Senate mulls taxing alcohol, sugary drinks to pay for healthcare July 9, 2009
Posted by Obi Jo in Tax Policy, health reform.Tags: affordable health insurance, alcohol, Congress, health, health care reform, health insurance, health insurance access, health Insurance exclusions, health insurance reform, health plans, health reform, healthcare, Insurance, insurance access, insurance benefits, Insurance Profits, medical care access, medical malpractice, patient care, patients, personal health mandates, personal health responsibility, sin taxes, small business, soda, tort reform, underinsured, uninsured
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“Sugar, rum and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.” — Adam Smith, The Wealth of Nations, 1776
Well, we can assume that since the father of capitalism, Adam Smith, made this comment, we know where Congress is going to look first in an attempt to pay for its utopian vision of health care. Interestingly, they seem ready to leave tobacco users and those who consume diet drinks alone (there is lots of evidence that diet drinks do a good deal of harm as well). In the end, Congress is scrambling for schemes to pay for their dream plan, when in fact, the solutions to Real Health Reform, are relatively easy – compared to the grandious plans they envision – and frankly not that expensive.
The one constant in all of this is that that Congress does NOT intend to give up any of its perks, ‘Cadillac health plans’ or other benefits. They only expect the citizenry who pay the taxes to do so. Dear members of the House and Senate, read our lips, no way! You either live and die by the same rules or leave the market alone to do what it has always done, exceed expectations.
Our health care problem is one of insurance and access, which can in large measure be resolved by many of the ideas we have articulated under ‘the plan’ here on this site.
Actions like preventing health insurers from dropping subscribers who become ill or use services; actions like preventing health insurers from denying access to any coverage due to a preexisting condition; actions like preventing health insurers from selling loophole policies, which cover patients, except for the organ system they have had surgery or treatment for in the past (selective exclusion policies); actions like cherry picking work groups to insure, excluding others, or rating some to a level where premiums become prohibitive; actions like addressing real tort reform so that physicians can be freed from the practice of defensive medicine which significantly drives up costs; actions like demanding personal accountability in the obtaining of health coverage and removing this hidden, burdensome tax from the backs of businesses, when in fact it should be a personal responsibility.
Certainly, I could go on, but for now that is sufficient. If Congress has its way, we will be taxed beyond recognition to pay for every possible dream project that is in fashion. If history serves me correctly, it was a mere tax on tea that furnished the catalyst for an unprecedented revolution in the 1770’s. Congress, get your act together, Real Health Reform is possible, but many of your visions are distorted and your zeal for taxes out of control . . . obi jo
Senate Finance Committee mulls taxing alcohol, sugary drinks to pay for healthcare reform
Different options are being considered to increase federal revenues to pay for expanded healthcare coverage. The Senate Finance Committee acknowledged the dilemma Monday as it released 40 pages of revenue raising options. They include cuts to providers and new taxes. Senators are considering such options as a “soda pop tax” on sugary drinks, increased taxes on alcoholic drinks, and removing the exemption on taxing health insurance. Congress is forging ahead on healthcare, with no consensus in sight on how to pay. Few of Obama’s proposed tax increases have been well received on Capitol Hill, and there aren’t many popular ideas coming from lawmakers.
The Finance Committee’s document laying out healthcare alternatives, contains comments from Chairman Max Baucus, (D-Montana) and Senator Charles Grassley (R-Iowa), the panel’s top Republican, saying that taxing health benefits would address so-called ‘Cadillac plans’ they said promote overuse of healthcare services and boost the cost of care. The two senators also proposed scouring Medicare and other aspects of the US healthcare system for cost savings. The increased revenues required to pay for Democrats’ broad legislation likely to require employers to provide health insurance to workers or pay a penalty, and to create a so-called ‘public option’ insurance plan, similar to Medicare, for some of the 46 million Americans who lack coverage.
Far from being a finished legislative proposal, the broad range of proposals included underscores the contentious task that remains of narrowing down the list of possible pay-fors. The notion of increasing the tax on alcoholic beverages prompted a strong reaction from the Distilled Spirits Council, which represents liquor producers and marketers. The council’s vice president, Mark Gorman, suggested the proposal could cost thousands of jobs in the hospitality industry and ‘would be a prescription for economic disaster.” There has been little support in the Senate for President Obama’s proposals to fund healthcare reform by limiting itemized deductions for taxpayers in the top two income brackets. He also would put revenue from estate tax changes, and tax changes affecting life insurers and securities dealers, toward the healthcare effort. Those proposals are tacked on, without discussion, to the end of the Senate options paper, in deference to the President.
Under the evolving plan, smokers and diet-soda drinkers would escape higher taxes, but wealthy individuals or workers with expensive health plans may have to pay taxes on their employer-provided insurance for the first time. Health savings accounts and flexible spending accounts could also lose some of their tax benefits. These options were among dozens of recommendations put forth by the committee ahead of a private meeting Wednesday where senators will discuss how to fund a healthcare fix that could exceed $1 trillion over 10 years.
A variety of tax reforms proposed in the document that will give opponents of Democratic healthcare reform plenty of fodder. Raising revenue by eliminating or reducing the favored tax status of healthcare expenses might prove irresistible to Congress, which values the revenue ‘lost’ to current policy at $194.2 billion a year. One of the key tax proposals, limiting the current tax-free treatment of workplace health benefits, also conflicts with the campaign position of President Obama, who lambasted Sen. John McCain (R-AZ) for advocating changes to the tax code in this area.
Aside from some ideas that have been bandied about already, such as taxing employee health benefits and sugary drinks, some proposals that caught our eye include changes to the rules around health savings accounts and flexible spending accounts and increased taxation of non-profit Blue Cross Blue Shield companies and non-profit hospitals.
Senate Finance Committee mulls taxing alcohol, sugary drinks to pay for healthcare reform – http://caloriecount.about.com/senate-finance-committee-mulls-taxing-alcohol-ft139359
Senate Committee Explores New Payment Rates, Taxes to Fund Reform – http://www.healthleadersmedia.com/enewsletter/web-version/HealthLeadersMediaDaily_19_May2009.html
Beer tax on tap for health care? – http://finance.yahoo.com/news/Beer-tax-on-tap-for-health-apf-15311771.html?x=1
Senate Mulls ‘Lifestyle Tax’ on Soft Drinks to Pay for Healthcare Reform – http://www.healthleadersmedia.com/content/233282/topic/WS_HLM2_FIN/Senate-Mulls-Lifestyle-Tax-on-Soft-Drinks-to-Pay-for-Healthcare-Reform.html
Sodas a Tempting Tax Target – http://www.freerepublic.com/focus/f-news/2254911/posts
Alexander Hamilton on rights of mankind July 7, 2009
Posted by Obi Jo in health insurance.Tags: choice, Divinity, free society, freedom, human, human rights, mankind, mortal, nature, power, rights, sacred
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The sacred rights of mankind are not to be rummaged for among old parchments or musty records. They are written as with a sunbeam in the whole volume of human nature by the hand of Divinity itself, and can never be erased or obscured by mortal power ~ Alexander Hamilton, 1775
Annual cost of billing-related tasks: $85,276 per physician . . . not acceptable July 7, 2009
Posted by Obi Jo in Physicians, health insurance reform.Tags: CMS, Cornell Medical College, health, Health Affairs, health care reform, health insurance, health insurance reform, health plans, health reform, healthcare, Insurance, insurance access, insurance benefits, insurance denials, Insurance Profits, Modern Healthcare, physician behavior, physician billing, physician payment, physician payments, Physicians, University of California
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This study confirms what all physicians already know – health insurers place obstacle upon obstacle in order to avoid payment of claims. Prompt payment, which is mandated by laws in many states, is a pleasant fiction. The first reform needed is to make sure that all health insurers follow a similar form and submission process, this includes electronic filing and payment, which does exist with Medicare and some Medicaid programs. Second, insurers need to be prevented from issuing approvals for care, tests, treatments and surgeries, followed by the familiar refrain, approval does not equal a guarantee of coverage or payment. Approval should equal coverage and payment, period. Third, all health insurers need to be prevented from denying coverage for pre-existing conditions. They also need to be prevented from dropping subscribers once they become ill or injured. Lastly, drugs, tests, treatments and technologies that are approved by the FDA should be covered for payment, maximizing the choices patients may enjoy as they work with their physicians to deal with the condition they face. Medical directors at health insurers provide a smoke screen for companies who claim they are not dictating care, when in fact they are by their coverage and payment policies. Only through these reforms can we eliminate much of the needless, unnecessary, wasteful and costly insurance “dance” that providers must do in order to justly paid for legitimate services . . . obi jo and jomaxx
Studies seek to put “price tag” on physician practices’ costs to interact with health insurers.
