any more and I have to specify that the medication “Zoloft” (a very effective antidepressant and anxiety medication) is used for “other than psychiatric” reason for my patient to have it reimbursed to him from BCBS (I don’t know the branch, specific policy or particular state this patient has it through). Tricare will not allow brand name medication “unless” the patient has had “severe”, meaning “hospitalization required” side effects to the generic, and even then they requested a retrial on generic Lamictal, after the patient ended up in ICU with Stevens Johnson Syndrome. The cost associated with ICU stay to “prove” that the patient can’t tolerate this medication is huge. The 8 year old girl with ADHD, doing well on generic Focalin, having to be exposed to a different medication with all the risks involved, because the generic Focalin is not available in the US (due to pharmaceutical not making it) and the Insurance refusing to give her the brand name to save money. These are all wastes of money and risks to patients that are simply not needed. Many patients who have to be exposed to numerous “preferred” medications, before they will be allowed to get what works with least risk and no side effects, due to the insurance companies dictating what the patient has to take, unless I take the time for the inevitable 45-80 minute phone call to the insurance company to explain why this is my medical decision, with most of the time is rewarded with the patient getting the medication I deem most effective with the least risk to the patient. But taking 80 minutes out of my day, cost the patients and me, not the insurance companies, who only stand to save money, because physicians can’t afford to do this. Nothing I can do about it, I tried.
Other factors contributing to the high cost of health care as I see it.
0. Showing up for appointments is not mandatory and too many patients see it as not needed and then call in crisis, need to go to ER with preventable events, if they simply followed up as scheduled. Aside the fact that it does cost me money, because of not getting paid if the patient is not showing up, and I am not allowed by the insurance company to bill the patient. The cost for ER visits, hospitalizations, needing to restart medications that have run out needlessly are staggering.
1. College and Medical School are very expensive, starting to make money in your 30’s with $ 100 K to 200 K in debt that needs to be paid off increases the amount of money a physician has to make to be able to afford a family.
2. While I worked in-patient child and adolescent psychiatry I saw many times that kids were admitted for ONE day and the insurance companies told me (the very next day) that the kid did “not meet” their criteria for being in the hospital and the phrase of “well doctor, we are not telling you to discharge the kid, we just won’t pay for it”, became routine, which is a reason why I quit. Also that insurance companies told me personally that unless I “medicate more aggressively” they would not pay for the stay and that insurance companies demanded daily face to face telephone contacts with their own doctors (of any specialty) to justify why they should continue to pay for the stay. Uninsured patients were seen for free by the MD, except that I am carrying the full responsibility for them for at least 21 years concerning malpractice. Finding out that the government reimburses the hospitals for uninsured patients seen and cared for, which never was passed down or shared with any of the MD’s as far as I know.
Only one insurance company allows RTC (Residential Treatment Center) stay, which in more than one case has helped so much, that no further hospitalizations or ER visits were needed and the kids and their families are thriving. The on call required to work in the hospital was excessive and totally unpaid, while the hospital profits from the ER visits with high charges and the physician having to be available for between 48 hrs and 7 days non-stop, ignoring the deleterious effect this has on patient care. During my time in the hospital three kids, ages 9-15 ended completing suicide, because after discharge they were not able to continue being seen by a psychiatrist, because of the lousy reimbursements, they could not find a provider, or because the family fell through the cracks. A simple follow up would have saved all three lives.
In my city of 2 million, Medicaid patients will not find psychiatric care as required, because these patients have the highest no-show rates and the reimbursements are too low to afford carrying these patients. In addition Medicaid takes up to a year of clean claims being submitted, re-submitted and kept track off that I had to chose between hiring a full time staff to get Medicaid to pay or let go of the patients. I love many of them and regret having to let them go. The quarterly letters by Medicaid to safe money under the “let-us-help-you-care-for-your-patients- pretense accusing me of malpractice by prescribing whichever medication they are trying to safe money on did not help either. Especially since these accusations of inappropriate prescribing is based on pharmacy records only, and no request from me, to please enlighten me on a “contraindication in this patient” has ever been answered. EG the teenager, who Medicaid claimed had a cardiologic reason to not be on Adderall, neither the teen, nor his family, nor my records reflected any “cardiologic” anything. Or the schizophrenic teenager, who lives with the delusion of being pregnant, with Medicaid simply accusing me of prescribing antipsychotic to a pregnant teenager. With Medicaid demanding medication changes every three months, which can’t be cost effective, with the patients being exposed to more medications, more relapses, more impairment and more hospitalizations needed to stabilize them.
