Monday, August 31, 2009

Health Insurance a legalized scam?

Following is an email I received from a person visiting Health Care NOW. I get many emails from Blog Readers but this one had to be shared. I think the following email represents the feelings of tens of millions of Americans. The person's name was omitted for privacy reasons.

Here are my observations,

When I was in New Zealand, I had my ACL broken in a baseball game. When I got back to the hotel, I noticed they had a hotel doctor. I called and requested his services. About 15 min. later the doctor arrived and evaluated my knee, told me what I was up against and offered suggestions on how to deal with it, including repairing it there in NZ. No charge and they have a national health care system.

While playing in Italy last year our catcher got hit in the ear from a bat swing. Someone drove him to the hospital where they immediately treated him, sewed him up with stitches, gave him drugs and a prescription. No charge and good immediate service.

A few days later our other catcher and 1st baseman collided foreheads at full speed chasing a pop up. Our catcher was minimally cut and the 1st baseman had his forehead cut open all the way from the left to right side of his forehead, very deep, past the flesh with lots of bleeding. We called and an ambulance came and picked them up and took them to a hospital. They spent two hours at the hospital. The catcher received 8 stitches above the eye and they stitched up the 1st baseman with many more stitches. They gave them both X-rays to make sure there was not other damage. They wrote up a report in english describing the entire procedure, what was done, suggested treatments and gave them copies of the X-rays. All this was so they could take it to their own doctors in the US. No charge and great immediate service as they have a natiional health care system.

When I needed to investigate my knee and head via an MRI last year, Blue Shield approved the one for the head but did not approve the one for the knee, despite multiple letters from my doctor. I had them both done anyway. Turns our there was nothing wrong with my head, fortunately, but there were lots of things wrong with my knee.

A while back my mother was very ill one morning. I called the Kaiser clinic who handles her medical care. They told me to call an ambulance and take her to a nearby hospital. The ambulance arrived and took her to the closest hospital, about 1/4 mile away. She stayed the night, had a couple of doctor visits, was attended to by the nurses and had some medications. Fortunately nothing was seriously wrong. Since she has Kaiser insurance and it was not a Kaiser hospital, it was several miles away, she later received a bill for $18,000. Does that seem excessive?

As an individual policy holder they keep raising my rates, this year they want to raise it to the tune of $700/mo. This seems outrageously high, especially if they are not going to cover various treatments and evaluations. I usually only have a couple of doctor visits a year, a blood test or two and various medications.

Deciding on whether to treat someone based on profit is not a good scenario. Fat cats in insurance companies and big pharma make way too much money and the administration costs are too high. Health quality in the US is about 30 on the list of civilized countries and we pay more for it than any other nation. Something is wrong with this system. Quality health care should be free and available to all US citizens. Scum bag insurance companies and big profits should be eliminated.

Insurance is a legalized scam. You just pay and pay and pay and most the time you get very little back. When you do need to make a claim they try and screw you out of what they promise. Insurance companies are the scum of the earth and I would be embarrassed to reach the Pearly Gates at the end of my life and have to admit that I spent my life taking money from people and giving them nothing in return but promises and lies. What a useless existence to society.

That's my Red Neck thoughts, feel free to pass it on,

Friday, August 28, 2009

So the government can't do anything right?

The following was sent to me by my good friend Dennis:

An American Conservative Writes on Healthcare

This morning I was awoken by my alarm clock powered by electricity generated by the public power monopoly regulated by the US department of energy.

I then took a shower in the clean water provided by the municipal water utility.

After that, I turned on the TV to one of the FCC regulated channels to see what the national weather service of the national oceanographic and atmospheric administration determined the weather was going to be like using satellites designed, built, and launched by the national aeronautics and space administration.

I watched this while eating my breakfast of US department of agriculture inspected food and taking the drugs which have been determined as safe by the food and drug administration.

At the appropriate time as regulated by the US congress and kept accurate by the national institute of standards and technology and the US naval observatory, I get into my national highway traffic safety administration approved automobile and set out to work on the roads built by the local, state, and federal departments of transportation, possibly stopping to purchase additional fuel of a quality level determined by the environmental protection agency, using legal tender issued by the federal reserve bank.

On the way out the door I deposit any mail I have to be sent out via the US postal service and drop the kids off at the public school.

After spending another day not being maimed or killed at work thanks to the workplace regulations imposed by the department of labor and the occupational safety and health administration, enjoying another two meals which again do not kill me because of the USDA, I drive my NHTSA car back home on the DOT roads, to my house which has not burned down in my absence because of the state and local building codes and fire marshal's inspection, and which has not been plundered of all its valuables thanks to the local police department.

