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?

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Here It Comes: New Medical Taxes from BaucuSCARE

Thursday, October 29, 2009

There remains a great divide between Democrats and Republicans on health care reform and the time for construction of the actual bill is upon us. It’s not so much what’s in the bill, because the politicians will have their way, but a more significant area of disagreement is what the final bill will actually cost and how it would be paid for. One stipulation is for it to achieve the President’s commitment to being deficit neutral. In order to achieve that goal, the Senate constructed (upon the prodding of the White House) a plan called the “Doctor Fix” legislation (S1776) that would in essence buy their support by “freezing” the mandatory cuts in Medicare and Medicaid payments over the next ten years to the tune of nearly one-quarter trillion dollars. That meant “sliding” some of the cost of the overall healthcare reform to other legislation so that the cost of the healthcare reform would barely come in under Obama’s proposed limit of one trillion dollars. Now, that, my friends is one heck of a political shell game! (We already know they plan to cut half a trillion from Medicare and Medicaid).

If you haven’t been living in a cave, you know there has been healthcare bill proposed in the Senate by Senator Max Baucus and was supposed to be the work done by the Gang of Six, a committee of six senators headed up by Senators Baucus(D) and Grassley(R). Magically, Senator Baucus released his own document which he alone sponsored (no one else apparently wanted to lay claim to it!) and which is referred to as the Baucus Framework. It outlines key provisions that Senator Baucus would like to see in the final healthcare bill. With the acceptance of the Framework by the Finance Committee, this proposed legislation spent several days behind closed doors where Harry Reid, Rahm Emanuel, and others got their hands on it.  It emerged with an inserted Public Option….Uh-oh, they instantly lost some support! So, then they altered it to be a “States Can Opt Out Plan”. But that won’t work either. States will still have to fork over taxes to the federal government to pay for the States who opted in! That means that taxpayers in non-opted-in states will STILL be paying for someone else’s health care!

Besides “Doctor Fix” as a proposed way to disperse the cost for this monstrosity, the Baucus Framework has introduced several new taxes on pharmaceutical companies, medical device manufacturers, clinical laboratories and insurance companies. Let me put it a little clearer. Heart stents – new tax, motorized wheelchairs – new tax, and there’s more! In fact, anything that can be construed as a “medical device” (something that is used to improve health) and costs over $100 will have a new tax imposed upon it. The new taxes (Democrats call it “fees”!) over the ten year period would total $63 billion dollars just for pharmaceutical and the medical device industry. That’s a FAR cry from the more than $1 trillion cost as this legislation now stands! And guess what…. the cost of this reform is coming not from the filthy rich! It’s coming out of the hard-earned wages of middle America, those how are finding it more and more difficult to keep their heads above water. It’s coming from you!

Besides “Doctor Fix” as a proposed way to disperse the cost for this monstrosity, the Baucus Framework has introduced several new taxes on pharmaceutical companies, medical device manufacturers, clinical laboratories and insurance companies. Let me put it a little clearer. Heart stents – new tax, motorized wheelchairs – new tax, and there’s more! In fact, anything that can be construed as a “medical device” (something that is used to improve health) and costs over $100 will have a new tax imposed upon it. The new taxes (Democrats call it “fees”!) over the ten year period would total $63 billion dollars just for pharmaceutical and the medical device industry. That’s a FAR cry from the more than $1 trillion cost as this legislation now stands! And guess what…. the cost of this reform is coming not from the filthy rich! It’s coming out of the hard-earned wages of middle America, those how are finding it more and more difficult to keep their heads above water. It’s coming from you!


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!


More on the Healthcare Issue…

Thursday, October 15, 2009

Just a thought here:  Let’s say that the House and Senate can come up with a single plan and it goes to Obama and he signs it – with or without the public option.  How much do you think that Congress can change that healthcare program between now and 2013 when it actually takes effect?  The thought is more than I can comprehend just based on the “mind-boggling” actions Congress has done in passing these huge deficit inducing bills over the past year.

