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Tom, for your
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Phoenix, AZ
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Health Reform Matters Blog
Providers in the News
Policy Makers in the News
C-SPAN Videos
History of Health Care Reform in the US
Solving the Problem
Movies & Web Sites About Health Reform
PROVIDERS IN THE NEWS
Electronic
Imaging Costs Double for Medicare
Electronic imaging costs by doctors more than doubled between 2000 and 2006
prompting the Government Accounting Office to recommend that Medicare start
requiring preauthorization for these services. $25 billion is spent annually in
unnecessary imaging according to a study done by the McKinsey Global Institute. Skyrocketing costs in our "fee
for service" system has not improved health care according to several studies.
Under fee for service, doctors get paid every time they see someone or perform a
procedure. Outcomes are not measured and preventative benefits are not covered
by Medicare, although Medicare Advantage plans offered by private insurers
usually include this benefit. One of the issues raised was the transparency of
administrative costs charged to the burgeoning federal program. Medicare has
become an easy target for health providers and has a very poor track record of
containing costs. It was revealed recently that $700 million in payments had
been made to dead doctors in the last few years. July 24, 2008
Poor Quality of Care Doesn't Justify US Expense for Health Care
In yet another report condemning the high cost of seeing service providers in
the United States, quality was found to be lacking. Poor quality of care is one
of the root causes of a health care system whose costs are spiraling out of
control in a system where preventative medicine is not common. The Commonwealth Fund, a
nonprofit research group in New York is issuing another in a string of studies
done by various groups that shows the need to reform how physicians are paid in
this country. Physicians have long fought off any kind of control or reporting
about the quality of their work, even though several studies have been released
showing that overall, the quality is poor or lacking. The latest study
alarmingly showed that the trend was getting worse, not better. The
U.S. is also reported to have fewer physicians than any other country using
electronic health records, one of the necessary components for controlling costs
and making it easier for patients to seek adequate care or change providers when
they feel like they aren't getting adequate care.
Without some kind of
incentives to provide good outcomes and reporting to show that adequate care was
delivered when it was most cost effective, our economy will continue to be
saddled by run-away inflation in this sector that makes us less competitive in
the world economy. Doctors, the highest paid professionals in the country continue milking
the economy while providing substandard benefits. According to the study, the United States ranks last in preventable
mortality even though U.S. physicians are paid at least twice as much as any
other country
Bullying Doctors Cause Medical Errors
JCAHO (pronounced jāke-ō),
also known as the Joint Commission which is responsible for accrediting the
proper functioning and safety of hospitals, has announced that will put new
rules in place banning bullying by doctors when the quality of their care is
questioned by nurses in hospitals. Powerful high paid doctors are often allowed
by hospital administrations treat nurses and other team members as low paid
subordinates instead of team members, even when crucial care issues arise that
need to be addressed. Nurses, who provide most of the hands-on care and are also
highly trained professionals are often treated badly, ignored, or threatened
when raising important issues about patient care. June 10, 2008
Large Prescription Drug Companies Lack Innovation in New Drug Development,
Wall Street Journal Letter States
Large drug companies that "license or otherwise acquire discoveries
from universities or small biotech companies, then develop them for commercial
production and sponsor the clinical research necessary for FDA," are "hardly
creative in the scientific sense," Marcia Angell of Harvard Medical School
writes in a Wall Street Journal letter to the editor in response to an opinion
piece published on June 28 (Angell, Wall Street Journal, 7/7). This makes us
wonder why pharmaceutical companies have become such a protected industry since
few innovations are funded by the most profitable companies. July
7, 2008
AMA Runs Deceptive
Ads
The American Medical Association started running ads targeted at
Senators that voted not to pass legislation that would have increased costs and
reduced benefits for millions of seniors on Medicare. Among the benefits mostly
likely to be cut if this bill passes are the kind of preventative care that is
usually only delivered as an afterthought in our "sickness culture". Sickness
culture treats illness after it happens. Preventative medicine is seen as a
money loser by physicians and pharmaceutical companies that make their money
treating sick people. Original Medicare doesn't contain preventative
checkups. Preventative benefits didn't become widely available for Medicare
beneficiaries until Medicare Advantage plans became available. July 3, 2008
American Medical
Association to Press Senate for More Subsidies
AMA President Nancy Nielsen, which represents the highest
paid profession in the country, said her group will employ a "full
court press" on lawmakers over the recess. According to the Chicago Tribune, AMA
is "formulating an advertising blitz to pressure several members of the Senate"
to support the House measure that would stop cuts to payments for Medicare
services. Although AMA has not announced where it will run
the ads, sources close to AMA said that they will run them in states where
Republican senators are facing re-election. The American Medical Association,
possibly the most powerful lobby in Washington, has long resisted any kinds of
controls or transparency to how much doctors and hospitals charge patients.