I then log on to the internet which was developed by the defense advanced research projects administration and post on freerepublic.com and fox news forums about how SOCIALISM in medicine is BAD because the government can't do anything right.

Thursday, August 27, 2009

Oregon Doctors are MAD AS HELL

HEALTH CARE FOR PEOPLE - NOT PROFIT!

Mad as Hell
http://www.madashelldoctors.com/


You CAN handle the Truth
There's no nice way to say it. The financial cost of health care is killing our citizens, hobbling our economy, crushing small business, and threatening the solvency of our government. In the meantime, the Health Care Industry is spending almost two million dollars a day lobbying Congress and manipulating public opinion to accept “reform” legislation that leaves a vicious, for-profit system intact. The "public option" is a trap. We need real reform that finds immediate savings, controls costs, and accomplishes the moral imperative of true Universal Access. A Single Payer plan is the only real path to a Health Care System that is socially, ethically and fiscally responsible. And yet, our elected officials refuse to even discuss the possibility of a Single Payer plan!
If that doesn't make you mad, we recommend checking your pulse.


The "public option" is doomed.
First: we will still have a dysfunctional health care system designed around insurance companies. Second: it will be impossible to cover everyone without raising taxes. The Obama administration is already saying it is acceptable to leave out 15 million people. Which 15 million? Will you be one of them? Who gets to decide? Third: in a "post-option" environment you can bet that the health insurance industry will manipulate the rules so that the sickest, most expensive patients will gravitate toward the public plan, which will cause it to fail. When it does, the opponents of real reform will point to the "public option" and scream: "See! Single Payer won't work!"


There is a time for compromise - this isn't one of them.
We are a small group of Oregon-Based doctors who care. We believe there is only one way to control costs, one way to remove profiteering from the system, one way to reclaim the care of our patients, and one way to be sure everyone is covered: we must replace our current pay-or-die system and with a comprehensive, publicly financed, privately delivered, Single Payer system that puts people first. Our moment to take a stand for Single Payer is NOW. We may not have another opportunity like this in our lifetime. Please support this unprecedented road trip to real health care reform.

http://www.madashelldoctors.com/

Wednesday, August 26, 2009

What our neighbors north of the boarder think of USA health care.

Published on Wednesday, August 26, 2009 by The Ottawa Citizen (Canada)
A Bailout for the US Healthcare Industry
by Rose Ann DeMoro

The fractured U.S. healthcare debate, replete with wild distortions of Canada's medicare, must seem incomprehensible to many north of our border.

News images of fabricated "death panels" or traumatized seniors on U.S. Medicare -- a government-funded program -- urging legislators to keep the government's hands "off my Medicare" must seem especially hard to fathom.

Equally puzzling, no doubt, has been the reaction of the administration and many of its allies in Congress whose response to the attacks is to move further away from comprehensive reform.

Entering the year with a Democratic president and strong majorities in both houses of Congress, and a clear public mandate to end our long health-care nightmare, President Barack Obama and Congressional leaders decided to compromise from the outset, and not pursue the most effective reform, Medicare for all.

Gambling they could bring along conservative opponents, the administration and Congressional leaders instead advanced a more limited plan that preserves the role of the insurance industry. Prospects of broader reform were further undermined by some liberal and progressive groups and labour unions, who chose to merely endorse the proposals of the administration and top Congressional Democrats, rather than fighting for a national system like single-payer, which many of them have long endorsed.

Overnight, the left flank was effectively gutted from the beginning of the fight. Most of the pressure has thus come from the right and those who embrace the status quo -- leading to further compromises by both Obama and the leading Democrats.

This retreat was clearly articulated by the former president, Bill Clinton, who chastised a conference of worried netroots activists Aug. 13, saying "I want us to be mindful we may need to take less than a full loaf."

But mobilizing activists for a half loaf has proven to be a challenge, as the White House and Congress have learned to their dismay in recent weeks as they struggle to counter those denouncing them from the right.

Even the grassroots network built by candidate Obama that set new standards for campaign activism last year has, the New York Times noted Aug. 15, failed to produce much enthusiasm for the current health plan, and most liberal constituency groups have not fared much better.

What's left is a proposal that will force the uninsured to buy private insurance with subsidies for low-income earners and only limited constraints on industry price gouging and care denials that characterize the collapsing insurance-based system.

In sum, it looks like another massive corporate bailout, following the earlier version for the banks, this time for an equally unpopular insurance industry, which will fuel even more public cynicism of the reform process and political system.