3. In private practice, the cost are increasing, because I need to have staff to keep up with the insurance companies (2) that I am still taking, and this is difficult, since clean claims constantly get refused, because of insurance internal problems, because of the amount of calling involved to follow up with the insurance company, because of the paperwork required to get authorizations, which lately have been refused, even though given less than a week ago, causing me to have to pay overtime to my staff, which is not reimbursed. The reimbursements are not keeping up with increased cost of running the business, not even to break even from one year to another. I am more and more struggling and having to see more patients to make the same money as last year. I can’t afford the electronic billing and record keeping demanded by the government, however much I agree with the benefits they can provide. I looked into it, but the cost is undo able for a one MD place with no corporate financial cushion.
At this time giving my patient the health care they deserve and that I see working well with minimal hospitalizations needed and patients getting better with least amount of medications is costing me:
12 hour work days, 6 days a week,
24/7/365 having to be available for call/emergencies (all call care is not reimbursed by insurances and can’t be charged to the patient per insurance demands, but serve to keep patients well and out of the hospital, which saves the insurance money. It also saves money to keep patients on smallest amount of medications and teaching them the life skills that they need to keep themselves healthy, which is also not reimbursed by insurances. This is also not reimbursed, because you can only charge one event per day or two per week and the sicker a patient is, the more often they need to be seen to prevent bad things from happening.
Missing out on life.
Physicians must remove the cloak of complacency. T.McG.
Just remember – no matter what is decided, Obama is shoving this through and wants it signed into legislation on July 31st – a Friday and a non-newsday.
Get organized, be loud, be heard and be intelligent. Contact those that will listen (they do exist) in both your State and Washington and let your voices be heard. Fax, e-mail, write, call. We have to come together to work quickly and efficiently. O’bama wants this pushed through without a shout heard.
I agree that the current system needs to be addressed and fixed but
it simply can’t be done in 41 days.
President Obama’s Healthcare reform has nothing to do with reform and/or correcting what is wrong with our current system. The fact he and his administration haven’t charged the private sector to identify what’s wrong with our system and recommend how to fix it only means that he wants CONTROL. Government control leads to poorly run governmental services such as postal services, medicare, medicaid,education, FDA, FCC and the list just goes on and on.
Those of us that work in Healthcare know that many things are broken and need to be fixed, many things need to be strengthened, that many people in our Country need coverage and on and on; however, it should be recognized that we have excellent Healthcare in America. To further support this fact is the amount of people that come to our Country for their own private Healthcare services from foreign lands.
The radical changes that Healthcare deserves can happen in three or four months and cost us a Trillion dollars. This would be as absurd as his stimulus package that no one, no one even read before voting on it which stimulated nothing.
The number one thing that could be done to reduce costs without costing a cent would be to eliminate defensive medicine altogether. The simple fact that he doesn’t get this or rather chooses to side with those legal entities that financially thrive off of malpractice suits and claims is another example of his desire to CONTROL rather than reform. In addition to this, until tobacco, alcohol and our high carb diets in America are dealt with we cannot expect the demand for Healthcare to decrease.
It’s very odd to me that our President doesn’t hold those “town hall” meetings with Healthcare providers as we all look to enhance our Healthcare system in America.
Remember this……….HEALTHCARE PROVIDERS HAVE ALL THE POWER IN THIS REFORM AND SHOULD NOT BE INTIMINATED INTO CHANGE THAT WILL ALLOW OUR HEALTHCARE SYSTEM TO BE REDUCED TO A GENERAL MOTORS. THIS IS YOUR OPPORTUNITY RECOMMEND AND FIGHT FOR THE CHANGES THAT ARE NEEDED IN HEALTHCARE. God knows we don’t need a President, a legislator or a judge to run our Healthcare.
And what about the 45 million Americans without insurance that were used to start this government take over of Healthcare?
