The Coming Health Care Changes

The past few months, I've been impressed with the coverage of New York Times writer Robert Pear in his coverage of how legislation and politics are affecting health care. His articles are highly detailed and he shows he has done a great deal of homework in preparing them. Underlying his reports, I find, is a concern for what is going to happen to consumers, and both Republicans and Democrats may find themselves the subject of his critical lens and pen. On November 1, 2010, the day before the elections, he presented findings of two federal courts ruling that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage regarding common chronic conditions such as multiple sclerosis, Alzheimer's disease, and broken hips:

Medicare will pay for those services if they are needed to maintain a person’s ability to perform routine activities of daily living or to prevent deterioration of the person’s condition, the courts said. Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.

Advertisement

The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis, Alzheimer’s disease and broken hips. Skilled care may be reasonable and necessary and covered by Medicare even if the person’s condition is stable and unlikely to improve, the courts said.

The government has not said whether it intends to appeal either decision.

Representative Joe Courtney, Democrat of Connecticut, welcomed the decisions. "People with chronic conditions are being denied care in the mistaken belief that Medicare requires improvement of a person’s condition as a prerequisite for coverage,” Mr. Courtney said Monday. “That’s not in the law. It’s urban legend."

In the next months I think it will be important for all of us to follow what goes in with Medicaid, Medicare, and other health care legislation, and I think looking for Robert Pear's byline is one way to obtain good information on crucial details that might be important for yourself or those you love.

William Van Ornum

 

Comments are automatically closed two weeks after an article's initial publication. See our comments policy for more.
6 years 10 months ago
Dr. van Ornum,

I  have had a podcast on my IPOD for a couple weeks on health care.  It is from the Hoover Institute at Stanford.  It is by a doctor at the Stanford Hospital and a fellow at Hoover named Scott Atlas.  I get emails from Stanford periodicallye and one pointed me towards this site on health care


http://www.hoover.org/research/health-care/other 


The Hoover Institute is generally very conservative but has some fairly impressive people.  Some of the things on the site are informative.


I have a soul mate who is a doctor in White Plains.  Next time I see him, I will ask him about fees and doctors in Westchester.  I know there are some who will not take insurance and deal only in cash and they do not seem to be short of patients.  I have another doctor who literally saved my life by his attentiveness.  He said he was concerned that all the new laws would make it unattractive to practice medicine both from a financial point of view and a regulatory nightmare.
Regina Sewell
6 years 10 months ago
I don't even know where to start.  The wealthcare package infuriates me.  This approch to Medicare infuriates me.  The whole system as it is infuriates me.  As its working now (the statistics bear this out in far to clearly) the system is benefiting greatly a small percentage of the population and sucking the middle class and working class dry.  The top 1 percent of the population controls 42 percent of the wealth in the United States (as of 2009 - it could be worse now).  Here's a way to further increase the split between those who have and can afford health care and those who can't.

It makes me wonder why our country isn't honest about it.  Why not tell people, once you get a deteriorating condition and hit a point that requires care, that's it.  You are goig to die.  Or better yet, why not just off them...   have some medical officer knock on our doors and say, "sorry, your mother/brother... has a condition that will cost too much so we killed her/him.  They did die a quiet and peaceful death."
Stanley Kopacz
6 years 10 months ago
To David,

Yes, a level playing field is necessary.  But when companies spend a lot of money in lobbying and lawyers to keep regulations from being enacted or enforced, they are culpable and responsible.   But their competitors are not each other as much as the needs and welfare of the American people.

we vnornm
6 years 10 months ago
I read the article carefully but will have to read it again. It seems to be saying that Medicaid/Medicare recipients will be at risk for rationing while those with private insurance will not. If this is going to be the case, then all of the recent changes will have made things tougher for those who are on Medicaid or Medicare-the poorest (or oldest)-an ironic unintended consequence. But I will have to re-read it again. I may not be seeing everything.

With the private insurers, it's been the insurance companies who have been setting the prices for the doctors. If a doctor signs on with an insurance company, their contract usually requires them to charge all patients the same rate or risk losing any reimbursement or referrals for the company.

So yes, right now there are different rates for Medicaid, Medicare, and private insurance, but most private insurers (I think?) are reimbursing roughly in the same ballpark. So when I wrote above that Mediocore doctors are earnng the same as the best ones, this is what I meant-all doctors in a sense are "socialized" and because doctors have to sign into these agreements with insurance companies, those doctors who may need to charge more (because of a better or more thorough work-up, etc.) cannot do so because they are constrained by the respective "bureaucratic requirements" of each system.

