Monday, December 26, 2011

Big Brother

What steps do you take to protect your financial information on-line? With the current health care law slated to go into full effect in 2014 the state and federal government will have your tax information online to determine your eligibility for premium support or Medicaid. This invasion of your privacy is now funded by the federal government and will also cost you through State taxes as of January 2015.

This action is a consequence of out-dated thinking by our political leaders who are wedded to central planning and price controls that have failed all over the world. Our nation is bankrupt, our employment situation is dire, our health care costs are out of control and consequently we do not have the resources to adequately educate our children. In-spite of this reality the new health care law is a maze of central planning and bureaucratic confusion. Health care exchanges, a key feature of the new law, is a prime example of this out-dated mentality.

An alternative method of health care, such currently implemented in Indiana through Health Savings accounts, allows state workers to have high quality care at an affordable price with no bureaucratic control.

Sunday, December 11, 2011

You should be responsible for your own health

Health Savings Accounts for every American will give our people the incentive to eat, shop and behave in a manner more consistent with healthy living. For example, if your doctor can show you that it will cost your health savings account a lot more money to eat junk food, you will not do so. This economic incentive to provide healthy foods will in turn render easier access to these foods, increasing jobs through growing localy and improving the environment through sustainable methods.

On the other hand, we could continue to be directed by our centralized government and watch our national debt increase, our health care continue to fail, and our environment deteriorate.

Monday, December 5, 2011

Empower the Individual

The reality is that we have an increasing number of our citizens who are incapable of succeeding in a competitive worldwide industrial world. Instead of focusing on the resources and energy we need to devote to educating future generations our political leadership devotes its energies on a failed health care policy. Using Health Savings Accounts funded by tax policy, where individuals are in charge of their own health care, we could be spending our National resources on the adequate education of our youth, enabling them to succeed in a competitive global economy.

Sunday, November 20, 2011

Health Savings Accounts for Universal Coverage

There is no doubt in my mind that we need universal coverage, but at a lower, not a higher percentage of gross domestic product devoted to health care. We need to provide care without increasing demand. The answer is health savings accounts (HSAs) with high deductible catastrophic insurance (HDCI) which has proven to dramatically decrease demand and costs in Indiana (WSJ March 1, 2010). Tax credits for those who pay income taxes, the earned income tax credit, and federal subsidy for the remainder would fund HSAs for all Americans. These accounts would be created at birth, grow tax free and provide the funding for health care when elderly. All Americans would also have a choice of several nationally offered HDCI, providing true insurance. Thus, each generation would be accumulating the capital to care for itself when elderly instead of depending on ever shrinking succeeding generations. Upon death the accumulated unspent capital would be passed on to their beneficiaries.

Saturday, September 3, 2011

Another Government Disaster

Accountable Care Organizations (ACOs) are part of the new health reform law in an attempt to decrease costs. Following the ACOs protocols, hospitals and physicians are paid on the basis of a fixed budget determined by the bureaucracy in Washington, instead of fee-for-service. Accountable Care Organizations, even though given a nice name, is an attempt by the government to control medical practice, regardless of individual patient medical needs and judgment of those needs by physicians. The start-up costs for instituting this agenda are huge, and the quality of medical care in this country will be further compromised.
Most of our best institutions have opted out of Accountable Care Organizations. The assumption behind creation of the ACOs is that physicians in America are practicing medicine that is too expensive, and that the solution is replacing fee-for service with fixed costs. It is true that Americans practice expensive medicine, but adding to our present centralized-planning price-fixed system will only exacerbate the problem. A major contributor to our high costs is the overuse of technology, driven by a perverse Medicare reimbursement system. For example, taking a good medical history, doing a thorough physical exam, interpreting simple tests, and conceptual thinking of an individual patient’s problems are not rewarded. In addition, there are several other costly Medicare issues as yet unaddressed: patients have no responsibility for the overuse of health care resources, there is a confusing advanced directive policy, and there is an ever-present threat of legal action. In addition to not addressing these problems, ACOs promote an assembly line style of medicine where physicians will have even less time to spend with patients. Thus ACOs are another misguided attempt to decrease Medicare costs by adding to an already excessive maze of regulations.
There are alternatives to our present highly bureaucratic attempts to provide medical care to our population. One alternative that would allow every generation to pay for its own benefits while providing universal coverage at a cost this nation can afford is as follows:

1. Health Savings Accounts (HSA), accumulating tax free starting at an early age, funded in large part by a tax credit for those paying income tax and a reverse tax for those not paying income taxes; the unused portion of those who paid with tax credits can be passed on to their heirs after being taxed. Expensive items would be covered by high deductable insurance that would be federally subsidized for the poor. This would meet the need for every generation to accumulate the funds to pay for their own benefits. Market forces and professional peer review would control costs, ensure quality and protect against legal action.

