Archive for August, 2009

A Dr. Point of View on Healthcare reform

Monday, August 31st, 2009

I have not verified any of this, but look at the article below that I have copied and pasted into the blog.  It is reportedly from a physician in Atlanta.  This written piece is circulating on the Internet, so take it for what it is worth, but there are many good points made regarding where our current government healthcare is (Medicare and Medicaid) and the proposed overhaul of the system.  Again, I have no verification of the info, so just keep that in mind.

Letter from local Atlanta Doctor  with Childrens Healthcare of Atlanta
Friends:
      I have  been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me  to  bring some clarity to the table and as your  friend by explaining many of the  problems from the aspect of a doctor.
      First off, the  government has  involved  very few  of  us physicians in the  healthcare debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents  17% of the  American physician workforce.
     I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. Why is this. For example, in the past  6 months I have  cared  for  three  young children on Medicaid who had corneal ulcers. This is  a potentially blinding  situation because if the cornea perforates from the infection, almost  surely blindness will occur. In all three cases  the antibiotic needed  for the eradication of the infection was not on the approved Medicaid list.  Each time I was  told to fax  Medicaid for the  approval forms, which I did.  Within 48 hours  the form came back to me which was mailed in immediately via fax and I was told that I would have my answer in 10 days. Of course  by then  each child would have  been blind in the eye. Each time the  request came back denied. All three times  I personally  provided the  antibiotic for  each patient which was not on the Medicaid approved  list. Get the point—rationing of care.
   Over the past  35  years I have  cared  for over 1000 children  born with congenital cataracts. In older children and in adults the  vision is  rehabilitated with an intraocular  lens
. In newborns we use contact lenses which are very expensive. It  takes Medicaid over  one year to approve  a contact lens post  cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time. Again, extreme rationing. Solution- I have a foundation here in Atlanta supported  100% by private funds which  supplies all of these  contact lenses for  my Medicaid and illegal immigrants children for free. Again ,waiting for the government would be disastrous.
     Last  week I  had a lady  bring her child to me.They are Americans but live in Sweden as the  father has a job with a big corporation. The  child had the onset of  double vision 3 months ago and has been unable to function normally because of this. They are  people of means but  are  waiting 8 months to see the ophthalmologist in Sweden. Then if the child needed surgery they would be  put on a 6 month waiting list. She called me and I saw her that day. It turned out  that  the child had  accommodative esotropia (crossing of the eyes treated with glasses that  correct  for farsightedness) and&n bsp; responded to glasses within  4 days, no surgery was  needed.  Again rationing of care.
     Last  month I operated  on a  70 year old  lady with double vision present for 3  years. She  responded quite nicely to her surgery and now is symptom free. I also operated on a 69 year  old  judge  with vertical double vision. His surgery went very well and now he is happy as a lark.  I have  been told- but of course  there is no healthcare  bill that has been passed yet- that  these  2 people, because of their age, would have  been denied  surgery and just told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously cheaper than surgery.
     I spent  two year  in the  US  Navy  during the Viet Nam war and was well treated by the military. There was  tremendous  rationing of care and we were told specifically what things  the  military  personnel and their dependents could have  and which things they could not have. While in Viet Nam, my wife  Nancy  got sick  and got essentially no care at the Naval Hospital in Oakland, California. She went home and went to her  family’s  private internist in Beverly Hills. While it was  expensive, she received an immediate work up. Again rationing of care.
    For those of you who are  over 65, this  bill in its present form might be lethal for you. People in England over 59 cannot  receive  stents for their coronary arteries. The government wants  to mimic  the British  plan. For those of you younger, it will still mean restriction of the care that you and your children receive.
     While 99% of  physicians went into  medicine  because of the love  of  medicine and the  challenge of helping  our fellow man, economics are  still important. My rent goes up 2% each year and  the salaries of my employees goes up 2% each year. Twenty  years  a go ophthalmologists  were  paid $1800 for a cataract  surgery and today  $500. This is  a 73%  decrease in our  fees. I do not know of many  jobs in America that have seen this lowering of fees.
But there is more  to the story than just the lower fees. When I came to Atlanta there was  a  well known ophthalmologist that charged $2500 for a  cataract surgery as he felt he was the best. He  had a terrific  reputation and in fact I had my mother’s bilateral cataracts operated on by him with a wonderful  result. She is now  94 and has 20/20 vision in  both eyes. People  would pay his  $2500 fee. However,  then the government came in and said that any doctor that  does  medicare  work cannot  accept  more than the going rate  (now  $500)  or  he or she would be  severely fined. This put an end to his charging  $2500.  The government said it  was illegal to accept more than the government allowed rate. What  I am driving at is  that those of you well off  will not be able to go to the head of the line under this new  healthcare  plan just because you have money as no physician will be  willing to go against the law to treat  you.
     I am a pediatric ophthalmologist and  trained  for  10 years  post college to become a pediatric ophthalmologist (add  two years  of my service in the Navy and that comes  to 12 years).  A neurosurgeon spends 14  years post college and if  he or she has to do the military that would be 16 years. I am not entitled to make what  a neurosurgeon makes, but  the new  plan calls for all physicians to make the same amount of payment. I assure you that  medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already the top neurosurgeon at my hospital who is in good health and only 52 years  old has just quit  because he can’t stand working with the government anymore. Forty-nine  percent  of children under the age  of 16 in the state of Georgia are on medicaid so he felt he just could not stand working  with the bureaucracy anymore.
    We are  being lied to about  the  uninsured. They are  getting care. I operate on at least  2  illegal immigrants each month who pay me nothing and the children’s hospital at which I operate charges them nothing also. This is true not only in Atlanta, but of every community in America.