Research suggests a physician may spend nearly three weeks a year on health plan-related tasks, two new Health Affairs reports attempt to put a price tag on how much a medical practice must spend before it can extract a check from an insurance company. In one study, University of California researchers calculated that the annual cost of performing billing-related tasks comes to about $85,276 per physician. In another study, Cornell Medical College researchers estimated that the total cost of the nation’s physician-health plan interactions is somewhere between $23 billion and $31 billion. The authors of the first study concluded that automation could be helpful in reducing claims denials, ensuring coding compliance and reducing days in accounts receivable, and that standardization of benefit plans ‘appears to offer great potential’ to decrease costs. The authors of the second study noted that their high-end estimate of physician-health plan interaction costs — $31 billion– is equal to six times the amount the federal government spends on SCHIP.
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CMS cuts, raises payments – pain and gain July 3, 2009
Posted by Obi Jo in Physicians, health reform.Tags: AMA, CBO, CMS, Congress, health, health care reform, health insurance access, health plans, health reform, healthcare, HHS, hospital billing, Hospitals, Insurance, insurance benefits, Medicaid, medical care access, Medicare, patient care, patients, physician behavior, physician billing, physician payment, physician payment cuts, physician payment increases, physician payments, Physicians, President, President of the United States, primary care, Secretary of HHS, specialists
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Clearly, this administration aims to tackle all issues at once. A noble, but daunting task. The proposed changes in reimbursement are not surprising nor necessarily unexpected. In fact, CMS has been adjusting payment rates to gradually minimize the differences between physicians for similar services (similar codes is the more correct term) for some time. However, the basic problem of physician reimbursement remains. In essences what CMS is doing is merely redistributing the pie, without offering any real or significant increases in physician payments overall. Currently, there exists a growing shortage of specialists in the United States. Static medical school enrollment quotas over the past 30 years, incentive programs for primary care training, and early retirment have left the US specialist work force spread thin, older and with fewer numbers and much larger per captia patient bases. As Congress and CMS work to adjust payments, they must look elsewhere, not to front line providers such as physicians and hospitals for cuts in spending. This includes health insurers, first and foremost, as well as pharmaceutical and medical device companies. While the AMA praises this, it is merely robbing Peter to pay Paul. While CMS’s budget for physician payments has risen, CMS acutal payments under the Medicare system to individual physicians, when adjusted for inflation, are actually no higher than in the early 1990’s. This trend cannot continue forever. Last time I checked, patients go to the doctor; are treated by doctors; have surgery performed by surgeons/doctors. Hospitals, drug companies, device makers and certainly insurance companies DO NOT provide direct care for patients, though there efforts to aid in improvments in patient care overall. CMS would do well to keep this in mind . . . jomaxx
CMS proposes Medicare payment reforms for physicians, hospitals
The Obama administration said it plans to cut Medicare payments for imaging services and specialists, and will use the savings to increase payments to physicians providing primary care. The proposal would put specialists’ payments for evaluating and managing illnesses on par with those of primary-care physicians starting in January. The move, combined with other changes, would boost payments to internists, family physicians, general practitioners and geriatric specialists by 6-8% next year according to the Centers for Medicare and Medicaid Services (CMS).