2. The Patient Self Determination Act (PSDA) to be amended, adding, “Consistent with providing beneficial care to the patient.”

3. A form to be completed with each hospital admission to correct problems with advanced directives and deal with consumerism.

4. Medicare/Medicaid being phased out and replaced with HSA & high deductable insurance that can be purchased before taxes and available throughout the country.

There is a growing physician based National grassroots organization, Docs4PatientCare, which aims to develop policies that are medically and economically sound. The alternative is more from Washington like ACOs.

Wednesday, July 20, 2011

Physicians Should Be In Charge

We as a medical profession are losing control of doing what is best for our patients. There is consumerism, strong special interests and a misinformed political leadership driving American medicine. The problem is that physicians have not banded together to make sure our nation can afford what we practice. We spend about twice as much per person as any other country, but still have millions feeling insecure about rising insurance costs and lack of universal coverage. The irony is that by multiple methods it has been determined that we spend about $800 billion on non-beneficial inappropriate care. Physicians must work together to address this overspending. Who is more capable of controlling health care costs while providing excellent individualized care, a growing federal bureaucracy or physicians in a collaborative working relationship?

Saturday, May 28, 2011

Medical Problems and Solutions

1. The National medical societies take no responsibility for the 30% of non-beneficial care. The AMA is greatly influenced by Congressional payments for the use of CPT codes and thus is not an independent body representing physicians and their patients.
Docs4PatientCare is being established as an independent physician group that receives no income from Congress or drug companies. It is funded solely by physician donations and dedicated to excellent patient care at a cost this nation can afford.

2. Medicaid causes extreme state financial hardship, decreasing funds for educating our children which is a threat to our nation’s future.
Having Health Savings Accounts from an early age and high deductable insurance for expensive items would eliminate the need for Medicaid.

3. There is a medical consumerism society in our country that is fostered by several factors: the courts (i.e. Baby K & Helga Wanglie cases), lack of clarity in the PSDA, and the proliferation of drug and medical device company ads on TV.
Amend the PSDA – “Consistent with providing beneficial care to the patient.” Two
physicians and a nurse would be salaried at each hospital to resolve conflicts and insure beneficial care.

4. There is a primary care shortage.
Have subspecialists as the caring physician for those patients with advanced disease who do not have a primary care physician.

Monday, May 9, 2011

Health Care Savings Accounts

A simple solution to save our government money is to create health care saving accounts. Every person in this country would receive a yearly health care tax credit. Individuals can then spend this money according to their needs.

This would provide universal coverage, and our government would no longer be in the business of determining physician fees.

Thursday, May 5, 2011

Health Care

Any concerned individual should be able to ask relevant questions about our health care. Why is our health care so expensive? Why does our health care system cost us jobs? And why, if we already spend so much, do we have to spend more to provide universal coverage, especially when other countries do so at far less cost? Read more in my free e-book.

Sunday, April 17, 2011

Hospital Advertising

Have you ever noticed that while driving on any major road in America you see billboards touting that the local hospital is in the top 100 as certified by this or that “prestigious” firm or accounting group? Hospitals are paying multiple millions of dollars to these “prestigious” companies enabling them to make these claims. The hospitals work hard to meet the firm’s criteria, enabling the company to say that the hospital is outstanding in this or that quality so as to increase the hospital’s prestige relative to its competitors and attract more patients. This is another costly advertising practice increasing our nation’s health care costs. In reality, there is no such thing as “the best” hospital. Every patient is unique and the special skills needed for that particular person may or may not be available in the hospital that has been declared “the best”. Maximizing benefit for the patient is served by having a trusted, knowledgeable, objective physician who knows her/his needs who then recommends the best place to meet that need. One way to decrease medical costs, therefore, is by having the public not place any credence to this form of advertising leading to its eventual demise.

Tuesday, April 12, 2011

Beneficial Care

Technology must be used wisely. There are instances where the application of procedures, for example heart catheterization and stents in selected patients, are extremely helpful. However, medical treatments are all too often employed when they are not indicated which neither helps and even harms the patient. This practice wastes Medicare resources. For example, it is estimated that up to 30% of all Medicare costs are spent on procedures and therapies that are not helpful. Procedures and tests such as heart stents, CAT scans, MRIs and intensive care, while in many circumstances appropriate, are frequently not necessary, with no chance of benefit to the patient. Refining Medicare to reduce excessive procedures and expenditures would eliminate the need to cut benefits to seniors. The PPACA, recently passed by Congress, is primarily funded by progressive decreases in Medicare payments which will result in significant decreases in care. This would not be necessary if we practiced thoughtful beneficial care.