So I think things have been more "regimented" than even you suspected...that was the point I was trying to make. It used to be that an entreuprenarial person could do well as a doctor in a solo practice...not anymore. The same in my profession in clinical psychology.

If you can, pm me on a different topic [email protected] bill
6 years 10 months ago
Dr. van Ornum,

If you are still following this thread then you may want to read an article in the NT Times on Saturday


http://www.nytimes.com/2010/12/12/business/12view.html?_r=1&src=busln


It is about health care rationing. 
we vnornm
6 years 10 months ago
p.s.

I know some physicians who are leaving the system entirely to provide concierge care. For a fee of around $4,000, paid up front to the doctor each year, the doctor (internist) provides all care and is available 24/7. They usually limit practice to 200 or so patients.

Obviously this is "capitalism" but it offers a higher level of care to the person and it allows the physician to practice at a higher and more independent level.

This kind of care has been bitterly criticized as providing a higher level for the rich.

Yet others counter by pointing out that it is not very much different from the system of private education in this country.

Interesting. bvo
we vnornm
6 years 10 months ago
Hi Janice,

Thanks for pointing those things out. Tort reform would be great but again, since most of our politicians are lawyers, realistically I don't see any chance of this ever occurring. As those who work with or live with developmental disabilities know, this group of people if often at risk when budget cuts happen so it will be important to be advocates for these people who often cannot speak out for themselves. best and amdg, bill
Marie Rehbein
6 years 10 months ago
Hey Bill,

Regarding your observation that people "balk when asked to see an eminent specialist for a work-up when the out of pocket will be $500 or $1,000".  It reminds me of when my children needed braces.  The pediatric dentist had a person who broke the financial news to the parents and then arranged for them to get financing through Wells Fargo.  It was still painful, as we had three in braces at once, but it was manageable because we knew the whole cost and paying it was geared to our ability to pay.  The problem from the consumer's perspective is that people are unprepared for these expenses because illness is unpredictable and the costs are seemingly a closely guarded secret until the point in time when one has few, if any, options.


Janice,

Regarding tort reform, do you have a specific aspect in mind that needs reforming?  I am thinking that there should be something done to discourage bringing lawsuits when people are simply disastisfied with an outcome rather than when a doctor has actually committed malpractice.  All too often, the malpractice insurers simply settle the claim, even when there has been no malpractice, because doing so is cheaper, but this only encourages lawyers, I think.  Maybe all cases need to go to court... 
Michelle Russell
6 years 10 months ago
My opinion on some of the comments made thus far:

I would contend that we actually do not have universal education, but rather universal schooling.  This is a very large topic, and deserves another very large discussion!  As an aside, I home-educate my boys.

Medicare (and other insurance)fraud:  I have no statistics to back me up, but I know that some of the so called "fraud" is actually inadvertant error.  For example, a visit is unintentionally double billed, for any number of reasons, and the doctor's office is paid twice - this is lumped into the "fraud" category.  This type of error occurs more often than any of us would like, call it human error, so please don't assume that your doctor is intentionally defrauding the insurance company or Medicare (although some do). 

Yes, to lower the cost of healthcare, tort reform at some level is necessary.  Many times a doctor may know with reasonable certainty (say, 95%) that a condition is not due to anything malignant/life-threatening, etc., but because of many factors which cannot be addressed here, multiple tests are ordered.  This is called "defensive medicine", and is what many doctors have been forced to practice out of fear of a lawsuit... not because the tests are necessarily "medically necessary".

Disclaimer:  my husband is a solo family physician in a remote area with no hospital any where near us.  He is on call 24/7, and sees patients after-hours for emergencies which on the mainland would be seen at the emergency room.  "Good" doctors, and I am speaking of family doctors, often in my experience make less than mediocre or poor doctors.  For example: They tend to spend more time with their patients, thereby seeing fewer patients per day. This is basic economics.  My husband's take-home pay is about half of what a doctor doing similar work on the mainland takes home because our cost of doing business is higher here, we have more complex patients who require more time, etc...  We made a conscious decision to practice this way, but it is an economic reality for many rural family physicians.