June 30, 2008
Merck Wrote
Drug Studies for Doctors
The drug maker Merck drafted dozens of research studies for a
best-selling drug, then lined up prestigious doctors to put their names on the
reports before publication, according to an article to be published in a leading
medical journal. NY Times April 16, 2008
American Medical
Association Says 'Secret Shoppers' Should Not Be Used To Gauge Quality at
Doctors' Offices
Chicago Tribune
Smart Healthcare Shopping A
Real Challenge
About Health Insurance
Mentally ill face extra-long
ER waits
USA Today
"Having health insurance is not enough. A study done a few years ago by The
Rand Corporation showed that Americans only got about 55% of the health care
that they should, that science says that they should get. That means that they
are not getting 45%. Just think, if FedEx or the Post Office lost 45% of their
packages they would be out of business. Yet, somehow, in medicine that is O.K.
It really isn't and people need to demand a lot more."
Dr. Bruce Siegel of George
Washington University, Health Policy Research Professor, speaking on C-SPAN
about a report commissioned by the Robert Wood Johnson Foundation, "Health
Disparities Across the Country". The report stated that people that have Medicare were not treated
equally and had different treatment and outcomes with the same insurance.
"...all forms of security, compulsory security, even against old age and
unemployment, represent a beginning invasion by the state into the personal life
of the individual, represent a taking away of individual responsibility, a
weakening of national caliber, a definite step toward either communism or
totalitarianism."
Dr. Morris Fishbein, the
AMA's President in explaining, in 1939, why we shouldn't have a national
healthcare system.
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POLICY MAKERS IN THE NEWS
Reform Activists Call for
Federal Insurance Standards
California Health Advocates, a policy research group that testifies
before Congress frequently on Medicare, Long Term Care, and other insurance
issues, called for Federal standards to be enacted so purchasers of Long Term
Care Insurance would have a better idea of what they were purchasing. In
testimony before the House Energy and Commerce Committee, they noted that state
regulation had failed to create any kind of standards, and often led to products
being approved in some states that could not be sold in other states. They also
claimed that definitions contained in policies varied from company to company.
House Votes to Delay
Medicare Funding Reform
After the huge gift that lawmakers gave doctors in this country last week
by increasing the cost that everyone will pay for Medicare Advantage plans, the
House of Representatives decided to avoid dealing with massive cost over runs in
Medicare until next year. The Democratic leadership doesn't want to start any
discussions about meaningful reform in an election year showing that politics
will continue as usual as the two major parties compete to see who can raise the
most money for their candidates. Under the 2003 Medicare Modernization Act the
President was required to submit a bill to help balance spending when Medicare's
costs exceeded certain levels. President Bush submitted a bill as required that
relied mostly on higher cost sharing of the country's higher income seniors. In
what appears to be a role reversal, the Democratic Party is now raising costs
for the poorest people while pandering to upper middle class and elite
professions such as doctors. June 25, 2008
Congressional Budget Office, Others Pan Obama Health Plan
Several groups scrutinizing the Obama plan cast doubts on it's ability to
deliver on it's promises. The promises also fail to mention that it barely puts
a dent in overall spending because of expected contributions by employers or
subsidies that would be made by the government from tax dollars. The "Chicken in Every Pot"
promises made by the candidate did not get the approval or verification from
several groups including The Commonwealth Fund, Kaiser Family Foundation, and
the Congressional Budget Office, all of which are highly respected non-partisan
groups studying how to reduce the total amount of money spent on health care.
July 24, 2008
Congress Overrides Bush
Veto, Gives $14 Billion to Doctors
Health care reform took another bloody nose from the Democratic
Senate and Congress when they bent to pressure by the American Medical
Association to fund a huge government giveaway program for the AMA's membership.