   The bottom line is that I urge all of you to  contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health.
     Furthermore, how can you trust a physician that works under these conditions knowing that he is controlled by the state. I certainly could not  trust any doctor that  would work under these  draconian conditions.
   One last  thing, with this new  healthcare plan there will be a tremendous shortage of physicians. It  has been estimated that  approximately  5% of the current physician work force  will quit under this new  system. Also it is estimated that  another 5% shortage will occur because of decreased men and women wanting to go into  medicine. At the present time the US government has  mandated gender equity in  admissions to medical schools .That means that  for the past  15 years   that  somewhere  between 49 and 51% of  each entering class are females. This is true of private schools also because all private schools receive  federal fundings. The  average  career of a woman in medicine now is only 8-10 years and the average  work week for a female in medicine is only 3-4 days. I have now trained  35  fellows in pediatric ophthalmology. Hands down the  best was  a female that I trained  4 years  ago- she  was head and  heels above all  others I have trained. She now  practices only 3 days a week.
 
Zane Pollard, MD

The Idea of Cooperatives For Healthcare

Thursday, August 27th, 2009

One of the new ideas floating around is that of Healtcare Cooperatives, as opposed to a total government ran insurance plan.  Like many things, it’s worth talking about, as it serves as a middle of the road approach to a full government ran plan and private enterprise.  Yet, in the end, it still feels like a government ran plan to me as taxpayers will be involved to  a degree and would still have an unfair competitive advantage.

One positive of this approach is that the debate turns more to how do we cover that magical 47 million number of the uninsured that is tossed around so easily.  Remember, there are not really 47 million uninsured Americans nor are there 47 million that can’t get coverage.  Of the 47 Million, 11 million are illegal aliens

The article below was sent to me via APPO and is taken from the Washington Post:

Washington Post: Cooperatives’ Record
Weighed in Health-Care Debate
Some Herald Them as Cure for Health Care; Others Question Their Power, Costs

By Steven Mufson
Washington Post Staff Writer
Thursday, August 27, 2009
Sen. Kent Conrad (D-N.D.), a pivotal lawmaker in the health-care debate, wants to deliver coverage to the uninsured by starting up new cooperatives modeled on rural electric cooperatives that were founded during the Great Depression. But rural electric cooperatives have a mixed track record, experts say. They brought electricity to millions of rural Americans who lacked it in the 1930s and today serve about 14 percent of Americans. But after 75 years, the rural electric cooperatives still rely heavily on federal credit subsidies, have weak balance sheets and, some studies suggest, operate less efficiently than privately-owned utilities. Over the past three years, some rural electric cooperatives have also come under criticism for excessive payments to executives and for pushing forward with new coal-fired power plants at a time when many people concerned with climate change want to slow down or halt such plants. Yet they remain politically powerful through the National Rural Electric Cooperative Association. Rep. Jim Cooper (D-Tenn.), a critic of rural electric cooperatives, agrees with Conrad that health-care cooperatives could help provide coverage for the roughly 47 million uninsured Americans. “I want everybody covered and I want it to be affordable,” Cooper said. “Co-ops could do that. They are a time-honored mechanism for almost all of rural America. . . . They’re kind of an interesting third way, halfway between the public and private sector.” But he warns that the new cooperatives would require close regulation to avoid many of the problems he says afflict rural electric co-ops. “You still have to watch co-ops like a hawk,” he said. He said that rural electric cooperatives “became too big for their britches” and “indistinguishable from for-profit firms except that they love government subsidies.” In an article in the Harvard Journal on Regulation last year, Cooper argued that rural electric co-ops “turned away from their historic role” and had taken on “deeply troubling anti-consumer behaviors.” Serving Rural NeedsRural electric cooperatives — nonprofit organizations owned by their customers — date back to 1935, when President Franklin D. Roosevelt created the Rural Electrification Administration to bring power to poor and remote farm areas. Rural poverty at the time was captured in the 1939 book of photos by Walker Evans and text by James Agee titled “Let Us Now Praise Famous Men,” which Agee opens by describing writing by the light of a coal-oil lamp. Today, electric lines reach into virtually every household in America, and many of the once-rural areas served by cooperatives have become part of sprawling urban areas, such as Dallas-Fort Worth or Northern Virginia. Yet they still rely on cheap, subsidized financing from the Rural Utilities Service, part of the Agriculture Department, which provides direct loans and loan guarantees. Co-ops also get financing from the National Rural Utilities Cooperative Finance Corp., a cooperative bank that in turn relies on billions of dollars of low-cost financing from the federal government and the Federal Agricultural Mortgage Corp., a government-sponsored enterprise commonly known as Farmer Mac. On June 11, Farmer Mac chief executive Michael A. Gerber said in congressional testimony that Farmer Mac had lent the CFC $1.8 billion and that it planned to boost that figure by another $1 billion. He said Farmer Mac planned to pool the loans, turn them into securities, provide guarantees of timely payment and sell them to investors. “A co-op by definition has several major advantages over private tax-paying corporations,” said Ken Glozer, a former Office of Management and Budget official and president of a consulting firm called OMB Professionals. “They don’t pay taxes, they borrow all their money from the U.S. government because they because can’t raise capital, and they are political as hell because they depend on the government. Over time they will seek and get untold favors that a private company won’t be able to get.” Glozer added that cooperatives are “quasi-federal agencies.” Debating the ModelConrad argues that co-ops can be effective, citing the success of the model at Land O’Lakes, Ace Hardware and Group Health, a health-care co-op with 600,000 members in Washington state, as well as the rural electric co-ops. In a recent opinion piece published in USA Today, he said that co-ops would be “a public-interest alternative, but consumer-controlled and not government-run.” But others have reached different conclusions. In his article on rural co-ops last year, Cooper said: “Co-ops in some regions of the country have been doing a particularly poor job of protecting member interests.” Robert D. Reischauer, president of the Urban Institute and former director of the Congressional Budget Office, said rural electric cooperatives aren’t a good model for health insurance regardless of their track record. “Those were providing a service where no private enterprise wanted to operate because the population density was too low and the capital costs were too high,” he said. “And what we’re talking about is trying to create a viable insurer that would operate in metropolitan areas and rural areas and suburban areas.” Reischauer added that a firm capable of providing effective health insurance needs to be big, because that would bring economies of scale in administration and market power necessary to bargain with health-care providers. Rural electric cooperatives, by contrast, tend to be local. There are around 800 rural electric cooperatives nationwide, including 16 in Conrad’s home state of North Dakota. “What you want is something that is big and nimble at the same time,” Reischauer said.