There are so many issues here, that even a book would not be long enough to addess them with sufficient clarity or depth.  But I do believe that when we begin to think of healthcare as a "right" (a legal right), you will see a vast change in the way medicine is practiced in this country, and a change in the attitudes of both physicians and patients.  I do believe basic healthcare is a human right, but am decidedly against it becoming a legal right - like the right to free speech.  Government does few things well.  Why would anyone want the government standing in between the doctor and the patient?   The article presented above illustrates that just because the packaging says "it's covered" does not mean that it will be covered (read the fine print), when not covering certain conditions, procedures, etc.. (aka, rationing) will result in cost savings, at the unfortunate expense of quality of life.  We are seeing this happening more and more in our small practice here.
6 years 10 months ago
Bill and Marie,
I agree that it's pretty unrealistic to expect our gov't to enact tort reform.  Trial lawyers have a powerful, wealthy lobby.  But, isn't it a sad commentary on the legal profession that laws that could benefit many through tort reform, aren't possible?  A large number in congress and senate are Catholic.  Maybe, a crash course in Catholic Social Doctrine (eg, the common good) would be appropriate for some of them!

Michelle Russell in comment 28 gives one of the reasons for tort reform.....defensive medicine which results in overuse of expensive meds, testing and equipment when less expensive versions would suffice.  Marie, you mention frivolous lawsuits.  Couldn't there be a legal mechanism in the court system to throw these suits out even before the insurance co gets involved?  Another issue is the exhorbitant settlements that have no rational basis as to severity of the malpractice and the amount of settlement.  Depends a lot on where you live.    A more equitable, rational legal system could help in recruiting young people to the medical field and may even weed out some of the incompetent doctors.  As it is, certain specialities that are most prone to lawsuits are needing doctors.

I have a personal example of two friends of mine whose husbands, both psychiatrists, were sued.  Both families suffered greatly through depositions sessions w/ attorneys, seemingly endless court hearings.  I know the details of one case, a patient who committed suicide......this doctor's suit was dismissed.  He won his case.  The other psychiatrist lost his case which resulted in financial ruin and divorce.  They lost home, bank accts, everything to pay for what the insurance didn't cover.  The ex-wife lives in a small apt in a crime prone area of the city. In her 70's she is unemployable.  The court settlement was exhorbitant.
Stanley Kopacz
6 years 10 months ago
I know people who try to live a healthy lifestyle because they don't have insurance.  They exercise, eat the right foods, take vitamins, watch Dr. Oz, etcetera.  Admirable.  But they don't control the food supply.  Try to cut back on salt by cooking your own food.  The food industry brines chicken meat so you can't make a salt/no salt decision.  GMO foods aren't advertised on cartons, so you can't make a decision about that.  They were probably genetically modified so they could bomb them with more insecticide and weedkiller.  But nobody changed our genotype to be able to eat more insecticide residue in our food.  Fly into any large city at dusk on a calm day and you see a layer of brown air.  That can't be good.  Try not breathing.  How much asthma is caused by car exhaust?  How much cancer is environmentally generated?
I think the companies and individuals who profit from them bear some part of the responsibility for the environmentally generated sickness in the population and their costs.  It may not just be a case of giving out freebees but a matter of reparations.
we vnornm
6 years 10 months ago
Dear Michelle Russell:

Thanks for the perspective of a physician and family.

In one state, auditors this year were told to go back and audit the Medicaid reiumbrsements to NON PROFITS to LOOK FOR PAST CLERICAL MISTAKES. So these agencies had to spend ridiculous amounts of time triple-checking everything-time that should have gone to service.

With best wishes and gratitude to your husband and family. bill
we vnornm
6 years 10 months ago
Janice,

Very sad examples you provide. I suspect there are too many inaccurate stereotypes going around concerning"rich physicians"-i.e. "bias" that we would not tolerate if we were speaking of our sisters and brothers of other religions. tx. bill
we vnornm
6 years 10 months ago
Stanely K:

"An ounce of preventionnis worth a pound of cure."

Clinically proven, an empirically supported treatment!

best, bill
we vnornm
6 years 10 months ago
David and Stanley K:

David, good example of the law of unintended consequences.

One thing I find interesting is how everyone is living longer despite all of the "bad" things in the environment around us.

We struggle for that balance between freedom, self-discipline and correction, and oversight by higher authorities.

bill
we vnornm
6 years 10 months ago
David,

On this example of surgery-is the patient paying everything out of pocket? Is a hospital involved? Insurance company? Something is not right.

Has anyone else encountered a situation like this?

bill
Michelle Russell
6 years 10 months ago
David, Bill, and all others frustrated by the "closely-guarded secret" costs of medical care!

Let me put my medical biller hat on and try to explain:  The biggest part to understand is that all of the charges (which come from the codes - the "magic numbers") come from the doctor's note - so without a note for the procedure which has ALREADY been done, a medical biller will not want to give you a "quote".  There are so many variables, and we are trained to say we don't know the cost without the code because so many things can happen to change that original procedure or surgery to make it more (or very rarely, less) expensive.  It is a "game" designed, not by the doctor, but all those forces at work around and outside the "doctor-bubble." (most doctors have NO IDEA what the charges are for what they do)

To get around that for cash patients (no insurance), we have set up our own "in-house" codes based on time and materials, because we cannot offer "discounts" to patients which are not offered to patients who have insurance.  So if we use different, non-standard, codes we can charge a different (lower) price.  I would suggest for any patient paying cash to sit down and negotiate a price with the doctor/hospital.  They can usually work with you.  Don't feel that the price is set in stone.  Most insurances take an adjustment off the charges, so it is fair for the office to take a "cash" adjustment as well - they just cannot call it a discount (due to contracts with insurance companies).

The rebel that I am, I do try to give patients as much information as I can, with all the requisite caveats.  I have also given patients information on the work RVUs (Relative Value Units - what a procedure is supposedly "worth") to help them negotiate with surgeons, other specialists, etc...  It is unacceptable, to me, for a patient to get the run-around as in David's example, but have heard that this is unfortunately not an uncommon experience.  And I do have an advantage, since I usually know for what the patient is being referred, so can figure out a "code-range" for the expected procedure.

Best of luck.  If you have other questions regarding this, I am happy to correspond with you off the "comments" section  - Michelle
we vnornm
6 years 10 months ago
Michelle,

Thank you very much for this information. It is important and not available to most of us. It doesn't seem right that a physician's "contracts" with an insurance company would keep a physician from setting up a compassionate charge with a patient.

One worry many have is that government take-over would increase "regulations" like this that would stifle doctors and their independence of care, both in what is charged and the care that is given.

Michelle, do you have any thoughts on this? 

amdg, bill
Michelle Russell
6 years 10 months ago
Bill,
To explain: contracts with insurances state that we cannot charge others a "substantially different charge" than we charge their clients.  There are ways around this:  a program named "Simple Care", check it out at www.simplecare.com; an office can do what we do, which is a variant of the simple care idea; an office can set up a sliding fee scale, for discounts based on income, but this adds a whole new layer of papework and time which most offices just don't want to get into.  But in general, if a doctor takes insurance, they cannot "advertise" that they offer discounts.  There is more to this than can be addressed here, but that is the basic idea.

You probably shouldn't ask my thoughts on the government take-over of health care and the problems "inherent in the system"!  But the short answer is yes, we are concerned.  I'm sure we'll still be able to charge whatever we want to, it's what we will be paid that is going to potentially be the problem, and who is going to decide that?  Granted there is already a lot of this now with our contracts with insurance and Medicare, but we envision it only getting worse.

Yes, by all accounts there will be lots of regulations which will "stifle doctors and their independence of care".  One of which I have heard:  a patient comes in, the doctor gives a diagnosis, the nurse then sends the code to the national/state group, which then will send back the approved treatment.  If the doctor deviates from this treatment plan, there is a large fine for the first offense and possible jail time for future offenses.  I know this sounds a bit over-blown and paranoid, but it is one reading of some parts of the health care bill.  There are many other scary sections.  Those of us in the trenches shudder at what is possibly going to happen to medical care over the next few years.  We already see what has happened with Medicare and Medicaid.

Again, so much more to this than can, or should, be addressed here.  I encourage all to stay informed - read "both sides", ask questions, do your own research if it is important to you.  And stay healthy! 

Thanks, Michelle
6 years 10 months ago
Since we gotten into medical codes and billing issues, everyone might be interested in a NPR Planet Money episode last July with Jonathan Bush who is George Bush's cousin.  He heads a company called Athena Health which does the billing for doctors and talks about the problems with insurance codes.  The podcast with the discussion is only 16 minutes and interesting.  Here is the link


http://www.npr.org/blogs/money/2010/07/06/128338526/ex-ambulance-driver-tries-squeezing-cash-from-health-insurance-companies 


The podcast link is at the top of the page and there are other links to relevant issues. 
Michelle Russell
6 years 10 months ago
David,
Briefly - I don't know much about Medicare Part A billing (hospital), but the amount your friend will have to pay will be based on what amount Medicare will pay for the procedure.  There will be hospital charges,anesthesia charges, surgeon charges...My suggestion is that if he has a family doctor (or internist) who would be referring him, is to have an office visit with the family doc, and see if the family doc can pry the CPT code that will be used for the surgery out of the surgeon.  With that knowledge you can most likely call Medicare and ask the "reimbursement" for that procedure code in your area.  That should help a lot. Of course, it won't necessarily be the exact amount, but it should at least give them a ball-park figure - but don't forget, there are usually more bills than the surgeon's fee (and it is usually the smallest one). 

Best of luck.  God bless,
Michelle
we vnornm
6 years 10 months ago
Michelle,

Thanks for the helpful information.

If there is to be a universal health care that works, I believe it has to preserve the fine points and traditions of the medical profession, among these indepenedence of judgment for a physician regarding treatment.

Many calling for universal health care would NEVER submit to the kind of bureaucratic supervision which becomes a routine humiliation for many fine physicians.

Would college teachers submit to someone in a bureaucracy outside of their college telling them what to write in their syllabus, how many minutes should be lecture & how many discussion, under criminal penalty as you note occurs in some cases (Accrediting agencies are mild...) 

Thanks for educating us on some of the intricacies of billing.

bill
we vnornm
6 years 10 months ago
Michelle,

Many thanks foe helping David on this.

David, good luck.


amdg to all. bill
we vnornm
6 years 10 months ago
JR Cosgrove:

Thanks for the great resource. It's interesting how there is a range of (in)efficiency
within both the government and private insurers. So let's figure out how the good ones do it.

Hope all that computer communication is secure.....   :-)/:-(


amdg, bill 
we vnornm
6 years 10 months ago
Note to all:

I'm especially pleased how the comments here turned out: much specific information provided to help us understand elements needed for effective healthcare, perspective of physicians, readers helping each other. Thanks to all and Happy Advent. bill
we vnornm
6 years 10 months ago
Hi Regina,

Thanks for responding. As I understand it, most of us will be relying on Medicare after age 65 (or whatever it becomes) after we will leave our employer-sponsored health care plans.

So this information about how chronic conditions like Alzheimer's, MS, broken hips, and chronic conditions is pertinent to everyone.

Some responders have suggested that AMERICA's bloggers are apologists for the Democratic Party, but here its clear that Obama is being called to task both here today and by the previously by the courts.

Why was this going on, and before election day? After the election, of course, realistic persons will assume that behind-the-scenes cost cutting is occurring. 

Some Republicans were excoriated for suggesting that their opposition wanted to encourage...er.....how do I say this....a cost effective demise?...but your phrase "sorry, your mother/brother...has a condition that will cost too much so we killed her/him. They died a quiet and peaceful death."

amdg, bill 
Marie Rehbein
6 years 10 months ago
I think it's a little silly to attribute the decisions pertaining to Medicare coverage to a particular president, Bill.  It's not as if Obama or Bush or someone else has issued a directive to cut back on what Medicare covers.  It's my impression that the NYT author is only referring to the Obama administration because that's whose in charge of the government while these cases are coming up in court. 

Though I had no reason to attend carefully to it, it was my recollection that several years ago in West Virginia, people who had been receiving home visits from nurses were cut off from that service.  The alternative, I believe, was to be nursing home care.  Unfortunately, I do not have the details, but I think it had something to do with nursing homes promising to do it cheaper. (if anyone has some facts on this, please correct me if necessary)

In any case, what I am saying is that the patient is always vulnerable to having other concerns take precedent over what would do the patient the most good.  Given that the cases pertaining to Medicare coverage have been decided in court, I would think that this would make it harder in the future to not give people the care that would benefit them most, which is good news, Regina. 

Lots of people buy nursing home insurance that kicks in when medical insurance no longer pertains to the situation.  In the cases described in the NYT article, the issue was whether the care was to be considered custodial or medical so as to determine who should pay, not whether the patient was worth taking care of. 
we vnornm
6 years 10 months ago
Hi Marie,

The president and his/her administration are responsible for enforcing whatever Medicare regulations have been put in place. This wasn't being done, and should have been but wasn't because they made up their own, and it took the court system to make this right.

I have previously commended President Obama for other things here. He has taken on a tremendous responsibility. best, bill

ps Let's hope everyone reads the fine print on their custodial care insurance to see if it covers these conditions!
Tom Maher
6 years 10 months ago
But how many years and at what cost did it take to sue the goverment to correct this abuse of goverement power and get the goverment to do its job?  Surely thsi case is not the first or only caase of goverment massively not performing its job at all or not adequately doing ithe job its supposed to under law.  The individual is at the mercy of all powerful and unresponsive goverement healtcate provider.   Goverment is not a reliable or effiecient provider of healthcare. 
Marie Rehbein
6 years 10 months ago
Bill,  
U.S. Rep. Joe Courtney, D-Conn., called the Medicare standard "backdoor rationing that has unfairly resulted in countless Americans being denied the skilled care they need and deserve."
"Since the ruling, I have pressed the administration and Medicare to end this decades-old problem," Courtney said.

It is a decades old problem.
6 years 10 months ago
@Regina said: "Why not tell people, once you get a deteriorating condition and hit a point that requires care, that's it.  You are goig to die.  Or better yet, why not just off them... "

As the system stands now, for all of us there is only demand for increasingly expensive health care services/procedures/products; aside from cost and prolonged suffering, there is little incentive to decline services. 

I wonder whether a system could be devised whereby a person who has a deteriorating condition could be offered an option to trade treatment for, say, 50% of the projected costs of future treatment to go to his/her heirs.  Healthcare costs drop, the heirs get a payday, the patient dies under his/her terms with reduced suffering and a last act of providing a gift to his heirs.
we vnornm
6 years 10 months ago
David,

Yours is the voice of reason, sanity, and maturity; somehow the activist part of me, perhaps a should-have-been-discarded remant of youthful idealism, still clamors for expression! best, bill
we vnornm
6 years 10 months ago
Tom,

I'd say in this particular instance Uncle Sam has let more than a few people down. Yet on the other hand, a correction of sorts occurred.

Can we generalize from this to all health care? I don't know!

Maybe this is a good affirmation for checks and balances.

best, bill
we vnornm
6 years 10 months ago
Marie,

So what we have here are two courts, one Democrat, and a blogger for AMERICA (his opinion, not the magazine's!) criticizing the curent presidential administation, which is democratic.

Score one for the first amendement and for crossing party lines! :-)

I suspect even the Pope receives criticism? Even when it's a centuries old issue?

bill
we vnornm
6 years 10 months ago
Michael,

You point out one of the factors that does drive up healthcare: the rounds of testing and treatments that may or may not be effective. And underlying your suggestion, which i suspect is a bit in jest to show how the system as it is now has irrationalities and waste, is the idea that each consumer and th family should have a strong voice in how care is rendered.

This is a suggestion that cuts across party lines, I think, and any healthcare recommendations that can emobdy this self-direction while being cost-effetive fior the system may prove to be the best recommendations of all.

bill
Marie Rehbein
6 years 10 months ago
Bill, it was not your article but Regina's reaction that prompted me to point out that this is not something new-there is no reason for such despair at this point.  People might be interested in the following article describing the sequence of events that led to the court case being filed:

http://www.pittsburghlive.com/x/pittsburghtrib/news/s_710443.html


I would like to put in a plug for faith in God and belief in the afterlife as helping to keep this topic in perspective.
Tom Maher
6 years 10 months ago
Dear Bill Van Ornum,

Yes you can generalize indeed that government is an unreliable and ineffiecient deliverer healtcare. 

The Obama administration admitted to a half trillion - repeat a half trillion - in Medicare fraud and waste.  What percentage of all Medicare revenues is half a trillion ? A  ridiculously high amount.  We are talking in hundreds of billions of dollars here more than the revenues of top 30 performing businesss in America.   What business would allow anything like this amount of money to be wasted.  It just would not happen.  A business would dilegently fight for  every nickel of waste and fraud and would have a micro fraction of such abuse.  Governemnt operations are extremely high cost due to massive waste and iniefficiencies.

As has been said many times before government is not he solution, government is the problem.  It is time to reasize good intentions do not deliver good results.   Government promises but consistantly delivers very poor results.  This is the lesson of the 20 th centruy where Marxist socialism failed and was reject by all countries that practiced marxist socialism where the government ran every industry including healthcare.  Why should we be surprised that government run programs inherently perform extremely poorly as a documented fact ?
6 years 10 months ago
When I commented  before on healthcare it was to say that the debates never get around to the real issues.


Two of them are:

 
There isn't enough resources to provide everyone with every possible option so any policy or legislation that theoretically tries to do that is dead in the water.  Any restriction on what someone gets is then rationing.  Traditionally, ability to pay has been a rationing system in our society.  Each year there are new medicines, new procedures, new diagnostic equipment and each costs more.  Costs are not coming down and until someone finds a way of giving us all 20 year old bodies, it will spiral out of control.  And if we all get 20 year old bodies, that would be an interesting challenge for society.