One additional step proposed by CMS is removing physician-administered drugs from the definition of doctors’ services in order to reduce the number of years in which doctors will be slated for fee cuts. The American Medical Association has called for removal for physician-administered drugs from the formula since 2002 and praised CMS’ announcement.
AMA President J. James Rohack said, President Obama, HHS Secretary Sebelius and White House Health Reform Director DeParle clearly understand that fixing the Medicare payment formula once and for all is fundamental to comprehensive health reform.
Republicans are likely to attack the regulatory proposal as a budget gimmick that does nothing to actually lessen the cost of overhauling the Medicare physician payment formula. The move to remove drugs from the spending target lessens the legislative cost of an overhaul by an amount that simply is shifted to the federal deficit.
Medicare Plans to Cut Specialists’ Payments – http://online.wsj.com/article/SB124646885862181139.html
Medicare Proposes Doctor Fee Increases for 2010 – http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aGmpS7.U19m8
CMS Proposes Partial Medicare Pay Fix – http://www.nationaljournal.com/congressdaily/hbp_20090701_7444.php
Administration trims health reform price tag – http://thehill.com/leading-the-news/administration-trims-health-reform-price-tag-2009-07-01.html
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Medicare Advantage? For whom? July 1, 2009
Posted by Obi Jo in Medicare, Tax Policy, health insurance.Tags: AARP, benefits, CMS, Congress, costs, doctors, enrollees, health, health care, health news, health plans, Hospitals, House of Representatives, medical socioeconomics, Medicare, Medicare Advantage, Medicare payroll tax, patients, payments, payroll taxes, Physicians, President of the United States, providers, Senate, seniors
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Here’s the rub. Medicare Advantage pays more to providers than traditional Medicare because they take risk in providing care to enrollees. They also often provide benefits beyond what traditional Medicare would provide. However . . . they do so by having more money directed to them for funding. As noted below, to the tune of some $43 billion. This means that since 2004, some $43 billion dollars was directed away from the traditional Medicare program, beyond what would have been paid for the same services in the traditional Medicare program. Again, the caveat is that some of those services would not have been covered or paid for by the traditional Medicare program.
In early 2008 there were 44.2 million Medicare beneficiaries. If one does the math, these extra payments amount to just shy of $1,000 per beneficiary over the 5 year time period. Not much you say. Perhaps. Perhaps not. The real issue is that Medicare Advantage was created to look for ways to SAVE on expenditures on Medicare. Instead, they have become the recipients of largess. Why? Because the programs in many cases are VERY GOOD and reflect more of what Medicare should look like but does not.
The key is for Congress to address the looming Medicare financing issues. This can only be done by a combination of tax and fee adjustments. This means that small adjustments in the Medicare payroll tax rate may be needed. It also means that small adjustments in the Medicare premium schedule may be needed. The continued attempt to adjust the balance sheet by excessive taxation on financially stable seniors is untenable and will not solve the problem.
Either Medicare is insurance or welfare. If it is both, the program will become increasingly divided and two tiered. If means is an issue, then subsidize that means via Medicaid not extra premiums on seniors who have already paid extra taxes into the program via the payroll system. Higher co-pays, deductibles and the like will also have to factor into the mix.
Solutions will not be easy. Medicare Advantage may be one such solution . . . but it does not address the entire problem . . . obi jo
$43 Billion In Extra Payments Have Been Made To Private Medicare Advantage Plans Since 2004
Private Medicare Advantage (MA) plans will be paid $11.4 billion more in 2009 than what the same beneficiaries would have cost in the traditional Medicare fee-for-service program, according to a new report released today by The Commonwealth Fund. This new analysis,The Continuing Costs of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009, estimates that since MA was enacted in 2004, $43 billion in extra payments have been made.