Be strong, steady and unified. Healthcare providers must diagnosis the problems and make their recommendations to our President and to Congress and then demand the changes that are needed to reform…we have the creativity, passion and talent to accomplish this task.
I would like the AMA to propose to the president this option: national health insurance, what about national malpractice insurance. He could kill two birds with one stone. This would set government guidelines for malpractice. National standards would be set for risk management and courses would be required. It would help us out at least in Pennsylvania. The democratic party trial lawyers could feel rest assured that they would be paid
Below is a health care plan that I believe is both practical and innovative. I am a physician and board-certified surgeon who has been actively practicing for over 20 years.
UNINSURED, BUT NOT UNCARED FOR: A MODEST HEALTHCARE PROPOSAL
Much political hay has been made over the fact that 45 to 50 million Americans are without health insurance. Little recognition is given to the fact that care was provided to these patients without compensation. While it seems to be politically popular to call for healthcare reform and find new ways to pay for this in the form of new taxes and restructuring government, one fact remains: patients in this country have always been cared for by physicians with or without payment. In this current economic crisis I would submit to you that we continue to allow providers to care for patients without the government compensating them, rather than generating some new type of Medicaid for the masses or fully a subsidized health care plan. I would suggest that we leave the current system in place, with the follow provisos:
1) Physicians continue to care for patients as they have, and all patients below a certain income level would be treated with no charge to the patient.
2) To compensate the physician caring for these patients we would simply allow them to take their reasonable and customary charge, reduce it by 50%, and then submit this charge on their income tax as a tax credit.
3) No physician would be allowed to actually receive a tax refund beyond what they would have owed in tax, so the best a physician could do would be to pay no taxes on money generated elsewhere in the practice.
It is often stated that patients show up for treatment sicker and further along in the course of their disease because they don’t have insurance and thus wait to the last minute to present in the emergency room settings with more severe complicated illnesses that require more services and protracted stays with higher risks of complications. By freeing the patients from the burden of worrying about how they will pay for this care, hopefully we will see the patients sooner and, in fact, make it less expensive for all parties concerned and have a higher quality of outcome for the patient. It would be important to pick a threshold number at which all people earning under a certain level of income (who are not already eligible for Medicaid or Medicare) would be the only ones eligible for this program. I submit that this level could be consistent with the current tax schedules for paying income tax. Additionally, we could give an incentive to employers to provide insurance to employees tax free.
The question of how this program would be administered is simple. The physicians would continue to care for patients, submit their claims directly on their tax return. They would be monitored by the Internal Revenue Service, and thus oversight would be criminal penalties should a physician falsify a claim. Quality could be controlled by the fact that physicians already have peer review and oversight, both through their medical boards and hospital committees.
Some would argue that this appears to be a tax break for physicians who don’t need a tax break, as they are relatively high wage earners in this country. I would submit that this, in fact, is not a tax break, but an actual small compensation for services that are currently being provided at no charge, and would continue to be provided at minimal charge, for amounts less that any program that could be created through government intervention.
For argument’s sake, let’s just do the math. There are approximately 300,000 physicians in this country, and the average income for a physician in this country is somewhere south of $150,000. If we were to take all the physicians in the entire country and say that they all participate in this program and every physician provided enough free care to pay no income tax, we would then say that the country would loose the revenue of all 300,000 physicians’ income tax amounting to 15 billion dollars. If, however, we were to divide 15 billion dollars into 50 million patients, we see that the care being provided would be at the cost of approximately $300 per patient annually, far less than any program that could be administered by the government. In reality, it is unlikely that all physicians would participate, so some revenue would still be generated for the Internal Revenue Service by physicians not participating in the program. It is also likely that physicians who participate would more commonly overshoot the free care they were providing, and thus be giving care without compensation.
Also, patients would gradually start to show up earlier and be less sick, so the actual charges generated by the physician would continue to go down. Thus, this program would have a built in quality improvement factor and an overall cost lowering feature.
I have presented this idea to several political campaigns and to several organizations, both legal and medical. Unfortunately, most of the time it is met with comments such as “this does not create new jobs”, or “this looks like a tax break for doctors”. As has been elucidated above, this is a sound program that would provide a service that would cost less than the government could ever dream of providing, continue our current system of health care which remains the best in the world, and remove the stigma that some feel is attached to an un-insured patient, thus resulting in overall better health for the American population as a whole.
Everyone wants to think outside the box and wants to come up with the next new program, but sometimes the answer stares you right in the face. I believe the time has come to do what is right and not what is politically enticing. I would submit that this is the former, not the latter.
Jean-Pierre Forage, M.D., F.A.C.S.
Austin, TX
512/443-5954
Let’s see, Government pumped out cheap money (the Fed), Government removed the moral hazard in most mortgages (Fannie & Freddy bought conforming loans, thus lenders could make otherwise shaky loans with no risk), Government spread these inherently risky loans throughout our financial system (Fannie & Freddy securitized blocks of shaky loans, which securities -coming then from Government, became AAA -truly a silk purse out of sows’ ears), and Government forced lenders to lend to parties they would not otherwise (the CRA regulations).
Barney Frank, Congresses’ current financial leader, never saw a lousy loan he did not like. Our President was one of the lawyers suing under the CRA, forcing lenders to loan where they knew the risks were too high. Etc. And we imagine these people will fix our economy?
Government has created the atrocious Medicaid and Medicare systems, not to mention the VA. And we are to look to these bozos to “reform” medicine?
I found Obama’s comments misleading. He warns against the fear of those that claim his plan is “socialized medicine,” but that is the description of the system is proposing. We cannot honestly believe that a government that runs Medicare and Medicaid into the ground would be able to run a broader health insurance program with greater efficiency, can we? Bottom line, anytime the government is involved in an industry or sector in which private companies are also involved, the private companies are the ones to suffer. They cannot compete with the (taxpayer-funded) immense resources of the government. Scale back the current government programs and open the market more to private companies to provide downward pressure on prices and allow them to negotiate with physicians for fair and reasonable compensation.
The current system frustrates everyone and does not reward those who care for themselves responsibly OR those who are kindest to their patients; rather, it punishes healthy people by forcing them to underwrite those who drink, smoke and eat too much, and it punishes cost-conscious, kind doctors who spend time with their patients with low fees. Underpayment for cognitive office visits encourages overuse of procedures. Forcing all seniors into a government plan is flat wrong. All people who are healthy enough to work should be encouraged to purchase regular insurance and not be forced into Medicare. The only people who will take Medicaid are generally unscrupulous gamers who jack up charges by doing unnecessary X-rays etc. that are office-based, and our public clinics, who are paid completely differently from regular providers–about twice as much for a regular visit. Most physicians would be delighted to see those patients for THAT price. Physicians HAVE NO SAY at the bargaining table and as a result, our fees have eroded 50% in the past 16 years. For us, insurers are nearly as bad as the government: both seek to set our fees below where they should be, and most of us are about to go broke, if we are not dermatologists, eye doctors or plastic surgeons, but since those people are still around and are highly visible, patients think we are all rich. If we must legislate our health, here are some ideas:
1. YOUR FAULT insurance: i.e., like the Safeway editorial in the WSJ said this week, and like auto insurance, your premiums and out of pocket costs should be higher at your workplace if you smoke, drink or are significantly overweight, and you should be rewarded if you improve in those areas. They do it at some companies, and it works. It motivates people and directly reduces utilization and improves quality of life. Want to know why our system costs so much, America? LOOK IN THE MIRROR! YOU ARE COMPLETELY IRRESPONSIBLE WITH THAT EXPENSIVE MACHINERY CALLED YOUR BODY. HOW you pay more could be creatively done. Perhaps the fairest way would be to tax alcohol, cigarettes and unhealthy processed junk food and fast food, and use those taxes exclusively to underwrite the health care costs of those vices. Then, when someone is having their heart attack, lung cancer or liver disease 40 years later, we can say “enjoy your illness, you have already paid for it, and now there is no charge.”