Second, you can not tell a doctor who he will treat.  If a doctor is the best neurosurgeon in the world, he is not going to receive the same pay as the typical neurosurgeon and he is going to determine who he will treat.  This could be based on the need in question but it also could be based on the amount the patient can pay.  And it goest down the technological skill levels as I know of nurses who have doubled the normal salaries because of their knowledge and abilities.  I met a nurse a couple years ago in an emergency room who was paid a very high salary.  Her knowledge of procedures, medicines, caveats was exceptional and all the ER doctors would have gladly paid her out of their own pockets to have her in charge.  Anything that restricts this will distort the system and force people to leave the profession or seek a new market place.


There are obviously several other issues but we can not act as medical care is a free lunch.  Most of the problems stem from that attitude as some just blithely assume or direct that all receive equal treatment.  It cannot happen and it should not happen as disparities drive the need to better the current situation.
we vnornm
6 years 10 months ago
Marie,

Thanks for the further information. We'll hope that these issues get worked out. I'm not despairing yet. How is the weather out West? bill
Marie Rehbein
6 years 10 months ago
Who is committing the fraud?  In some cases there are elaborate schemes with people posing as medical providers and fake patients, but in most cases it has to be actual doctors with whom we do business.  These people are criminals whether they get their payments come from the government, our insurance company, or our own pockets. 

Personally, I find getting health care to be such a bother that I don't bother most of the time.  If my children get sick with something, going to the doctor is the last resort.  Despite the fact that this should please the insurance company (a private business) no end, every single visit ends up with some kind of charge in dispute.  With a family of six, it becomes a part-time job following up on these.  

As Tom points out, there are too many people who think of defrauding the government as a sport.  Therefore, given the rampant dishonesty in our society, I favor a health savings account system with catastrophic insurance coverage and doctors being required to spell out the actual dollar and cents costs of whatever they may have to do pertaining to whatever ailment they will be treating so that patients can shop around and choose tests and treatments aware of what it will cost. 
Marie Rehbein
6 years 10 months ago
Bill,

The weather is nice.  Sunny, of course, with daytime temperatures in the sixties and nights in the thirties
we vnornm
6 years 10 months ago
Dear Tom:

Having grown up in Chicago, having seen three Governors go to jail and now a fourth one in the dock, having watched city workers display the true meaning of sloth, you don't have to warn me of the perils of big government. Original sin? Perhaps only in Chicago.

One reason I posted Robetrt Pear's article and referred readers to his series is that he takes specific health care issues and analyze them regardless of which political party is at fault. I think we need more issue-centered discussions on health care and less broad band.

Do you think somethimes there is too much "all or nothing" thinking on the healthcare debate?

thanks again for your thoughts, amdg, bill
we vnornm
6 years 10 months ago
Hi JR Cosgrove:

Before I respond to your points I will offer a thought that might even shock you. For 25 years I had a modest private practice and hence I can view this issue as a provider. You would be amazed at the many people of means who balk at a simple co-pay, or who ask for a sldiing scale but then withdraw this request when asked for a pay stub or tax return. Or will balk when asked to see an eminent specialist for a work-up when the out of pocket will be $500 or $1,000 (much less than was spent on the $5,000 vacation recently taken.) Sadly, medical/psychological care is seen as an entitlement.

Sometimes I think we should go the route of the medical spending accounts, let providers charge what they want, the patient pays up front. The best providers will be rewarded. Let the market work. (This is a fleeting thought...it won't work...you get my drift.)

Sometimes, when I look at our consumeristic society, I don't think we spend ENOUGH on medical care!

In response:

1. For discussion sake....we have been able to bring about universal education. Why not the same with health care????????

2. Yes, you can tell doctors who to treat. Right now the insurance companies tell doctors who to treat. If a doctor does not treat the patients referred by the insurance company, the doctor will not receive any more referrals from the insursance company. If the doctor goes beyond the protocal of treatment dictated by the insurance company, the doctor will not receive more referrals. Soon he or shen will have to close the practice.

Right now MEDIOCRE DOCTORS EARN THE SAME AS THE BEST DOCTORS.  This has occurred because of the siutation above.

This is why many young people are not going into medicine. There is no incentive any more for being "the best."

What you are afraid of has already happened!

I hope yor look back on the Robert Pear archives. The devil is in the details on healthcare and he is pointint them out.

best and amdg, bill
6 years 10 months ago
''1. For discussion sake....we have been able to bring about universal education. Why not the same with health care????????''