To residents of all other industrialized countries, terrors over a government role in promoting and protecting the health and safety of its citizenry, and the reluctance of political leaders to effectively respond to these attacks must be especially confounding. Among major nations, only in the U.S. is health care not a fundamental right, but bartered for profit by a maze of health-care corporations. The result is that the U.S. continues to fall far behind other industrial nations in a variety of measurements, from access to care to equality in treatment, and even in the much discussed issue of waiting times for medical care.

While the U.S. spends twice as much as every other nation on per capita health care, there remain more than 45 million Americans with no health coverage and tens of millions more with insurance who are routinely denied medical care because their insurer doesn't want to pay for it.

Medical bills account for 62 per cent of personal bankruptcies. Half of all Americans skip doctor visits or immunizations for their children because of high out-of-pocket costs, troubling news indeed with the U.S. already leading the globe in swine flu infections and deaths.

The nation's registered nurses and many doctors continue to press for real change, a national or single-payer system that would look familiar to Canadians and the rest of the industrial world. It is still possible to achieve stronger reform, but time is running out.



© Copyright (c) The Ottawa Citizen
Rose Ann DeMoro is executive director of the 86,000-member California Nurses Association/National Nurses Organizing Committee, the largest U.S. union of nurses.

Saturday, August 22, 2009

Complex and Complicated: America needs to be educated

The health care debate has become extremely complex and complicated. So much so that there is more misinformation than credible information. The fact that our health care system is broken and needs reform is unquestionable. What to do and how to do it is very difficult. The politicalizaton of health care will result in the status quo. That is, lack of access to health care for tens of millions of Americans, and continued rising costs. This seems to be the true goal of special interest and the GOP. Without real reform, we are all in big time trouble. What makes this really strange is that opponents of health care reform will suffer as much as proponents of health care reform. Go figure!

That being said, the following issues must be addressed in order for real reform to take place.

1) Insurance industry must have to compete with Medicare for ALL (public option) in order to drive down costs.

2) Pharmaceutical and medical device companies must have to compete in order to drive costs down.

3) Tort reform must be included in order to increase access to health care and to drive costs down. Professional liability insurance is far too expensive for health care providers to make ends meet. Providers require more protection while patients require recourse to gross negligence. A middle ground must be created so that access to health care will be made available at a reasonable cost. Our finest legal minds should be working on a solution to this signifcant infulence in health care costs.

4) Providers must have to compete for patients in order to drive down costs.

5) Access to health care MUST NOT BE LIMITED. Pre existing conditions, delay in treatment, and denial of payment for health care must be removed from the equation.

6) We must change the way we think about health. We must develop knowledge and strategies that promote wellness beginning with prenatal care and in the schools. This includes how and what we eat, drink, and consume. This includes behavioral health and not just physical health.

7) When treating illness and injury, patients must have some responsibility unless they are totally disabled and have no resources (see number 9 below).

8) If a non US citizen is injured or becomes ill, they must pay for the health care or their country of origin should pay for the health care. An alternative could be international health insurance.

9) Medicare should be expanded to include any American who wants it. We all pay for Medicare through our employment. Those who are self employed pay for Medicare when they pay their taxes. Medicare requires some modification as well. For example, since there would be no more co-pays, insurance premiums, or deductibles in a public plan (Medicare for All), current Medicare payroll deductions could be increased 15%--20% to fund a public plan. Further, Medicare reimbursement to providers must be increased to reasonable levels. And finally, balances between fees for service and Medicare reimbursement must be negotiated to an agreeable level between patient and provider. This will place health care decisions where it belongs between patient and provider and bring free enterprise back to medicine.

10) By addressing issue number 9, there will be an increase in applications to medical school resulting in generating more primary care physicians and specialists. Currently we are on track for major shortage of health care providers in the not to distant future.

11) If the above issues are addressed, all current government programs would be consolidated into one single payor system. VA, Medicaid, Department of Labor, Worker's Compensation, etc would no longer be in the health care business resulting in significant cost containment.

12) There must be review and reform of regulations governing health care. Many of the existing regulations result in increased costs to providers which leads to increased costs for health care. This doesn't count the protections afforded to the insurance industry and pharmaceutical industry. Remove those loop holes and watch health care costs plummet

13) Ameliorate the waste in health care spending. This would save $1.2 trillion and could fund health care for all. The combination of health care insurance executive salaries, share holder profits, reduced waste, consolidation of existing government programs, and competition for policy holders, pharmaceuticals, medical devices, and patients would lead to REAL HEALTH CARE REFORM. That is, increased access to health care, significant cost containment, free enterprise back into medicine resulting in education and training of more providers.