Right now there really isn’t a single healthcare plan.  There are at least five proposals out there right now.  Some pet aspects from each of the versions will have to be cut when they put the different versions together – but they will not be forgotten.  So, you could expect “disgruntled” Democrats to come back time and again to get those added to whatever version gets passed into law.  This scenario is not so far fetched with the healthcare plan that is being shoved through our Congress right now and given how much debate is going on – even within parties.   However, none of the proposed plans will contain the crucial elements that most Americans are adamant about – those being tort reform, capping drug and insurance costs, and cutting waste in Medicaid and Medicare. 

No one is saying that malpractice shouldn’t be litigated, but there should be some restrictions in place in such a way as to what constitutes frivolous lawsuits, time limits for litigation should also be shortened, and there should be caps placed on the awards.  Drug companies should not be allowed to rob US citizens in favor of citizens of other countries to make their businesses profitable.  The insurance companies should also be held accountable for running premiums costs up just to increase their bottom line.  Waste in the administration of Medicare and Medicaid and fraudulent claims should be addressed and dealt with, too.  And you know what?  If these things were added to the legislation, that would be real healthcare reform!


Social Security Sucks You Into Gov’t Healthcare

Monday, October 5, 2009

Brian Hall is a senior citizen. He is suing the government over its current mandatory healthcare practices.

Huh?! We don’t have a national healthcare bill passed yet, but he’s got problems with government-run healthcare already? You betcha!

When Brian turned 65, even though he had private healthcare insurance he wanted to keep, he was forced by the government to enroll in Medicare. That meant he would have to give up his private health insurance which he believed was better than what Medicare offered. He contacted the Department of Health and Human Services and the Social Security Administration and was told he could not opt out of Medicare.

Actually, what the Social Security Administration said was that even though he paid into Social Security for his entire working career, he cannot opt out of Medicare without giving up his Social Security. So, he consulted with his own attorneys and he’s now suing the government for what he rightfully deserves – his Social Security check…. without the strings of Medicare attached.

We know that Medicare and Social Security are virtually financially broke or soon will be. Actually, Social Security will pay out more in 2010 than they take in. Medicare will be bankrupt within five years. So why are these government’s entitlement programs forcing seniors into their healthcare program?

If seniors have the ability to pay for their own hospitalization coverage through private insurance, from a financial standpoint, doesn’t it make better sense to let them do it and get them out of the money pit of Medicare? Why won’t the government allow seniors to opt out of their most costly portion of their program, Medicare Part A which covers hospital insurance?

The answer is because with each person who opted out of Medicare, it would require the government to give up a small piece of power, and that would put a crack in their universal healthcare plan. They do not want anyone to be able to exercise their legal right to pay for private insurance if that’s what the people prefer. So, if you ignorant enough to think that your private insurance will survive if a public option (of any version) gets into healthcare reform, think again!

Just so we’re clear, there is no law that says any Social Security recipient must subscribe to Medicare, but some “backdoor” administrative measures which were adopted back about 16 years ago by these entitlement programs are what they are using to push seniors into enrolling in Medicare Part A — under the threat of losing their Social Security. This current policy is a violation of the individual’s right to make their own healthcare choices; and further, it violates both the Social Security and Medicare laws.

So, if this is a foreshadowing of what is to come under the ObamaCare or BaucuSCARE, then even if a “private option” remains on the table along with the “public option”, policies have already been put into place that can be adopted across the board which will eventually eliminate the option to chose private insurance or to opt out of Medicare, thereby forcing you out of your private insurance coverage into a governmental plan for health care coverage.

This slight of hand, this political mumbo-jumbo (is it a public option or is it a co-op?), these scare tactics cannot be allowed any longer. Call it what it is. And if you talk to people about the issue, point out the deceptions.

 People must be allowed their basic life and health choices rights without governmental blackmail. Go get them Brian Hall!