The UN Is Useless

Wednesday, August 26th, 2009

You know, I just think the UN is useless.  In my unscientific observation of the UN, I really wonder if they don’t do more harm than good.  I know, I know, they do lots of humanitarian good in the world.  However, Of note, most of their money comes from the USA.

Yet, today, I saw that they are now advocating teaching 5 years olds about sexuality.  Without me spelling it out, take  a look at the following article:

http://www.foxnews.com/story/0,2933,543203,00.html?test=latestnews

August 25th Legislative Update From SIIA

Wednesday, August 26th, 2009

This is the SIIA update of August 25th on healthcare legislation.  It seems clear to me that the public does not want the plan, and those numbers are growing daily.  These updates from SIIA continue to be some of the best I have seen from lobbyist on the ground involved in the debate.

Public Support for Reform DwindlesWASHINGTON REPORT AUGUST 25             Polls show 6% less support in a month: Business Insurance magazine reported this week polls by the Kaiser Family Foundation indicating that public support for healthcare reform legislation has dropped to less than a majority: 45% this month compared to 51% in July.             The ‘ins’ and ‘outs’ of reform: BI reporter Jerry Geisel quoted Washington observers to the effect that a public option health plan is losing support in Congress and that a compromise may focus on nonprofit health care cooperatives. Predicted legislative scenarios include insurance underwriting reforms such as banning exclusions of preexisting medical conditions and a possible individual coverage mandate.             Still time to contact members of Congress: As summer recess continues this week and next, SIIA members can find opportunities to visit or call their representatives. All aspects of healthcare reform remain on the table for discussion. In the House, HR 3200 has been approved by three committees but has not yet reached the floor for debate. The Senate HELP Committee has approved a bill and the Finance Committee’s version is still under construction. Those will require reconciliation before floor debate.             Contribute to the debate rather than the noise: While working in their home districts, members of Congress now tend to avoid strident demonstrations against healthcare reform legislation, but that leaves plenty of room to discuss serious reform elements. If the core goal is still to provide coverage for uninsured people, tell your representative that the surest way to do this is to allow small-to-medium sized businesses to pool together in competitive employee group health plans organized regionally or nationally. As millions are employed by small businesses – many of which cannot afford employee health plans without such a cost-saving measure – this would be the quickest way to reduce the number of uninsured people without creating a top-heavy and wasteful federal bureaucracy.             Sound bites on health care reform from the Wall Street Journal:             “Although administration officials are eager to deny it, rationing health care is central to President Barack Obama’s health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive.” – Martin Feldstein, chairman of the Council of Economic Advisors under President Ronald Reagan, in his WSJ commentary of August 19.             “Incredibly, Congress’ proposed health care reform plan risks skimping on anesthesia. HR 3200…would reduce reimbursement for anesthesia by over 50%.”Dr. Ronald Dworkin in his WSJ commentary of August 20.             “No one is arguing that reform is unnecessary…The much-discussed public health insurance plan is all too likely to create an uneven system, undermine what works in the existing employer-provided group health insurance marketplace, and costfuture generations trillions of dollars. But a series of reforms to our existing system can reduce costs and improve outcomes for millions.” – Samuel H. Fleet, president of AmWINS Group Benefits of Rhode Island, in his WSJ commentary of August 20.             “I write as if health-care reform…is already a loss, a historic botch, because it is. Even if the White House wins, they lose, because the cost in terms of public trust and faith was too high.” – Columnist Peggy Noonan, WSJ of August 22.