14) REMOVE SPECIAL INTEREST FROM HEALTH CARE!!! Senators and Representatives must stop politicising health care and must stop taking campaign contributions from insurance companies, pharmaceutical companies, and professional organizations interested in maintaining the staus quo.

Thursday, August 20, 2009

Something YOU can do

I received an email from Stand Up for Health Care suggesting we all get involved in Health Care Reform. HEALTH CARE NOW is my attempt at getting involved. YOUR TURN

Death panels? Socialized medicine? What won't they say to stop reform?

Opponents of HEALTH CARE NOW are stopping at nothing to block health insurance reform, even if it means shouting outright lies in the media and in their communities. You can do something to help to take back the conversation and put an end to their disgraceful tactics.

Currently, your Senators and Representatives are in their home States. They are visiting local communities and holding town halls about health care reform. Attend a town hall near you and represent the truth. Find a local event near you at http://www.standupforhealthcare.org/

The majority of Americans recognize the urgent need for reform and support it. Don’t let shouting from angry mobs stop HEALTH CARE NOW.

Combat the false rhetoric, and give your representatives the best reasons for health insurance reform....your own personal stories. Communicate your issues about denial of coverage due to pre existing conditions, delay in treatment, denial of payment, extraordinary premiums that line the pockets of insurance company executives and shareholders. Talk about how WASTE exacerbates the high costs of health care. Talk about how life style impacts health (obesity, smoking, abuse of drugs and alcohol), and how we need primary prevention programs to promote health and avoid illness.

Talk about how we need to educate parents, teachers, and school boards about basic health, and more importantly, WELLNESS. The best cost containment method is to avoid illness. We all need to change the way we think about our health in order to change our behavior regarding our health. These are the issues that should be SHOUTED to our representatives. You know the truth, it is time you personally get involved.

With your help, we can fight back with the truth and obtain HEALTH CARE NOW for all Americans. Tell your neighbors and friends what the real facts are about health care reform.
Find an event and help spread the truth in your community.

Monday, August 17, 2009

Letter from Senator Barbara Boxer of California

Following is a response from Senator Boxer to my letter discussing using the health insurance corporate profits, executive salaries, and savings from remedying and recovery of $1.2 trillion as a wasted expense in the current broken system to provide health care for ALL Americans. Unfortunately she does not address these issues. However, she does address issues of access to health care and cost containment. Please read on.


Dear Dr. Rubin:

Thank you for writing to me about pending health care reform legislation. I am committed to working with President Obama to ensure that Americans have access to high-quality, affordable healthcare that they can rely on. With the right legislation, I believe we can greatly improve care for our families, while containing the growing costs of health care.
The status quo is unsustainable- Americans will spend more than $2.5 trillion on health care this year, more than one in every six dollars in the U.S. economy. In all, we spend twice as much per person on health care than other advanced nations, yet the United States ranks near the bottom of the 30 leading industrialized nations in basic measures of health such as infant mortality and life expectancy.
The situation is even worse for individual families, who are struggling to afford skyrocketing premiums and increased co-pays and deductibles. Health care premiums have more than doubled in the last nine years, and one respected study shows that, if we fail to act, the average California family will have to spend 41 percent of its income for health insurance premiums by 2016.
The growing number of uninsured is also contributing to higher costs- 46 million Americans do not have health insurance, and every day, another 14,000 Americans lose their coverage when they become seriously ill or lose or change their jobs. To make up for the coverage gap, families pay on average an extra $1,100 a year in premium costs.
Moreover, poor regulation of insurance companies means that even those with health insurance coverage are not always guaranteed to get the benefits they are promised. Every day I hear from Californians who can't get health insurance because of a pre-existing condition, or who are denied the medical treatment prescribed by a doctor because of insurance company bureaucrats. This is wrong, and we have to do better for our families.
That is why I have joined President Obama and many of my colleagues in support of some basic principles for action. Any health care reform must allow every American who likes their current health coverage to keep it. Health coverage must be made accessible and affordable, and insurance companies must no longer be allowed to discriminate against those with pre-existing conditions or drop you if you become seriously ill. We must increase investments in prevention and wellness as that will save billions of dollars. And health care reform must not add a single dollar to the Federal deficit.
As we move to enact health care reform, I will fight for a bill that meets these principals. As a U.S. Senator, I can choose from a wide array of health care plans, and I believe that all Americans deserve this opportunity.
Again, thank you for writing to me. Please feel free to contact me again about this or other issues of concern to you.Barbara BoxerUnited States Senator

Sunday, August 16, 2009

Obama Administration bows to special interest. GOP and Health Insurance Industry prevail

WASHINGTON -Bowing to Republican pressure and an uneasy public, President Barack Obama's administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.
Facing mounting opposition to the overhaul, administration officials left open the chance for a compromise with Republicans that would include health insurance cooperatives instead of a government-run plan. Such a concession probably would enrage Obama's liberal supporters but could deliver a much-needed victory on a top domestic priority opposed by GOP lawmakers.
Officials from both political parties reached across the aisle in an effort to find compromises on proposals they left behind when they returned to their districts for an August recess. Obama had wanted the government to run a health insurance organization to help cover the nation's almost 50 million uninsured, but didn't include it as one of his core principles of reform.
Health and Human Services Secretary Kathleen Sebelius said that government alternative to private health insurance is "not the essential element" of the administration's health care overhaul. The White House would be open to co-ops, she said, a sign that Democrats want a compromise so they can declare a victory.
Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.
With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.
"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."
Obama's spokesman refused to say a public option was a make-or-break choice.
"What I am saying is the bottom line for this for the president is, what we have to have is choice and competition in the insurance market," White House press secretary Robert Gibbs said Sunday.
A day before, Obama appeared to hedge his bets.
"All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform," Obama said at a town hall meeting in Grand Junction, Colo. "This is just one sliver of it, one aspect of it."
It's hardly the same rhetoric Obama employed during a constant, personal campaign for legislation.
"I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices and assure quality is a public option that will force the insurance companies to compete and keep them honest," Obama said in July.
Lawmakers have discussed the co-op model for months although the Democratic leadership and the White House have said they prefer a government-run option.
Conrad, chairman of the Senate Budget Committee, called the argument for a government-run public plan little more than a "wasted effort." He added there are enough votes in the Senate for a cooperative plan.
"It's not government-run and government-controlled," he said. "It's membership-run and membership-controlled. But it does provide a nonprofit competitor for the for-profit insurance companies, and that's why it has appeal on both sides."
Sen. Richard Shelby, R-Ala., said Obama's team is making a political calculation and embracing the co-op alternative as "a step away from the government takeover of the health care system" that the GOP has pummeled.
"I don't know if it will do everything people want, but we ought to look at it. I think it's a far cry from the original proposals," he said.
Republicans say a public option would have unfair advantages that would drive private insurers out of business. Critics say co-ops would not be genuine public options for health insurance.
Rep. Eddie Bernice Johnson, D-Texas, said it would be difficult to pass any legislation through the Democratic-controlled Congress without the promised public plan.
"We'll have the same number of people uninsured," she said. "If the insurance companies wanted to insure these people now, they'd be insured."
Rep. Tom Price, R-Ga., said the Democrats' option would force individuals from their private plans to a government-run plan as some employers may choose not to provide health insurance.
"Tens of millions of individuals would be moved from their personal, private insurance to the government-run program. We simply don't think that's acceptable," he said.
A shift to a cooperative plan would certainly give some cover to fiscally conservative Blue Dog Democrats who are hardly cheering for the government-run plan.
"The reality is that it takes 60 percent to get this done in the Senate. It's probably going to have to be bipartisan in the Senate, which I think it should be," said Rep. Mike Ross, D-Ark., who added that the proposals still need changes before he can support them.
Obama, writing in Sunday's New York Times, said political maneuvers should be excluded from the debate.
"In the coming weeks, the cynics and the naysayers will continue to exploit fear and concerns for political gain," he wrote. "But for all the scare tactics out there, what's truly scary — truly risky — is the prospect of doing nothing."
Congress' proposals, however, seemed likely to strike end-of-life counseling sessions. Former Alaska Gov. Sarah Palin has called the session "death panels," a label that has drawn rebuke from her fellow Republicans as well as Democrats.
Sen. Orrin Hatch, R-Utah, declined to criticize Palin's comments and said Obama wants to create a government-run panel to advise what types of care would be available to citizens.
"In all honesty, I don't want a bunch of nameless, faceless bureaucrats setting health care for my aged citizens in Utah," Hatch said.
Sebelius said the end-of-life proposal was likely to be dropped from the final bill.
"We wanted to make sure doctors were reimbursed for that very important consultation if family members chose to make it, and instead it's been turned into this scare tactic and probably will be off the table," she said.
Sebelius spoke on CNN's "State of the Union" and ABC's "This Week." