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In the News

Good news, or so you think. But, first they say that you have to demolish your house, rebuild according to their design and specifications and use their
“qualified” stove. If you choose your own stove, there will be penalties. Also they will determine what your payments will be and by the way they will have access to your bank account for automatic deductions. Is this about fixing your stove? Or about control?

The American health care system is composed of heath care services – the care you get and health care management – how that care is managed and paid for. Health care services in America are excellent. Many people travel here for care they can’t receive in their home lands. Like the stove, health care management  would benefit from a tune up but it does not make sense to bulldoze the entire system. Tune up tools should include tort reform, increasing the tax exemptions for money  saved in HSA’s, increasing insurance competition and portability, allowing small business owners to pool resources when shopping for affordable coverage, and placing all third party payors under the jurisdiction of state insurance commissioners to increase accountability enforcing prompt payment laws. Howard Dean just said in a recent town hall meeting that tort reform was not included because the authors of the bill, while willing to face opposition, were not willing to face the American Bar Association.

Why is the AMA behind Obamacare? The AMA membership represents only 19% of all US MDs. One third of these members are medical students or residents who have not yet practiced in the private sector and another 25% practice in a group or university setting.  Therefore the AMA generally does not represent physicians in private practice who by and large are caring for the majority of the American population and are to be most impacted by any universal health care plan. Maybe the AMA is supporting Obamacare to make sure that they have a place at the table and share in the control. Already they make a majority of their money not from membership but from publishing the codes that doctors have to use to describe your problems and treatments to insurance companies. I am sure the AMA will be positioned to be a significant publisher of all of the additional codes and regulations that Obamacare entails.

What about uninsured who do not have health insurance? First let’s find out more about these reportedly 45 million “uninsured”. One fourth either have Medicaid but don’t consider it health coverage or are eligible but have chosen not to apply. Another 25% can afford insurance but choose to spend their money elsewhere. Twenty five percent are not Americans but live here. Only 11 million are Americans who have some health matter which makes their premium beyond their budget. It is these Americans who would benefit from some locally managed health care pool or tax credit to facilitate their purchase of insurance. In our community, Community Medical Access Program (CMAP) is available for uninsured people who require more health care than they can afford. CMAP is staffed by volunteer local physicians and health care personnel. Another solution would allow physicians, like hospitals, to get tax right offs for any charity care they provide. That would increase the number of providers available for these patients.  Obviously, it makes no sense to upend the health care of the rest of America to solve the difficulty of these few, when solutions exist to assist this specific group.

Will there be rationing? Short answer – YES. The committee is called the Health Advisory Benefits Committee. The President will have the power to appoint up to 17 of of the 26 members. The committee “shall at least include providers, consumer representatives, employers, labor, health  insurance insurers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies” ( emphasis mine) By the way the committee will have at least one practicing physician or other health professional. Imagine the committee which will determine what services are going to be offered to which people has at least one physician! To be precise it does not even have to be a physician just a health care professional. This is so “no single sector unduly influences the recommendations of such a Committee”. If this committee decides that a certain type of cancer treatment does not provide enough benefit to enough people, then it will not be allowed. What do you think that will do to innovation and new research? Who will control the committee which determines what type of health care we get and therefore controls health care spending which currently represents one third of our economy? Yes that would be the Executive branch which will have the power to appoint over 60% of the committee. What happened to checks and balances?

Who will pay? Short answer – You will. We have been told repeatedly that only the “wealthy” will pay. In states like Tennessee, Maine and Massachusetts which have universal health care, health care costs have gone up for the average healthy American. This is because premiums are no longer determined based on your age bracket’s general health, but through “community ratings” which requires that insurers cover any one who applies, regardless of their health condition. That is why a young single healthy male in Maine pays $762 and next door in New Hampshire his costs would only be $222. Also if you do not have a “qualified” health insurance plan ( no one knows how that is to be defined) then you will be charged a 2.5% tax on your adjusted gross income. The government gets a cut of what you make before you pay your first bill.  FYI aliens will still get the health care but not be taxed. Also each person will be issued a machine readable National health ID card  through which they will determine if an “individual is eligible for a specific service with a specific physician at a specific facility” and they will have access to your bank account for electronic transactions. That is a lot of control for a governmental entity. Lord Acton said “ Power corrupts and absolute power corrupts absolutely”

What will be covered? That will be decided by Health Advisory Benefits Committee. What we do know is that there is a strong incentive to have advanced directives and end of life plans and there will be funding specifically for “advanced care planning consultants”. That could become a growth industry for you young people who are looking for a steady income career especially since we are all getting older! Currently if you don’t agree with your insurance or how they treat you, you can appeal the ruling or get other coverage. Under a government plan there will be no place to appeal a decision and no alternative plans for coverage.  Ultimately whether or not you get a lifesaving medicine or surgery will be calculated on your BTS score. For those of you not familiar with the new speak, BTS is “benefit to society”. Least you think I speak too strongly on this matter, I refer you to an article in the medical journal Lancet January 2009 by a bioethicist Dr. E Emanuel, who happens to be brother to the White House Chief of Staff. He writes that rationing of health care for older Americans is not discrimination, rather it is justifiable under “The complete lives system”. He believes that as a 65 year old you have enjoyed more life years than a 25 year old and therefore merit less health care. This type of rationing would make health care a competition in which a federal board - Health Advisory Benefits Committee - would determine who most merits care. This system would change how we view other people. Instead of seeing them as fellow travelers in life’s health challenges, they will be viewed as competitors for limited health care resources and providers. Your physician would no longer be rewarded for being your champion in your crusade for health, rather he or she will be penalized if they “over utilize” health care resources or referrals.  This system would increasingly build distrust between physicians and patients and between the mature and the youthful and the fit and unfit. While the framers of this bill undoubtedly have good intentions, we know that “good intentions pave the road to….”. I personally could not recommend medicine as a career to anyone in that type of environment.

So after all this serious information, where is the fun?
 Before we get to that, there are proposals in which abortion would be included as part of the universal coverage. This will present a problem for Catholic affiliated health care systems. Currently one out of eight hospitals is affiliated with the Catholic Church and provide 16% of hospital admissions.  Already the line between faith based values and health coverage has been tested and the faith based organization lost.  ( see WSJ August 13, 2009 Houses of Worship: Patrick Reilly)). Regardless of your position on abortion, are you willing to subsidize another person’s choice with your money?  That is the question that we will all be asked to answer. So where is the fun? Since it appears that O’care may have us subsidize other people’s choices, as a plastic surgeon, I would advocate that augmentation, Botox and Fillers should be added to the list of what is universally covered. I know there are lots of ladies and many men who would appreciate the life enhancing benefits of these procedures. If you think that is too generous, maybe instead we could allow people who save more than their deductable amount in their HSA, to use the difference for cosmetic procedures. That would give many people the incentive to save more money! Joking aside there are lots of ways to reform the management of health care, without transforming it into a government monopoly.

So where is the faith and hope? I had the opportunity to go to our local town hall meeting regarding health care. They were expecting only 50 to 70. The room was filled to capacity and was overflowing…more than 400 people. I have only seen more people “pumped” with excitement and passion at a Georgia Florida game!  Reportedly the same thing happened in Waycross and apparently across the nation. People care and are interested enough to attend…on a work day in the rain. While I do not know the outcome of this contest, I suspect that the Washington was unprepared for this volume of response. I also suspect that while they may tone down their approach, they are still committed to controlling your care in the name of improving it, and will try to find other paths to that goal. Based on the research that I have done, it appears that O’care ultimately is not about making the system function more efficiently or at lower costs. It is certainly not about improving your care or your coverage. It appears to be about increasing government’s control of your life (and death) and eliminating your choices while it exercises it choices to ration care. While you may not agree with these conclusions, I would encourage you to do what many people are doing, find out for your self. Read the bill. Do not let politicians or appointed government bureaucrats tell you what is best for you and your loved ones. Take the time and initiative to make sure that the government does what it was tasked to do by our Founding Fathers which is to give us the liberty to pursue our best interests, not to further their own special interests in the name of good intentions.

References:

 http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/medical-student-debt.shtml

 

CMAP -  Community Medical Access Project
1.)  CMAP opened in 2003 and has provides some $17M in free health care services to area uninsured since then.

2.)  We have 250 volunteers with about 100 medical/dental providers, 100 nurses/nurse practitioners etc., and 50 administrative support folks

3.)  CMAP provides 3 core services:  Primary and Specialty care including vision and dental; MedBank Membership prescription assistance to some 110 pharmaceutical companies; and disease management services with a focus on diabetes.

4.)  CMAP has 18 employees and operates with $1.5M/year

 

Change in costs of gas, stamps and eggs and
Surgeon’s payment paid for same procedure 1999 -2007

 

1999

2007

% change

Gas

1.22

2.80

200% increase

Stamp

33

41

30% increase

Dozen eggs

89cents

1.34

50% increase

Payment to surgeon

 

 

25% decrease