How Healthcare Works, and Why You Should Care

Sunday, March 14, 2010

I haven’t been able to keep posting to my blog for the last few months because I found one of those “non-existent” jobs… or rather it found me… and it has consumed all my time and energy.  This new job happens to be in the medical field, an area that I have never worked in before.  It has been interesting to be on the inside (in light of the healthcare debate now raging!) and to get glimpses of what is really going on.  Not only have I learned how to do my job, I have been exposed to the hierarchy of the medical world and can comment more knowledgeably than I once could.

I work for a physician and here is what I have discovered.  The physician can only charge fees based upon a CPT code, which is owned by the AMA (American Medical Association).  Interestingly, only a small percentage of physicians in the US are actual members of this organization, and I’ve been told that many of those are in the area of research or teaching rather than actual practice.  The physicians are required to pay a licensing fee for the use of the codes.  It is also interesting that there are no other options.  I believe that is called a monopoly!  (By the way, do you remember the backroom deal that Obama had with the AMA EARLY ON in the healthcare debate?  Don’t you wonder what was negotiated at that time?)

Then there are the insurance companies that come along and create “service networks” and recruit physicians to join the network by enticing them to take less than the AMA’s established fees.  The insurance companies get that portion of the cut, and I don’t know the percentage the insurance companies get, but you can bet your first born that they get quite a lot since insurance companies constitute a large portion of our economy.  And do you remember the backroom deals with Obama  on lowering premiums on healthcare.  Of course, they would negotiate on that.  It opens up the field for them to get more patients into their pipeline!)

Each negotiated network is different, but I believe that you can estimate that the doctor’s fees, as ascribed by the AMA, is cut by about 30 to 35%, sometimes as much as 80%, depending upon the procedure.  Then Medicare and Medicaid come in and chop the AMA fees right off the top by two-thirds.  What I found out over the past few months, especially in regard to the Medicare and Medicaid issue, is that in addition to that original chop, the rates they will be paid have been reduced by another 21% from their “regular rates”.  

What the Obama healthcare plan would do is, in essence, make all healthcare a Medicare/Medicaid program.  If doctors cannot make any money at 20% of what the AMA has determined as the fees, what doctor would want to remain in the profession?  And where is the incentive to continue their education, to remain current in the latest techniques and procedures.  That is expensive and time consuming.  They would not be able to afford the staff they need to run their practices.  There is a trickle effect in question here the same as there is an any business.  

So, as I have been observing the healthcare issue from an “inside vantage point”, I am beginning to see that it’s not the doctors who are the villains in the healthcare issue, but rather the victims.  Of course doctors make a good salary, but it’s due to volume of patients, not the cost to the patients, where they receive their salaries.  Another thing I’ve noticed in this particular doctor’s practice is that more than 50% of the patients are Medicare patients.  His income on these patients in only one-third of what he is supposed to make.  (And the government wants EVERYONE in the US on a Medicare/Medicaid-type system!  No wonder many physicians have threatened to leave their profession if this healthcare reform is passed.  Who could blame them?)

I could go on with the above explanation, but I don’t want to make this long and drawn out.  It does substantiate what I have said before in my blog, and what I’ve read in other blogs, the problem doesn’t lie in the “healthcare” provided.  The US still has the best  healthcare in the world.  Rather, the problem lies in the system.  Presently the system is a monopoly run by the AMA, complicated by the insurance industry, and though I haven’t touched on this part of the equation, inflamed by the legal profession who are so eager to litigate and courts who award unreasonable settlements.  These are the factors that contribute to the high cost of our healthcare and the issues that really need to be addressed.  So, do we want to trade that for a government-run system as based upon the Medicare/Medicaid model, which is broken and corrupt?

In my opinion to mess with  healthcare itself is a gross mistake.  But what really needs to be addressed, and yea, even fixed, is the problems which lie within the system that behind our healthcare.  That’s where the greed lies.  That’s where the problems are.  If the US government wanted to, they could get that under control, break the monopoly the AMA has on healthcare services provided, address the tort reform issue, then the whole issue of medical care would be just as the rest of the free market – healthily (pardon the pun) competitive.  The GOP has been saying, and people are beginning to listen, that the government isn’t interested in affordable healthcare in spite of what they’re saying.  They’re interested in controlling healthcare.  Healthcare is one of the more intimate and private areas of our lives.  So, we as voters MUST think long and hard about this issue.  Do we REALLY want to have the government involved in the most intimate and personal aspect of our daily lives?


Is ObamaCare DOA at Senate?

Sunday, November 8, 2009

So, the House squeaked out enough votes to pass their horrendous healthcare bill against the wishes of the majority of Americans.  I had assumed it primarily had to do with the fact that the uber-liberals were just hell-bent on pushing through their agenda based upon their socialistic ideals, or that they were running on the stale “mandate” of 2008 Obama campaign.  However, the polls suggest that Americans have changed their mind on Obama’s change!

So, that gave me pause to think, why would so-called “intelligent” people and large organizations be in favor of this vastly aggressive bill.  I happened on to an article that Dick Morris and his wife, Eileen McGann, wrote on The Hill.  Now, I’m not necessarily a big fan of Dick Morris.  I’m always suspicious of someone who changes political allegiances, and especially when they change back again.  In this case Dick was a Republican who went over to the left to work for Clinton, and now is on the right again.  In fact, I have about as much respect for him as I do Arlen Specter.

However, in their article, Morris and McGann did shed some light on that nagging questions.  They claim that there was some “bribery” involved.  I must say that makes sense.  But, isn’t that “business as usual” that Washington is known for and what Obama vowed to change?  Oh,but  no, it wasn’t that kind of Washington change he meant, was it?   He meant that he would have a sub-cabinet that that was neither elected or approved, that wasn’t answerable to Congress, and that had no restrictions upon them – but that’s for another time.

In today’s blog I’m dealing with why would groups like AMA and AARP be in favor of Obamacare.  Morris and McGann pointed out that there was a little wheeling and dealing in a back room at the White House. 

Morris and McGann stated that the AMA, under the current law, was facing a 21% cut in physicians’ Medicare reimbursements that have accumulated over year after year rather than being repealed by Congress.  Obama promised to kill the cut if they would endorse his bill.   (Ah, now that makes some sense…. and perhaps why the trustees okayed the endorsement without the support of the membership.) 

Likewise, AARP apparently got a financial windfall for their support as well.  It appears that they are doing like some of the non-banks that are now banks.  That is to say, they dabbled in insurance through their subsidiary company, so they are morphing from an advocacy group into a full-fledged insurance.  They had their own Medi-gap insurance which is costly for seniors.  This Medi-gap picked up where Medicare left off… but Bush passed Medicare Advantage program.  It did the same thing, but at a lower cost.  (And where was it now that Obama was going to cut Medicare to pay for his plan?  Oh, yeah, Medicare Advantage!  Hmm.  That eliminates competition for AARP, doesn’t it?)

But there’s one other entity that I had questions about and not a lot has been said about it.  That is the negotiated deal between Obama and the drug companies.   So, what kind of deal did Obama do for them?  Well, let’s see… Morris and McGann say in their article that for backing his ObamaCare bill, the drug industry could get a 10-year limit of something in the neighborhood of $80 billion on prescription drug costs, plus there would be a ban on imported Canadian drugs, and the drug industry was to also make their huge advertising budget available to the Obama Administration.

So, who are the other winners?  How about the Insurance industry itself.  I haven’t heard them screaming bloody murder about this governmental competition.   Perhaps that because they will have potentially 40 million new customers whose premiums will be paid by the government.  But wait, they were perhaps a little premature in their elation.  It appears that the honeymoon with ObamaCare ended when the Senate Finance Committee bill lowered the penalty from $3,500 to $1,500.  That meant that the penalty was more affordable than their insurance premiums.

Among the losers in this scenario is the industry that makes medical devices.  They wouldn’t go along with ObamaCare and it’s cost them.  The BaucuScare bill imposed a tax on their devices.  These include arterial stents, prosthetics, hip and knee joints, pacemakers, and automated wheelchairs.

Now that these facts have come to light, people are becoming better informed than ever before and the Senate needs to understand that when Americans say they don’t want ObamaCare, they mean it!  If they don’t listen, the American people will be the real losers here.  They will lose the quality of care that is the envy of the whole world.  They will lose the right to choose their insurance coverage, to choose their doctor, and to choose the type of medication and/or treatment.

Pelosi’s HR3962 Is Worst Socialist Legislation – EVER!