The Economy

Tuesday, August 25th, 2009

I was listening to Dick Morris last night on Hannity, and continue to be impressed with him.  For so long during the Clinton years I thought he was the political enemy, when in reality we now know that he was the catalyst to turn Bill Clinton toward conservative ideas like Welfare Reform to save his Presidency.

Last night, Mr. Morris said that he is expecting a double dip recesssion.  One where we see the current recession basically resolve itself, and the economy look like it is prospering again only to see a more severe recession in the Spring or Summer of 2010.   From the beginning of this recession, I have believed that is exactly what will happen and here is why.  Right now, we don’t have any inflation to speak of in the USA.  Yet, we just can’t run the kind of debt that the US has without inflation kicking in at some point.  When that happens (Spring of 2010?) Obama will be hard pressed to “stimulate” the economy as he will only increase inflation.  The administration will get caught in a catch 22 situation where nothing helps from the government.

So, is this really Obama’s problem and not George W. Bush?  You bet.  Obama told us we had to have the Stimulus, we had to pass the omnibus, and now we are looking at a projection of 9 Trillion dollars of debt over the next 10 years.  This President is literaly going to bankrupt the nation along with this congress.  The sad thing is that they don’t even see it coming or are choosing to ignor it to get their social programs in place.  Because of the debt, I can already say that Obama will go down as a terrible President in history.  We can’t spend our way to prosperity.

I have said it on here before, but my basic Economics class in Cullman High School in Alabama taught me all I needed to know.  With out of control debt, inflation is coming.  When it comes, stagflation potentially can set in, and we will be in for a wild ride.  

It’s time to vote into office fiscally conservative members of congress and to the Presidency as soon as possible.  I don’t care if they have a (D), (R), or (I) by their name.  It’s time we get serious as a nation about our spending problem.  Moreover, God help us if we add a Government Healthcare giveaway social program to the mix. 

Tenncare and The National Healthcare Debate

Friday, August 21st, 2009

I had a post yesterday regarding Tenncare.  To my surprise, the GOP forwarded an article that appeared in the Wall Street Journal regarding Tennessee and the experiement with TennCare. I guess several of us were thinking about TennCare yesterday.  The article is below.  I am curious as to everyone’s thoughts on TennCare and how it relates to the current debate.  Those of us with a birdseye view of TennCare know what a disaster it was.

Tennessee Experiment’s High Cost Fuels Health-Care Debate

By AVERY JOHNSON 
Wall Street Journal
August 19, 2009

In 1994, Tennessee launched an ambitious public insurance program to cover its uninsured. The plan, TennCare, fulfilled that mission but nearly bankrupted the state in the process.

As originally envisioned, the Tennessee plan expanded Medicaid, the government health-care program for the poor, to cover people who couldn’t afford insurance or who had been denied coverage by an insurance company.

With an initial budget of $2.6 billion, TennCare quickly extended coverage to an additional 500,000 people by making access to its plans easy and affordable. But the program became so expensive that Tennessee was forced to scale it back in 2005.

Now, as Congress debates a national health-care overhaul, state experiments like Tennessee’s are informing the discussion.

Unlike Massachusetts’s more recent universal coverage law, the TennCare plan is most often cited by opponents. They say TennCare’s runaway costs show that the public health-insurance proposal by House Democrats could bankrupt the federal government.

In a letter to Congress last month, Rep. Marsha Blackburn (R., Tenn.) compared the public plan envisioned in the House bill to TennCare, warning that TennCare became so costly at its peak that it ate up one-third of Tennessee’s budget.