Seniors may see some Medicare Advantage benefits shrink
Big changes are coming to Medicare benefits received through some private plans, and they affect private insurers that provide coverage to Medicare enrollees under programs known as Medicare Advantage plans, which can sometimes offer a larger array of benefits for certain enrollees. Recently, the Obama Administration put providers on notice that reimbursements could fall and plans with low enrollment could be scrapped next year as the nation deals with financial issues in Medicare and Social Security. The changes affect private insurers that provide coverage to Medicare enrollees under programs known as Medicare Advantage plans, which can sometimes offer a larger array of benefits for certain enrollees. Frustrated by higher costs associated with the alternative program, the Obama administration recently put providers on notice that reimbursements could fall and plans with low enrollment could be scrapped next year as the nation deals with financial issues in Medicare and Social Security.
Medicare benefits slated to change – http://articles.latimes.com/2009/may/24/business/fi-retire24
Medicare Advantage Plans- http://www.medicare.gov/choices/advantage.asp
Extra Payments to Medicare Advantage Plans to Total $11.4 Billion in 2009, or More Than $1,100 Per Enrollee – http://www.commonwealthfund.org/Content/News/News-Releases/2009/May/Extra-Payments-to-Medicare-Advantage-Plans-to-Total-11-4-Billion-in-2009.aspx
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Medical Bills Underlie 60% of U.S. Bankruptcies June 26, 2009
Posted by Obi Jo in health insurance.Tags: access, acute illness, affordable health insurance, bankruptcy, chronic illness, CMS, Congress, health, health care reform, health insurance, health insurance access, health insurance cancellation, health Insurance exclusions, health insurance reform, health plans, health reform, healthcare, Insurance, insurance access, insurance benefits, Insurance Profits, medical bankruptcy, medical care access, medical debt, patient care, patients, policy cancellation, population health, pre existing conditions, President, President of the United States, previous illnesses, Public Health, underinsured, uninsured
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We continue to advocate our plan as having real, substantive, financially prudent and politically feasible grounds.
Go to http://realhealthreform.wordpress.com/the-plan/details-on-the-plan/ to read about this in more detail.
The idea of medical bankruptcy occurring to insured families is morally repugnant. The fact is, that as is pointed out in this study, that the reason for these bankruptcies was primarily related to insurance companies dropping coverage once a subscriber became ill. A practice which goes on daily in this nation and is a scandal. We have, in the most strong terms, advocated that health insurance should not be denied based on pre-existing conditions, previous illnesses or surgery. Also, coverage should never be terminated for any reason in the private sector other than failure to pay premiums.
Please read these excerpts from “details of the plan”.
(9) As a regulated utility, the prices set should be wholly market based and not risk stratified for individuals or select groups
Basically, this is no different than offering any other product for sale. The price is not based on WHO is doing the buying, but based on the value of the product being offered as set by the overall buyers in the marketplace. By offering coverage to ALL individuals, the risk is shared and a proper premium structure, along with surcharges if needed, can be arrived at. The current system allows for some of this. However, all to often the result is denial of coverage from the get go or limitations on coverage, such as pre-existing condition exclusions.
(10) Adoption of item 9 means pre-coverage physicals, pre-existing condition exemptions and the like will no longer be necessary – the premium is set and if I can afford it I buy it. I cannot be denied coverage for non-financial reasons. Companies will have to compete on efficiency of their systems and overall quality of their services.
As an outgrowth of item 9, this is perhaps among the most important of all tenants of this proposal. The major obstacles to health insurance access are limitations imposed by insurers on who they will cover and financial resources. The former can be EASILY remedied by adoption of national standards prohibiting discrimination in the purchase of health insurance. The latter can be dealt with through the current programs in place (as discussed above in item 4) as well as adjustments in the minimum wage and tax credits as needed.
(11) The base package of services required to be offered is pre set and supplements can be offered. Minimum basic policy defined (like auto insurance) with individual deciding on increased benefits. However, the base must be very broad to make sure the pricing factors in overall gross population risks, as opposed to sub group risks. Minimum basic policy defined (like auto insurance) with individual deciding on increased benefits.