Saturday, November 7, 2009

If you’re looking for more deficit spending and higher taxes for everyone, increased costs for insurance coverage, rationed care (particularly for elderly and the sick), a long waiting period for coverage under the new healthcare plan for those with pre-existing conditions, and “creative” (if not illegal) Congressional accounting, then The Pelosi healthcare bill has it all!  The health bill she unveiled last Thursday (and which President Obama quickly proclaimed a “critical milestone”)  is probably the worst piece of socialist legislation ever introduced and, quite frankly, forced upon Americans. 

Rumor has it that Speaker Nancy Pelosi has said to her fellow Democrats that she is “all in” and prepared to lose seats in 2010 if that’s what it will take to pass ObamaCare.  Well, if that’s the case, I say let her’s be the first one to go!  (No single person should have as much power as she THINKS she has.   She’s got the representatives in the House by the  — well, she’d got them literally dominated!) 

The Democrats under Pelosi’s dictatorship leadership are no longer even making the pretense of wanting “bipartisan” support for this bill.  Instead they are using pure political power plays to shove through what is probably an unrepealable middle-class entitlement that will continue to expand over time and raise taxes steeply.  This ObamaCare will expand government control of healthcare, and that means that all medical care will be administered through the Congress – what kind of healthcare, how much healthcare, who gets it and who doesn’t, how much it costs, etc.  Do you really want some other Congressman or Senator from some other state having a say in meeting your health care needs?

It is almost beyond comprehension that the Democrats have begun such a purely political power play, especially with the unpopularity of their own agenda.  People from all political positions are expressing great concern over this governmental seizure of this large portion of the nation’s economy.  But the goal of these liberal (and wimpy moderate) Democrats is to ram through this part of Obama’s overall income-redistribution plan.  It’s all about gaining more CONTROL in every aspect of American lives.  

Congress claims that  HR 3962 is “universal coverage” – but keep in mind they have admitted that it’s still NOT going to cover everyone.  The actual result if this is passed will be destruction of the world’s best healthcare system, of our country’s fiscal stability, of private industries, of opportunities for prosperity, and ultimately, the personal freedoms fo every American.

This proposed legislation that Pelosi is ramming through the House with super-sonic speed costs considerably more than it was supposed to.  It costs even more than the HR 3200! And again,  it doesn’t even offer healthcare to everyone – as the Obama campaign promised.  It does NOTHING to change the things that are wrong with the present system.  Instead it creates the framework for even more problems — in spades!  And further, as we have seen time and time again, the estimated costs of government programs are always only a portion of its actual costs.  This bill was supposed to come in at around $900 billion or Obama wouldn’t sign it.  But it’s now well over $1 trillion at this writing and he doesn’t sound hesitant at all in his praises of this bill!  (Some have calculated that over 10 years, this bill will have a price tag of $2.4 trillion!) 

(Note:  Remember how Obama used the “Republicans/Bush’s deficit” as a talking point in his campaign and how he was going to turn it around… well, instead he has created a mountain of debt that makes the Bush deficit look like a tiny blip on the deficit screen – and he isn’t through – the Cap and Tax is working its way through the Senate now!)

“House Call” on Washington

Tens of thousands of people marched on the House on Thursday at noon to protest this healthcare legislation.  (Interesting how no one will give a solid estimate of how many people there really were, but it was literally a sea of people encompassing the Congressional buildings.  But if Code Pink were to stage a protest, they’d have a pretty good headcount and post that amount (times 100 – or 1000!)  Regardless, the message from these people is that this bill is a piece of crap!  If you asked people in that group if they believed that we need healthcare reform, most of them would say that we do.  However, they don’t want an overhaul.   They would tell you, “Let’s fix what is wrong with the one we have!”

Sure our present system has flaws – that is something that no one disputes.  But we have identified where the problems are and everyone in Congress knows where they are.  The FIRST flaw is that we don’t have a cap on non-economic compensation when there is a malpractice lawsuit.  Everyone also knows that the lobbyists for trial lawyers have paid off most if not all of our lawmakers.  Suspiciously, this is the one segment of professionals that have had absolutely no comment or been seen taking a position during this hotly contested debate, but if we really fixed what was wrong with our present healthcare system, they certainly have a dog in the hunt.

Like Rats From a Sinking Ship!  (After the public spoke in NJ and VA!)