2. Legislation prohibiting doctors from organizing into bargaining groups must be repealed at once. No other labor group is prohibited from bargaining for their pay. This anti-trust legislation is a farce. It was pushed through by insurance companies before physicians even realized what would happen to them, and the situation is untenable. Insurance companies don’t even pretend to negotiate any more: they simply post a new, LOWER fee schedule every year. We absolutely CANNOT continue doing our work with overhead going up and fees going down. The government itself admits Medicare fees cover only 83% of physician costs, yet the insurance companies are trying to lower ALL our fees to that level, and get us to work for nothing, after we go to school until we are 30. Our most recent fee schedules from some carriers cut our fees 10-20%, depending on the item. My overhead is 70%. If you cut me 20%, you just cut my salary two thirds. I will be gone soon at that rate. Then, people are putting off going to the doctor: that may cut my gross 20-30%, and I am OUT of business; most people would be.
3. Get rid of insurance agents in health care altogether. These people provide absolutely NOTHING to the health care equation. Doctors are being treated like we are pork fat and need to be cut out; these people ARE. I cannot go to the website of a major carrier and get a quote and sign up for a policy. WHY NOT? I am FORCED to purchase through an agent, who gets 10% of my premium, OFF THE TOP. This person is not a patient, physician, hospital or drug company, and does NOTHING for that money month after month. My agent came to my office ONCE, 3 years ago, to get our signatures. I don’t even know his last name, and have not seen nor heard from him since, yet he collects a CHUNK of my health care financing dollars for NOTHING, EVERY MONTH. Clearly, he is obsolete. The entire amount of my health care dollar that is spent on physicians is 20%. Add that 10% to it, and physicians could have back the 50% their fees have fallen in the past 16 years. These commissions are COMPLETELY irrational. Better yet, why don’t physicians BECOME insurance agents? The training takes all of…..oh, maybe 50 hours? Let the primary care physicians do this, and we wouldn’t have to worry about raising their fees and lowering the specialists’. Let specialists who ARE the PCP for a number of their patients do it too. Like school choice and vouchers….if a PCP did a good job, they would get more people buying insurance through them, and if they did a poor job, they would lose customers.
4. Figure out what it costs the entire system to process a claim, and eliminate all insurance company coverage AND PRICE CONTROLS of procedures costing less than that amount. Better yet, figure out what “affordable” procedures are, and apply this concept to all of those. Currently, I have to file a claim for every injection that costs only $11 (think 3-4 gallons of gas!!) It clearly costs the system more to process that claim than the cost of the claim. This is a completely irrational system, in that case. People pay more than that for a manicure or a single person’s meal at a cheap restaurant. Insurance is supposed to cover UNFORSEEN or EXPENSIVE events. What would your car insurance cost if it covered gasoline? Yet this is what our insurance is being asked to do. This is micromanagement, and it’s insane. Remove all procedures costing less than a tank of gas (or $100, or some rational amount), which we all pay cash for every week, from coverage and pricing by the entire industry, and LOWER premiums by the savings. Put the difference in HSAs. Let doctors price these procedures competitively in the marketplace and let people choose what they want to consume and pay directly for these services from their HSA. Then the money would be there, but the insurance company wouldn’t need to be involved. The 10% insurance agent fee and the 20-30% insurance company overhead fees would be gone, and the dollars could go directly where the patient chooses; into actual CARE, not middlemen. Physicians who do a lot of low cost procedures would have lower overhead, so there would be savings all around.
5. We need to stop kidding ourselves that every person vested in our country should eat steak. Health care is NOT a right, it is a privilege. And just because people are not insured doesn’t mean they aren’t GETTING care. Those who cannot afford regular insurance should have a good public system to access. They should get a card enabling them to go to the public hospital clinics and the federal community clinics that are so cost effective and do a great job. We should build more of those. Medicaid mills should be put out of business. Medicaid patients cost the taxpayers more than regular patients, because the payment for services to them is so abusively low that providers feel justified in abusing the system back with excessive procedures. We already have a lot of elements in our system to take care of the poor. I run a totally free clinic on Saturdays. If doctors weren’t so underpaid, I could get more to volunteer, like they used to.
We should not be tying up too many resources at this time in an effort to change who administers the financing of healthcare. All of our time and money should be spent directly addressing the main cost drivers that are responsible for our high costs. Once we get a handle on costs, we can then decide who should pay for care. We might make a different decision at that time than we would have made at this point in time.
Absolutely against this reform. I am a Medicare-Medicaid provider. That system is bad enough w/out this cost raising rationing reform proposal.