The giveaway will be funded by raising premiums and cutting benefits to Medicare
beneficiaries, many of whom are on fixed incomes or receiving other government
assistance.
Doctors, already the highest paid profession in the country, refused to bow
to Clinton era reforms that would have cut Medicare costs. Because doctors rely
on a fee for service system that encourages them to only see their patients
after they get ill or are dying, they found no incentive in the threat to cut
payments if they did not improve their performance as they were supposed to
according to the law that was enacted in 1995. Meanwhile, a report has just been
issued by the Commonwealth Fund, a non-partisan health reform think tank,
showing that health care over the same period actually got worse, the opposite
of what the cuts to doctors was meant to accomplish. The report cited among
other things that overtreatment of some illnesses and preventable deaths
continued to soar. July 24, 2008
Bush Vows to Veto Cuts to
Senior Health Benefits
President George W. Bush vowed that he will veto a bill that will
reduce the number of people enrolling in Medicare health plans in order to
maintain United States physicians as the highest paid physicians on the planet.
The legislation passed in both Democratic controlled houses of Congress is very
popular this year because of the election even though it undermines the supposed
principals of the Democratic Party. Physicians, who have done a much better job
of public relations by distancing themselves from the growing crisis in health
reform, have found it is easy to get out of the way and let insurers and easy
target since insurers have had to try to control spending, something that is
very unpopular in a country that also believes it shouldn't save money for
retirement or any other future expenses. July 14, 2008
Congress Continues to Create Difficulties for Health Reform
The House and Senate agreed today on mental health legislation that would
give mental health parity with other illnesses. Even though the Healthy
Americans Act introduced in both the Senate and House, which seems
likely to pass both houses, is a bill that would do away with employer based
health plans, new language may be passed into law that will mandate employer
sponsored plans to provide this benefit. Congress seems to lack the will to
tackle anything controversial in this election year because of negative
publicity that will come from powerful lobbies like the American Medical
Association. The AMA has consistently fought against having any kind of
standards, quality controls, or modifications to how physicians are reimbursed
for their services. July 11, 2008
Senate Puts Physicians Interest Above Low Income Seniors
Ted Kennedy returned to the Senate to cast the deciding vote on a bill that
will cut benefits to seniors so doctors can continue to be one of the highest
paid professions in the country. Physicians that charge $100-200 for a five
minute visit felt that they weren't getting paid enough to see Medicare
patients. Many physicians refuse to see Medicare patients at all. Cuts to
physicians scheduled to go into effect July 1 were delayed while the two parties
bickered over whether the Democrats would allow compromise legislation to be
negotiated. They never allowed those discussions to take place. Instead of
providing meaningful comprehensive reform of our health care system, the
Democratic leadership has been pandering to powerful interest groups that blame
insurers for rationing care. Their solution, a one-payer system in which care
will be even more severely rationed, has yet to be unveiled. July
10, 2008
Federal Insurance Bills Pass Committee
Two bills meant to streamline insurance regulation in the United States
passed committee. HR 5840 which would create a federal insurance regulatory
office and HR 5611 which would create a national registry of insurance agents
and brokers will go to the full House of Representatives for a vote sometime
this year. HR 5611 is a revived and revised portion of earlier legislation
reforming the financial services industry that creates NARAB (National
Association of Registered Agents and Brokers), which originally would have taken
much of the regulatory power away from the states. Under the current version
NARAB would contain a slim majority of state regulators on the NARAB board.