The voices of the “tens of thousands” is being heard, though.  The Blue Dogs saw what happened in Virginia and New Jersey last week.  On the heels of that demonstration, they saw how quickly a very large group of people could be called to and attend a march on Congress.  Now, they’re considering their options.  Some are wring their hands moaning, “What to do, what to do.”  The question is are they more afraid of Nancy Pelosi – or their constituents!  Will they “walk the plank” for Ms. Pelosi and the trial lawyer lobby? 

Not only are the Blue Dogs in a quandary about which side they’re willing to commit to,  the members of AMA (American Medical Association) who Obama proclaimed again this week supported his Obamacare, are now saying that the AMA should not be supporting the House’s health care plan because the issue of endorsement hadn’t been formally approved by the membership. 

Actually, it was a board of trustees for the AMA that made the endorsement without taking an official vote among the members of the organization.  This week, there’s been some developing outrage among AMA members who feel like this endorsement was made against the general consensus of the AMA’s members.  So, in a few days, probably on Monday, the members will cast a vote on a resolution that could officially reverse the AMA’s Obamacare endorsement.  (Note:  If Pelosi gets her way this weekend, though, it’s too late in the game to be withdrawing a much-publicized endorsement and would be nothing less than a token gesture.  Where have the AMA members been all this time???  Have they, too, seen the handwriting on the wall?)

No One Knows What Goes On Behind Closed Doors —

Thursday, October 22, 2009

Or do they?  You know politicians like to talk – a lot. And those who work with them seem to always be jockeying for position and/or attention. So, if you just get people to talking, you’re bound to find out something that “the powers that be” wouldn’t want you to know.

The Obama Administration has claimed the endorsement of the AMA for Obama’s healthcare reform, but as many physicians will tell you, most practicing physicians are not members of the AMA.  Do you remember the staged doctors’ meeting in the Rose Garden at the White House?  Where the hundred or so doctors were given white lab coats to wear so they would “look” like doctors?  Nice photo op – except the there weren’t any hospital or practice logos or names embroidered on them and the unfortunate pictures of staff handing out lab coats didn’t lend any credibility to the effect, either.   If one was so inclined, they could assume (as seen from the back anyway) that these may have been lab techs — or butchers from local grocery stores!  Apparently that gathering wasn’t an accurate representation of a wide-ranging support of physicians for Obamacare. 

As you know, the Senate elite plus Rahm Emanuel have been holed up behind closed doors  – and EVERYONE knows this is in direct opposition to the promise of total transparency Candidate Obama promised (everything would be on CSPAN – indeed!) –  trying to hammer out a Senate healthcare bill that will be acceptable to the wary moderates in the Senate.  On Day Seven of the closed door sessions, the White House and the Senate leaders came up with this brilliant idea of ordering Congress to pass a $247 billion bill (S1776) as a payoff to doctors to try and gain their support for this comprehensive healthcare reform. 

In regards to the “Secret Bill”, as reported by The Hill, “The White House and Democratic leaders are offering doctors a deal:  They’ll freeze cuts in Medicare payments to doctors in exchange for doctor’s support of health care reform.”  The $247 billion “Doc Fix” bill totally excluded any public debate, or for that matter, any public knowledge.  This “secret” bill was designed to get a large block of physician support – only it didn’t work as planned and Harry Reid blames the AMA, though not by name.   (Apparently the AMA lobbyists were supposed to “deliver” about two dozen Republican votes for this bill, but that didn’t materialize even though some Republican Senators have supported short-term freezes to Medicare cuts in the past.)

Physicians have been forced to take cuts in medicare payments for quite some time and now a promised half-trillion dollars more in cuts to Medicare and Medicaid over the next ten years.  The only place that cuts can come from is from the payout to doctors who are treating Medicare and Medicaid recipients.  However, I would imagine that the doctors would much rather see the Medicare/Medicaid payment structure be a part of the reform and not be the “backbone” of how Obama/Pelosi/Reid plan to pay for their healthcare system. 

Anyway, this week the Senate used cloture to bring the “Doc Fix” Bill S1776 to a vote, but it failed 47 to 53.  So, it looks to me like perhaps our lawmakers are aware that the public has become more enlightened about what is going on in Washington and ordinary citizens have become focused on their legislative activities. Perhaps this closer scrutiny and the sharing of information between people and groups are making lawmakers squirm a bit when it comes to ramming something like this “Doc Fix” bill through without much semblance of debate or use of “legal trickery” to move a bill through quickly…. afterall, it is their political futures that are on the line!