“The promise of TennCare has gone unrealized,” she wrote. “Many of the concerns we have expressed about the proposal before us today are the stark realities of a system that went terribly wrong in Tennessee.”

The Obama administration says TennCare is different from the proposed public plan because its administration of the Tennessee program is contracted out to private companies. A federal public plan would more likely be run by the government, although the White House on Sunday signaled that it wouldn’t insist on having a public option.

Another difference, the administration says, is that a public option would increase competition in the health-insurance market by offering an alternative to private insurers; TennCare was the primary option for Tennessee’s uninsured.

What the Tennessee experiment did share with health-care-overhaul supporters was its ambition to cover the uninsured. To qualify, patients only had to show a denial letter from an insurance plan. TennCare charged $2.74 a month in premiums for people earning just above the poverty level. Its rolls quickly swelled to 1.4 million people, leaving only 6% of Tennessee’s population without health insurance. It never achieved complete universal coverage in part because of an income cap.

“The lesson is you can quite quickly cut the number of uninsured,” said Alan Weil, executive director of the National Academy for State Health Policy. “Tennessee is not a well-off state and they just kind of did it.”

TennCare had its failings. The plan, for example, paid health providers less than private insurance plans, prompting some physicians and hospitals to increase charges to private insurers. Some of this resulted in so-called cost shifting, with insurance companies passing on the costs through higher premiums. Opponents of a public option warn the same thing will happen nationally, to the detriment of people who already have health insurance.

Rep. Blackburn says TennCare shows that a public plan would undermine the current employer-based health-care system, citing data from University of California at San Diego that showed 45% of people claiming TennCare’s benefits had left employer-provided insurance. Darin Gordon, TennCare’s current director, says the switching was more limited than critics allege.

Another Tennessee congressman, Republican Phil Roe, says that as a physician who worked under the program, he saw TennCare’s shortcomings up close. He says TennCare reduced access to care: physicians refused to see TennCare patients because of the program’s lower reimbursement rates.

“As soon as I heard about this public option, I thought, ‘I know how this works,”‘ said Dr. Roe. He said he has been repeating his cautionary tale about TennCare to colleagues “until I’m hoarse.”

TennCare aimed to pay for much of its expanded coverage with cost savings — mostly by reducing unnecessary care.

In its first five years, TennCare had the lowest per capita cost of any Medicaid program in the country, saving between $245 million and $2 billion by cutting down on emergency-room visits by uninsured patients, for example, according to the Tennessee Justice Center, a public-interest law firm for the poor. It has championed the program and sued the state over cutting people from its rolls.

“TennCare covered the majority of people and did it with the money that was saved by squeezing waste out of health-care infrastructure,” said Michele Johnson, managing attorney at the Center.

However, the program’s costs quickly escalated. After rising at a roughly $300 million annual rate in its early years, TennCare’s budget swelled from $5.4 billion in 2000 to $8.5 billion in 2004. During that period, the state re-assumed much of the risk of managing the program from private insurers who complained they were losing money administering it.

In 2005, with the state’s solvency in jeopardy, Gov. Bredesen reduced TennCare’s rolls by about 170,000 by booting some people who weren’t eligible for Medicaid. He also created a separate limited insurance option called CoverTN that covers only up to $25,000 in annual medical costs.

Emily Tell of Nashville is among those who got bumped off TennCare’s rolls. Uninsured after she lost a job in customer service at an insurance agency, she went on TennCare in 2001. She said the program paid an expensive medical bill from a car wreck that resulted in two foot surgeries.

When she got a letter in the mail several years ago telling her she no longer qualified for the program, she says she didn’t know what to do. She eventually enrolled in CoverTN, which covers most of her medications for high blood pressure, cholesterol and attention deficit. But she gripes about its $125-a-month premium and regular co-payments.

“That’s expensive for a single person,” she said. “I know they are trying to save money, but we should have access to health care.”

SIIA Update and Tenncare

Thursday, August 20th, 2009

Here is the latest on the Healthcare debate from SIIA on August 19,2009.  Before reading their info, pay attention to the notation regarding Tennessee and Tenncare.  For those of you that don’t know, we in Tennessee essentially were “given” the Bill proposed by Hillary Clinton 1993 healthcare reform plan.  Tennessee ended up as a test ground for the 1990s version of proposed health reform, which has many similarities to the current proposal.  At the end of the day, 25% of all Tennesseans were on the Tenncare plan, and it almost bankrupted the state.  A legislature ready for change and a Democrat governor that I supported, punted Tenncare to the ash heap of history as it was needed.  Study Tenncare if you want to know what will happen under the proposed new health reform plan. 

‘Public Option’ Reportedly FadingWASHINGTON REPORT FOR AUG. 19             Media see softening administration position: Signs that a government-controlled health plan may not be part of national healthcare reform were reported early this week by many news media. The Wall Street Journal on Monday said, “The Obama Administration gave its strongest signal yet that it would be willing to compromise on plans to expand the government’s direct role in health-insurance coverage as it a fights growing crescendo of opposition to its effort to overhaul health care.”             President Obama dials down his rhetoric: At a weekend town hall meeting in Colorado, President Obama said the public option plan, “Whether we have it or we don’t have it, is not the entirety of healthcare reform. This is just one sliver of it, one aspect of it.” Apparently the public option is more than ‘a sliver’ to the thousands of citizens who have demonstrated against government control of the U.S. healthcare system.             Obama officials also downplay public option’s importance: The WSJ reported that HHS Secretary Kathleen Sebelius said Sunday that a new government-run health insurance program isn’t the “essential element” of reform. During the same period of national public affairs TV programming on Sunday, Robert Gibbs, the president’s press secretary, said Obama wants “choice and competition” in the insurance market.             How the Tennessee experiment is working: News reports this week indicated that Tennessee’s health insurance program TennCare that was created to cover those who couldn’t afford insurance or had been denied coverage nearly broke the state and had to be pulled back. Healthcare reform opponents say that experience shows that the current proposal by House Democrats could bankrupt the federal government.             Ask your representatives if they agree with these reform elements: As SIIA members continue to contact their representatives and senators during the summer recess, they would do well to ask them if they support certain elements of “America’s Affordable Health Choices Act,” the 1,018-page bill that has been reported out of committee in the House and will be further debated when Congress returns to session. Our hunch is that very few lawmakers know in detail what the bill contains. So their reactions to the following three elements may be very interesting.             Will new enrollment in private plans be shut off? While a public option plan is still in this bill despite administration waffling, it also states that there will be a limitation on new enrollment in private plans after the bill becomes law. While the president often repeats that anyone who is satisfied with his or her present coverage may keep it, members of existing plans will apparently be prohibited from changing to another private plan. Membership in private plans would inevitably erode until they are actuarially unfeasible and all members are funneled to a public plan. Do your representative and senators agree with this?             Self-insurance would be denied to small and mid-sized businesses: The bill mandates that an audit of self-insured plans will be made and that, “Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-sized employers to self-insure.” So we could forget about any ability of smaller employers to find a level playing field by pooling together in plans sponsored by their professional organizations or trade associations. Do your representative and senators agree with this?             The Health Choices Commissioner will be all-powerful: As set out in the bill, the Health Choices Commissioner will be appointed by the president and will preside over the Health Benefits Advisory Commission, two-thirds of which will be appointed by the president. This resembles a Soviet-style “politburo” that serves as the rubber stamp validation of the ultimate leader’s will. Do your representative and senators agree with this?             Join the health reform strategy session next month in Orlando: While debate still rages in Congress, new communications strategies to defend the employer-based health care system will be unveiled during SIIA’s Annual Educational Conference & Expo in Orlando on Sept. 21-24. Find out more and register today at www.siia.org.