July 10, 2008
Senate Continues Election Year Politics Instead Providing Meaningful Health Care
Reform
Senator Max Baucus continued his campaign to make sure that physicians
remain among the highest paid professionals in the world today, even though the
quality of care in the United States and our economy can't support this. He
promised to bring House bill 6331, which passed by a large majority in the
House, to the floor of the Senate sometime this week, even though the bill will
get a veto from President Bush. Even though the bill is extremely unlikely to
ever get enough votes in the Senate to override a veto, Democrats have decided
that insurance companies are a soft target that will help them gather votes in
November. Republicans and Democrats have been unwilling to tackle real health
reform since the Truman plan was defeated in 1947. House bill 6331 would raise
premiums for Medicare Advantage plans and reduce about $13 billion worth of
benefits for the poor while doing nothing to reduce the cost or improve the
quality of care by providers. July 8, 2008
NAIC Chief Steps Down
The National Association of Insurance
Commissioners, which has a 2008 budget of $68.3 million, will lose it's chief
executive. Catherine Weatherford, executive vice president and chief executive
officer of the National Association of Insurance Commissioners, is leaving her
post, the NAIC says. The NAIC, a group that coordinates activities between state
regulators and acts as a lobbyist in Washington, is coming under increasing fire
as state regulators struggle to hold onto power. There is wide support in
Congress for a federal insurance commissioner which many people feel would make
the United States more competitive while sweeping aside many state regulations
that make it difficult for consumers to find insurance that is appropriate and
affordable. The NAIC and state regulators have generally failed to bring
sensible and comprehensive reforms to the industry, allowing insurance products
in one state that cannot be sold in another or insurance products that aren't
appropriate for anyone and then prosecuting agents that sell those products. The
lack of national standards and protections create confusion for consumers and
and excessive expenses for agents that have to get licensed in every state they
do business in. July 7, 2008
Congress Continues Sickness Policies for Countries Poor
Congress
passed legislation that blocked several Medicaid cuts, mostly to hospitals
already struggling to keep their doors open, sought by the Bush
Administration but one Medicaid rule change that CMS sought wasn't blocked. The
rule that was allowed to stand prohibits payments for certain services, such as
dental and preventive care, for Medicaid patients. The change is expected to
save $300 million nationwide over the next five years, according to analysts'
estimates. Since dental and preventive care have proven to be such a large
component in lowering costs, limiting or preventing chronic illnesses, and
educating people about their health, this cut will probably end up costing
taxpayers billions of dollars. The main beneficiary will be doctors that provide
care after people get sick and pharmaceutical companies whose drugs will be used
as treatment after people get ill.
June 30, 2008
Partisan Bickering Delays Medicare Reforms
Cuts to the amount physicians get reimbursed by Medicare will go into effect
after the US Senate failed to get legislation to a vote on Thursday June 26,
2008. They decided to go on vacation instead of finishing their work and will
take this matter up again later. Legislation proposed by Democrats was blocked by Republicans that
requested some changes in the bill. All attempts at any compromises were refused
by the Democratic leadership including an extension to temporarily stop cuts to
physicians scheduled to take effect on July 1, 2008. The Democrats proposed to
pay for stopping the scheduled cuts to physicians by reducing benefits to
seniors or raising the amount of money seniors would have to pay for Medicare
Advantage plans.
Challenges for Health-Care Reform
Chairman Ben S. Bernanke
At the Senate Finance Committee Health Reform Summit, Washington, D.C.
June 16, 2008
"one of these days you and I are going to spend our sunset years telling our
children and our children's children what it once was like in America when men
were free."
Ronald Reagan, in his LP
Record “Ronald Reagan Speaks Out Against Socialized Medicine” before he became
President of the United States as the
spokesman for the secret "Operation Coffeecup" in which
the American Medical Association tried to defeat passage of Medicare by sending
LP records out to AMA "Ladies Auxiliary" members with a message to write to
"Congressmen" and Senators to kill the legislation.
Healthy Americans Act
Ron Wyden's
proposal now gathering bi-partisan support in Congress and the Senate.
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ADVISORS IN THE NEWS
Advisors Not Up to Date on Annuities
Survey shows strength in accumulation phase not matched when it comes to income
and asset preservation. Advisors need more help understanding converting assets
to income.
C-SPAN VIDEOS
International Health Systems
History of Health Care Reform in the United States
The American Medical Association killed the first attempts at
universal
coverage by demanding that no limits be placed on what providers can
charge
their clients. The following is an excerpt from one of their
publications.
"Compulsory sickness insurance...is a variety of socialized medicine or
state
medicine and possesses the evils inherent in any politically controlled
system.
It is contrary to American tradition and is the first and most dangerous
step
in the direction of complete state socialism. The American Medical
Association
rejects any such scheme as a method of the distribution of medical
care."
- Editorial from The Journal of the American Medical Association, Dec.
1948
As an insurance agent I would willingly give up all commissions on sales
of
basic health insurance. If you view access to health care as a human
right, and I do, then just as surely this isn't something that I want to charge
money for. There are other equally important things that we as agents need
to be speaking with our clients about to ensure their financial future, health
insurance being one of the cornerstones of a financial plan. It would make it
far simpler for people to save and plan for their future access to basic
services
was a given, not a complex problem that forced an indirect tax on the middle
class with no sense of financial security because health care costs instead of
being more of a fixed expense are, under the current system, a runaway
inflationary item that threatens to destroy any kind of planning.
Spending on health care in this country is currently 17% of
Gross Domestic
Product, a number that is unsustainable, makes us less competitive
in the global market, and prevents investment in other key areas like education.
That number will grow to dominate our economy as the demographic bubble
of aging people
continues to swell which will be catastrophic in the years to
come. The country
with the next highest percentage of GDP is half our rate
yet we rank 37th in
terms of the quality of our health care. Expensive doctors
don't mean high
quality health care. Recent studies that emphasize that life
style choices that
lead to the epidemic of obesity mean that even though these
people will not
live as long, they will be sicker and require more expenditures
in their
lifetimes
than someone that lives longer but doesn't have this chronic
disease.
Mandates by some states put a band-aid on this problem by insisting on
"reforms"
without doing anything to control spending. As a matter of policy
it has done nothing more than nitpick around the edges of the problem while
ignoring the larger reasons why people don't have access to providers in the
first place. Insurance has never been a barrier to a provider agreeing to see a
patient. Not everyone can afford, nor should they if they have no assets to
protect,
any form of insurance. Mandates for insurers by states, like those in
Washington
state, are more like a deliberate distraction from dealing with the root causes
of
the problem of being able to access basic services. This has been more like a
full
employment act for service
providers while producing little of substance
in
the way of benefits for
consumers.
The reason we don't have universal health care is because members of the
American Medical Association, doctors and hospitals, have defeated every
attempt to limit the amount of money they can charge their patients. Doctors,
as a group, oppose reforming a system where the risk of losing profit outweighs
the importance of providing measurable outcomes for their patients. But this
system has been abused and needs to be brought into the same kind of
scrutiny and control that any other major decision, financial or otherwise. A 90
year old that can't follow along in a conversation shouldn't be subjected to
open heart surgery if the consent wouldn't be legal for any other kind of
financial transaction.
For more information about the history of attempts to establish universal
health
care in the U. S. see the links below. You can find many more yourself.
President
Truman Addresses Congress on Proposed Health Program
United States health reform under Truman
Truman, FDR and universal health coverage
One Nation, Uninsured
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Solving the Problem
Health spending is now 16-17% and at the current pace of growth will exceed
22% of gross domestic product by 2020 and represent 50% of all federal
spending by 2050 according to Federal Reserve Board Chair Ben Bernanke in
his
testimony before Congress on June 16, 2008.
We need multi-payer, non-profit insurance companies, and controls on how
much providers can charge. That was the common theme of the most successful
programs implemented around the world. Billing costs inside provider offices
make up the largest expense they have. By moving to a
standardized pricing
structure, most of that expense could be eliminated.
Medicare should be
balanced to pay the same rate, not 20-30 cents
on the dollar as it does now.
There should
be
incentives for outcomes and
strict guidelines that require
providers to make
full disclosures to patients,
especially elderly patients,
about all of the
possible risks and downsides to
treatment.
We need to remove many of the legal barriers to qualified service providers
to share information, and electronic health records so patients can own and
control their information and take it where they need to go instead of making
it the sole property of insurers and health care providers who like to manage
this information as if it were their property, not the patients.
Changing to a universal health care system doesn't mean that we will have
to increase our taxes or our budget for health expenditures. It should be our
goal to reverse that trend so that that aspect of our economy looks more like
other industrialized countries and so that portion of our economy is
sustainable,
not a catastrophic liability. It would help greatly if we started investing in
our
future by helping more people with their education so we have a more legitimate
expectation that providers and other highly educated professionals that we
depend on for services won't have as many problems participating in these
kinds of public works without feeling such a great financial insecurity to be
able to do so.
Upgrading and modernizing our infrastructure, including
adapting a more
detailed coding system that is in use by the rest of the world,
should also
help reduce the amount of errors and time it takes to manage care.
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