To a certain level we have universal education.  But I do not think anyone would say we are universally educated at the same level.  If you want to apply it to medicine, then everyone would receive a high school education level of medicine but not the master's degree level.  And at the master's level not everyone can get in the best schools or receive the best education.  A degree from certain schools is worth a lot more than one from others.  The disparity in education in this country is well documented.  A lot of this disparity is that the better student seek out certain universities thus ensuring that this school's graduates are generally better.  But they pay a lot more.  Stanford is charging over $50,000 a year for undergraduate and some graduate programs are $100,000 a year.


''2. Yes, you can tell doctors who to treat.'' 


Well for certain doctors that is probably true but for others it is not.  Find out who the best specialist is in a certain field and see if they charge the same as everyone else.  I know doctors who do not take certain insurance programs.  My wife is limited by her insurance to whom she can see for her orthopedic problems.  If she paid more for her insurance which she could, she could see more doctors.  And there are some who will gladly see her for cash.  She said last year's insurance plan which she changed to reduce her premiums would let her see more doctors.  The co-pay was also much higher for some doctors.


So I am not sure that I buy the claim that mediocre doctors are getting paid the same as the best doctors.  The word would get around who is best and only they would be getting appointments.  Cost is rationing their services since they can only see so many patients.  Time is another rationing mechanism but in our area, suburban NYC, it is mainly costs.  There are reasons why some plans are more desirable than others.
6 years 10 months ago
To show an example of time rationing, one only has to turn to the Canadian system for lots of examples.  Here is an unfortunate situation that happened within the last week:


http://www.thestar.com/news/canada/article/902581-woman-dies-waiting-in-er-as-ag-finds-little-movement 


In my wife's limited insurance policy, she needed an MRI and it took two days to get it done after it was prescribed.
we vnornm
6 years 10 months ago
"Same level service"

I find it interesting that many who are in academia passionately demand "equal" medical care for everyone. Yet at the same time they do so from positions of privilege: a prestigious university rather than a community college.

Suggest that all college teachers across the country teach eight courses per year, have the same class sizes, the same lab equipment, etc. etc. ("equal education")....no way!

Do you see the disconnect here that I do?


"Doctors"

Yes, you are right. When different insurance plans are involved there can be a disparity.

But if you have friends or good acquantiances who are doctors/specialists, ask them a bit about this. best and merry christmas, bill
6 years 10 months ago
According to US Rep. Joe Courtney, the Medicare regulation in dispute is "backdoow rationing that has unfairly resulted in countless Americans being denied the skilled care they need and deserve."

Maybe living on the West Coast with our neighbors Oregon and Washington having euthanasia laws, I am more sensitive and hyper vigilent when I read Robert Pear's article.  In Oregon, medical care rationing and euthanasia have come together.  There's a story about a woman who was denied a potentially life saving tx and given rereferrals to doctors who perfom assisted suicide.    I smell a whiff of eugenic thinking in that medicare regulation and hope the government has the sense not to appeal the ruling against it.  There are other ways to reduce medical costs, some mentioned in the comments.  I'd add tort reform.  Why is it the most vulnerable who get the shaft when there are economic crises??

Thanks Bill, for alerting us to Robert Pear's articles.  It behooves me-us to educate ourselves and not fall into partisan bickering.
we vnornm
6 years 10 months ago
I was in Canada last sumer and when I asked Canadians about their plan it was evident that it's not as rosy as many in the USA depict it to be!

bill

Advertisement

Don't miss the best from America

Sign up for our Newsletter to get the Jesuit perspective on news, faith and culture.

The latest from america

Imtiaz Cajee, nephew of Ahmed Timol, poses with his book about the activist on Aug. 24 in the North Gauteng High Court in Pretoria, South Africa. (AP Photo, File)
A judge has overturned a finding of suicide and ruled that Ahmed Timol was murdered by South Africa’s Security Police 45 years ago.
Anthony EganOctober 23, 2017
Activists with Planned Parenthood demonstrate in support of a pregnant 17-year-old being held in a Texas facility for unaccompanied immigrant children to obtain an abortion, outside of the Department of Health and Human Services in Washington, Friday, Oct. 20, 2017.
Texas bishops: "No one -- the government, private individuals or organizations -- should be forced to be complicit in abortion."
Catholic News ServiceOctober 23, 2017
It is time for the laity to speak out and act like true disciples of Christ in spreading the joy of the Gospel. 
Thomas J. ReeseOctober 23, 2017
Pope Francis speaks from the Vatican as he addresses Canadian youths in a video message that was included in a Salt and Light Television program on Oct. 22 (CNS photo/courtesy Holy See Press Office).
“The world, the church, are in need of courageous young people, who are not cowed in the face of difficulties," the pope said.
Michael J. O’LoughlinOctober 23, 2017