Monday, April 4, 2011

Necessity of an Appropriate Care Committee

Seniors will not get the medical care they need because of the PPACA. Our government is broke, so is cutting care to save money. Instead, our government could institute a salaried, three person committee in each hospital to ensure that only beneficial care is provided. This could save up to 30% of Medicare health care costs, or around $145 billion dollars, that is otherwise spent on care of no value.

***Benefit of Appropriate Care Form***

Procedures that are not indicated result in more suffering. The addition of an admission form will help the patients, physicians and salaried medical team make rational decisions for beneficial care while avoiding the patient solely managing the complexities while they are sick and distraught. In the long term this will help hospitals and physicians because Medicare payments will not be cut.

Saturday, April 2, 2011

Can Medicare As We Know It Be Saved?

Medicare is in deep financial trouble. Federal spending for this program in 2011 is expected to be $487.9 billion. This amount is projected by the Congressional Budget Office to increase to over one trillion dollars by 2020 which, if not addressed, would bankrupt the federal government. In response to this projection, the deficit and the desire for universal coverage, the newly enacted Patient Protection and Affordable Care Act will arbitrarily decrease Medicare payments, cutting spending by $523 billion over the next ten years. This will decrease care for many if not most Medicare patients by severely limiting their access to physicians and hospitals.

There is a better way to control Medicare’s costs and provide universal coverage. A great deal of our total medical expenditures, almost one-third by several different estimates, is for non-beneficial inappropriate care. A physician committee in each hospital to help provide only beneficial care individualized for each patient would avoid over-treatment, decreasing Medicare costs by at least 20-25%. As therapies of no benefit expose the patient only to risks, this would also improve outcomes. Resources would then become available to fully fund Medicare, provide universal coverage and maintain the financial viability of the federal government.

Saturday, March 19, 2011

Another Terry Schiavo like Tragedy

Due to an end-of-life issue a Canadian child was moved from a Canadian to a U.S. hospital, as reported on March 14, 2011 by Jim Slater of the Associated Press.

Tragically a couple in Canada lost one infant eight years ago to a probable genetic degenerating neurologic disease. The couple is now trying to cope with a similar outcome in a second child thirteen months old. This second child is in a permanent vegetative deteriorating state, with the Canadian hospital wanting to “take him off assisted breathing.” The parents objected, thinking that removing assisted breathing would cause the child to suffocate, undergo undue suffering and die. Instead they wanted the child to have a tracheotomy, reasoning this would extend his life by about six months and then die at home.

The parents took their case to a Canadian Court and lost. They then sought help from hospitals in the U.S. via the internet. Cardinal Glennon Hospital in St. Louis agreed to take the child, with transport supplied by a New York City group, Priests for Life.

Rebecca Dresser, a Professor of Law and Medical Ethics at Washington University, is reported to have commented that in the U.S. courts generally decide with the family in such cases, even in seemingly hopeless medical situations. Furthermore, she believes that similar end-of-life cases will likely become more common in the U.S. because of cost issues.

I believe this case is representative of many misconceptions present in today’s thinking about end-of-life issues.

1) Did the parents receive genetic counseling before attempting another pregnancy that could result in a similar outcome as their first child? There was no mention of this in the news report.

2) Were the parents advised of the possibility of a repeat problem when pregnant with the second child, and if so was there pre-delivery testing?

3) Could this child have been sent home with the breathing tube, dying at home as per the parents’ wishes, but without the tracheotomy?

4) Can a human in a permanent vegetative state suffer? If the child’s cerebral cortex is no longer functioning, blood flow scans, etc., the child can no longer experience suffering.

5) Can a child who does not have a functioning cerebral cortex be called alive? In effect the parents and the St. Louis hospital are keeping a heart beating in what appears to them to be a child, but in reality is only the container of that child; that individual is gone.

6) Was the professor who commented that cost issues will bring to the fore many more of these types of cases referring only to financial cost? I would respond that there are many complexities in the term “cost”. The most obvious is the amount of treasure spent without changing the outcome. There is also the cost of prolonged suffering of the parents in a vain attempt to put off the inevitable. Additionally there is the cost of time, energy and frustration spent by the medical staff knowing it will have no benefit.

The issue is the inability of the parents, Priests for Life, and the St. Louis hospital to understand what constitutes “life.” Without a functioning cerebral cortex there is no “life”; what they are seeing is only the shell that contained that life. The question becomes, at what point are the parents using this shell of a child as a means to their own ends? Unfortunately in this world sometimes very sad things happen to very fine people. Nothing is gained by not dealing with reality.