Will The Government Monitor Your Bank Accounts?

Wednesday, August 19th, 2009

Wow, the healthcare debate rages on each day.  I often wonder, and I am giving more credit here than I should, if the congressmen/women in the House of Representatives even understand what goes into these bills to being with.  In House HR3200, we find the following jewel of a passage that needs to be examined: 

(C) Enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice; 

This is found on page 59 of HR 3200.  Now, I have seen the emails floating around on the Internet that say this is the Government’s back door way of getting into your banking accounts.  I am not sure that is the case, but it certainly is a frightening passage just tucked away on an obscure page in HR3200. 

The context of Page 59 and the section in general, is regarding quick adjudication (processing) of claims and the attempt to do everything in real time electronically.  Basically, my read on the above is that the government is trying to allow quick payment by the Insurance carrier to the medical provider.  However, HR3200 also wants the provider to be able to tell the patient at time of treatment exactly how much they will owe the provider, virtually impossible at this time. 

The danger I see in this passage is this; what if the government in 4 years or 8 years decides to use this as a way to justify looking into your bank accounts as an individual demanding that you pay the provider with an electronic withdrawal from your account?  It has the makings for a bureaucrat to make such a dumb decision probably later, not at the beginning of the program.  Combine this with the National ID card with your info on it as outlined on page 58, and you start to see where all the problems come in.  Page 58 states:

“enable the real-time (or near real time) determination of an individual’s financial

responsibility at the point of service and, to the extent possible, prior to service, including

whether the individual is eligible for a specific service with a specific physician at a specific fa

cility, which may include utilization of a machine-readable health plan beneficiary identi

fication card” The bottom line?  The government is moving big time into your personal affairs.  Do you want them there?

What the Dutch are Doing With Healthcare

Tuesday, August 18th, 2009

Two months ago I traveled to the Netherlands and experienced the culture and beauty of this small European country.  My first stop was to Amsterdam, arguably the most liberal city I have ever seen from a social standpoint.  The promotion of the red light district is shameful and watching young men and women waist away smoking Pot in “coffee shops” is somewhat hard to believe. 

Yet, the country is beautiful, and our recent history is tied together from the 20th century.  You can see today in Washington D.C (the Virginia side) a beautiful bell tower donated by the citizens of the Netherlands for our efforts in World War II. 

Beyond the classic old windmills (only about 900 of them left), it is amazing that they are bucking the current movement in healthcare regarding socialized medicine.  In 2006 The Netherlands passed a bill “The Health Insurance Act of 2006” which took a centralized (social medicine) and turned it back into an American form to an extent of healthcare.  In other words, they privatized the system.  Today, private insurance companies cover the citizens for profit.  Ahh, that evil profit the Dems hate so badly, but it works.  The Dutch have been innovative in trying to undo the socialism failures and to implement a market based system. 

I found a great article below, which tells more about the Dutch system and stats on some of the European countries.  It’s worth reading and noting that maybe in America we just need to fix what is wrong with our system, instead of revamping the whole process.

http://www.weeklystandard.com/Content/Public/Articles/000/000/016/847hvjdk.asp?pg=2

As the article reports from a study “that the percentage of the respondents in need of elective coronary bypass surgery who had been waiting for more than three months was 0% in U.S., 18.2% in Sweden, 46.7% in Canada, and 88.9% in the United Kingdom”, which indicates European medicine may not be what cures America. 

Trial Balloon By Obama

Monday, August 17th, 2009

This weekend the HHS Secretary floated a trial balloon.  The balloon?  The suggestion to take out the public healthcare insurance option from any future healthcare reform bill.  The Whitehouse is backing away from those comments made yesterday, but make no mistake it was a trial balloon to see the public’s reaction.

Maybe, just maybe, the public outcry is finally reaching the Whitehouse.  Take the Public Insurance option out, and then craft a bill that reforms the system, and for heaven sake include Tort Reform!