What should be in the base package? First, all aspects of a major medical policy should be included. Second, emergent care. Third, preventative services (vaccinations, screenings, etc.). Deductibles can be varied to adjust price, as they are now, however, there should be limits on how high deductibles can be set for primary policies.
(12) Fine of $100,000 to any insurance company that denies writing the policy (basic) regardless of age, gender, sexual orientation, race, genetic assessment, pre-conditions, etc. Policies are not cancelable except by death or lack of financial qualification of coverage under item (1) above.
This site does not like onerous enforcement tools. Again, however, insurers need to know that there are penalties which will be applied if they discriminate against policy seekers for ANY reason other than inability to afford premiums. Individuals must be able to purchase coverage regardless of their health status which can and will vary from time to time.
. . . obi jo and jomaxx
Medical bills are behind more than 60% of U.S. personal bankruptcies,
Researchers reported that healthcare reform is on the wrong track. More than 75% of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine. Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year, the report reads.
http://www.medscape.com/viewarticle/703948?sssdmh=dm1.482806&src=nldne
Over 60% of All US Bankruptcies Attributable to Medical Problems – http://www.amjmed.com/webfiles/images/journals/ajm/AJMMedicalBankruptcyJun09FINAL2.pdf
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Health Insurance: An Individual Responsibility June 23, 2009
Posted by Obi Jo in health insurance, health reform.Tags: access, affordable health insurance, Congress, health, health care reform, health insurance, health insurance access, health insurance reform, health plans, health reform, healthcare, individual mandate, Insurance, insurance access, mandated health coverage, patients, personal health mandates, personal health responsibility, pre existing conditions, President, President of the United States, underinsured, uninsured, universal coverage, universal healthcare
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All persons must have health insurance from the private sector or government sponsored plans
Many have objected to this as a violation of personal choice and freedom. However, I would suggest that it is a dereliction of civic responsibility (if such a thing still exists in America) to force others (fellow citizens, doctors, hospitals, insurers, government - i.e. taxpayers) to pick up the tab for you when you become very sick or injured (as you WILL at some point in this life). By mandating coverage with REAL penalties, just as we supposedly do for auto insurance, we put personal responsibility back in the equation. It has been far too long since that was the case as the government in particular, along with big labor and big business to varying degrees, have sought to remove responsibility from the individual and to displace it to some other entity. Some view this an unworkable due to the natural tendency of some to avoid personal, civic or moral obligations. No doubt there will be persons who refuse to obtain coverage – they then will have to suffer the financial consequences that come with such a decision. Our goal should be to extend the opportunity to obtain coverage to all Americans without restriction. Our plan will allow that happen. So called “universal care” in the end, inevitabley, impose restrictions on the responsible to provide a safety net to the irresponsible. At some point, American ideals of self-reliance and personal responsibility must be brought into the equation. . . obi jo
The Individual Mandate — An Affordable and Fair Approach to Achieving Universal Coverage
Some of the most prominent shortcomings of the U.S. health insurance market are rooted in the fact that the system is a voluntary one. Outside the state of Massachusetts, which recently instituted broad-based health care reform, no one under the age of 65 years is required to obtain health insurance coverage of any kind. Voluntary insurance markets have led to a system centered on segmenting health risk instead of one whose primary mission is ensuring affordable access to necessary and efficiently provided high-quality medical services. Health insurers engage in many practices that make it difficult for people with health problems to obtain and maintain their coverage; they do so for the express purpose of protecting themselves from the potentially enormous financial consequences of adverse selection. If we required that every person obtain at least a minimum package of health insurance benefits — that is, issued a so-called individual mandate — we would eliminate adverse selection, and these barriers would become unnecessary and, in fact, indefensible.
The Individual Mandate — An Affordable and Fair Approach to Achieving Universal Coverage – http://content.nejm.org/cgi/content/full/NEJMp0904729
All persons must have health insurance from the private sector or government sponsored plans – http://realhealthreform.wordpress.com/the-plan/details-on-the-plan/
Individual Mandates for Health Insurance: Slippery Slope to National Health Care – http://www.cato.org/pub_display.php?pub_id=6243
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President to AMA: Health Reform . . . Sort Of June 19, 2009
Posted by Obi Jo in health insurance, health reform.Tags: affordable health insurance, Congress, damage awards, health, health care reform, health insurance, health insurance access, health Insurance exclusions, health insurance reform, health plans, health reform, healthcare, Insurance, insurance access, insurance benefits, Insurance Profits, malpractice, malpractice caps, mandated health coverage, Medicaid, medical care access, medical malpractice, Medicare, patient care, patients, personal health mandates, personal health responsibility, physician behavior, physician billing, physician education, physician payment, physician payments, Physicians, pre existing conditions, President, President of the United States, tort reform, underinsured, uninsured
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President Obama addressed the American Medical Association this past week. He laid out his vision for health reform. Many in the audience applauded his general statements of reform. But when it came to specifics, there were skeptics. The President seems to believe that health reform can be accomplished without major tort / malpractice reform. He seems to believe that health reform can only be accomplished if the federal government offers an option for insurance. He seems to believe that costs can be contained if only doctors would practice medicine based on judgment, not defense.
Unfortunately, real health reform, may be slipping away as the President fails to provide the much needed courage of leadership on the difficult choices. Let’s examine just a few of these choices.
TORT / MALPRACTICE REFORM
Without a meaningful attempt to reign in the trial lawyers lobby, cost cutting will not occur. As we have pointed out in a previous post (Medicine’s Most Expensive Technology: The Doctor’s Pen June 10, 2009), physicians control much of the costs of the system via the tests, medicines and procedures they order. The vast majority of “excess” that occurs in these areas is due to concern about “covering your bases” in case a lawsuit occurs. The government has focused on physician ownership, when in fact, that is a small, perhaps negligible part of the issue. The real nemesis here is the trial lawyers lobby. The President, a lawyer, seems unwilling to address this issue head on in a serious way. States that have malpractice caps have seen moderation in rates. Caps on damages in these states almost always apply only to PUNITIVE awards, NOT to medical expenses. Recall the definition of punitive: inflicting or intended as punishment. The very nature of this implies that physicians and other health care providers intentionally seek to harm patients. The number of cases of gross negligence, when compared to the overall number of malpractice claims is minimal. The vast majority of suits are filed for “bad outcome” (generally complications) and to a lesser extent for “wrongful death” (meaning the doctor caused the death needlessly through action or inaction). In almost all of these cases, no claim can be made for willful malice, negligence or intent to injure, only error – and in most cases not error, just that things did not go the way all hoped for.
FEDERAL INSURANCE OPTION
This one is actually easy. Anyone know of any health insurer offering PRIMARY health coverage to individuals who are of Medicare age? Well, if you are working and have group coverage through an employer you might, but the vast majority of Medicare eligible citizens will find NO primary option to standard Medicare – a government health insurance program (well sort of, since there is some adjustment of premiums based on income, it is also a form of health insurance welfare). As for Medicaid, the same is true. The fact is that if the government offers a tax payer financed option t0 compete on the open market, you will, over a relatively short time, have no private health insurance options available for primary coverage. To be sure, supplements will abound, just as they do under Medicare, but in essence, there will only ONE health insurance plan and that will be the government option. Which means . . . all citizens will have to have the government option for their primary coverage, since the private market will offer only supplements to those already covered by the government plan. I know, I know . . . the President said this is not his intention, that this will not happen . . . folks, wake up . . . Mr. Obama knows full well this IS what will happen (and that is the meaning of IS). He talks softly and reassuringly on this issue, but the outcome is already well known. Once again, just look at the example of Medicare.