Tuesday, March 8, 2011

The Medicaid Payment Crisis

The Wall Street Journal published a front page article on Feb. 21, 2011 tittled, "Governors Scramble to Rein in Medicaid Costs." Our states' budgetary crises are in large part due to the fraction of Medicaid costs and services federally mandated on the states. The fundamental problem is that we as a nation spend on average $7,538/person on health care, twice as much as other industrial countries (OECD data) and this amount of spending has profound negative effects on both federal and state budgets..
As noted on this blog there are multiple reasons as to why we spend so much: the ten minute doctor visit causing an assembly line style of medicine, atrophied physician history taking and physical diagnostic skills. Rampart medical consumerism and the lobbying power of special interests are additional factors. These negatives cause approximately $800 billion of our health care dollars to be spent on non-beneficial inappropriate care.
If we could control that excessive spending the federal government could then fully assume the costs of Medicaid. States would then be able to devote the savings to educating our children much more effectively so that almost all would have the skills to compete in a global economy.

Friday, February 18, 2011

How to Fix Advanced Directives

One of the major reasons for our excess spending is how we presently use advanced directives. They were created by The Patient Self Determination Act of 1990 in response to the Karen Ann Quinlan and Nancy Cruzan cases and were created to give patients choices as to their preferences in end-of-life situations. Although created with the best of intentions at the time, there are many unforeseen consequences. Patients cannot possibly predict their health situation years in advance. What may be appropriate for someone in their fifties may not be appropriate for the same person in their eighties. Most patients who have advanced directives do not discuss them in detail with their physician or their designated proxy. Many patients, perhaps most, are not aware of the technical issues involved with specific choices. An inappropriate choice in light of the patient’s overall condition, i.e. terminal cancer, puts the physician in the position of ordering therapies while knowing they cannot succeed rather than focusing on pain relief and comfort care. An overwhelming majority of patients never create an advanced directive, leaving the hospital and medical team no choice but to press on while knowing it will not be beneficial. Alternatively, an advance directive gives patients the sense of more control than is realistic in many situations. Families, often when emotionally distraught, are frequently put in the position of making very difficult choices in extremely complex situations. The net effect of all this is a great deal of non-beneficial even detrimental care causing increased suffering at alarmingly increased costs.

Although these issues have been discussed and written about for years, the Congress is either unaware of these problems or has chosen not to address them. This post is intended for the public to be aware of this very serious problem. It could be solved with relatively simple Congressional action, an amendment to The Patient Self Determination Act stating, “Within the bounds of evidence based beneficial care tailored to the individual.” This would in effect cause the patient and the physician to collaborate creating a rational advanced directive with each hospital admission.

Friday, February 11, 2011

The Doctor Patient Relationship

The present health care reform law euphemistically called The Patient Protection and Accountable Care Act (PPACA) is deeply flawed. It pays lip service to the fundamental problem in American medicine; the lack of time patients and physicians have to spend with each other developing a long lasting therapeutic relationship. The diminution of this core value has driven medicine to the over use of technology and a lack of coordinated care for the chronically ill.
Our nation's excessive health expenses are a large factor causing us to lose our competitive edge in manufacturing, straining the standard of living of millions of Americans. The PPACA will needlessly add to our national health care expense and will exacerbate this problem. Our increasing Medicaid expenses are causing states to scrimp on public education, just the opposite of what we need for our future.
Other advanced societies care for all their citizens costing them much less than what we spend. We can and must do better. For starters, I suggest a $2,000 federal tax credit for all adults and $1,000 for all children per year creating health savings accounts for most outpatient care and high deductible catastrophic health insurance for more expensive items. Reverse tax payments on a sliding scale for those who do not pay taxes. From this account choose your doctor; spend at least 30 minutes at each visit.
Have a system in place by which doctors help each other practice high quality efficient medicine. At each hospital admission have patients, their families and doctors decide what would be appropriate care. Do not hurt people by providing care that is of no value. Physicians and patients together can practice excellent medicine at a cost that unlike the present will not put our country into financial ruin.

Friday, February 4, 2011

Reasonable and Beneficial Care

Who is more able to help patients as to what is reasonable and beneficial medical care, physicians or Washington bureaucrats? As previously mentioned on this blog, it is now time physicians, supported by their colleagues and medical societies take responsibility for the delivery of only appropriate care. With a formal system of physician review, physicians would be able to abandon the present style of expensive defensive medicine by having the ability to confer with their peers.