COST CUTTING
His comments about guidelines and such, lead one to believe that he views “medical judgment” as a matter of following written codes of practice/conduct (i.e. cookbook medicine) and that if doctors will only do so then malpractice issues will fade away. This is naive at best, and disingenuous at worst, as he knows full well that exercising true medical judgment requires freedom from frivolous legal actions and the freedom to make choices for individual patients, not blindly follow an outline based on meta analysis of published studies with expert opinions added in. This site is well versed in modern medical guidelines and algorithms. They are helpful and continuing to update them is both challenging and useful. But they are NOT a substitute for sound, medical judgment when caring for the unique ills of an individual patient. They are a tool, not a panacea. Cost cutting efforts by doctors will only have broad acceptance when medical malpractice abuse is eliminated.
In the end the road to Real Health Reform is not as complicated, expensive or disruptive as the President and many around him would have us belivee. Common sense, with a dose of true market oversight and meaninful regulation is all that is required to address most of what is wrong (see Details on “the plan” @ http://realhealthreform.wordpress.com/the-plan/details-on-the-plan) . . . obi jo and jomaxx
In his remarks, he noted that for the vast majority of Americans, physicians “are the health care system” and are therefore an integral part of any reform discussions. He also noted that while he does not support caps on non-economic damages in medical malpractice cases, he does support reform of the system so that doctors are not forced to practice defensive medicine and can go back to treating their patients in the manner in which they feel is best, without having to look over their shoulders. He also noted that his intention is to allow physicians to stop spending their time acting as administrators and accountants and allow them to instead be physicians.
Obama takes healthcare campaign to doctors – http://www.boston.com/news/health/articles/2009/06/16/obama_takes_healthcare_campaign_to_ama/
Cost Concerns as Obama Pushes Health Issue – http://www.nytimes.com/2009/06/16/health/policy/16obama.html?_r=1&ref=us
Obama opens to applause at AMA – http://www.suntimes.com/news/politics/obama/1623150,obama-chicago-health-care-reform-ama-061509.article
Obama strengthens pitch for health care at AMA – http://www.usatoday.com/news/washington/2009-06-14-health-care-reform-tax_N.htm
Obama calls cost of healthcare a threat to economy – http://www.latimes.com/news/nationworld/nation/la-na-obama-ama16-2009jun16,0,2626159.story
Obama pitches health care reform to MDs – http://www.washingtontimes.com/news/2009/jun/16/obama-pitches-health-care-proposal-to-doctors/?feat=home_headlines-
Obama pushes for healthcare reform – http://www.ft.com/cms/s/0/c5583f24-59cc-11de-b687-00144feabdc0.html?nclick_check=1
Senate Mulls Over Health-Bill Details – http://online.wsj.com/article/SB124506633511614937.html
Obama Tells AMA Current Health System Not Working – http://www.bloomberg.com/apps/news?pid=20601202&sid=aX9aTOF6pQKg
Despite differences, Obama and medical community vow reform – http://features.csmonitor.com/politics/2009/06/15/despite-differences-obama-and-medical-community-vow-reform/
Obama tells AMA U.S. health-care costs are a ‘ticking time bomb’ – http://www.chicagotribune.com/business/chi-biz-obama-ama-meeting-june15,0,5236331.story
Obama presses doctors to back health care overhaul – http://news.yahoo.com/s/ap/20090616/ap_on_go_pr_wh/us_obama_doctors;_ylt=AgYroJQmkU1FiizWex6dY2Rp24cA;_ylu=X3oDMTJubzR0ZjFuBGFzc2V0A2FwLzIwMDkwNjE2L3VzX29iYW1hX2RvY3RvcnMEcG9zAzEyBHNlYwN5bl9wYWdpbmF0ZV9zdW1tYXJ5X2xpc3QEc2xrA29iYW1hcHJlc3Nlcw–
Obama’s counterattack on healthcare – http://thehill.com/leading-the-news/obamas-counterattack-on-healthcare-2009-06-15.html
Will Doctors Buy ObamaCare? – http://www.forbes.com/2009/06/15/obamacare-ama-congress-business-healthcare-obamacare.html
Obama’s Doctor Knocks ObamaCare – http://www.forbes.com/2009/06/18/obama-doctor-knocks-obamacare-business-healthcare-obamas-doctor.html
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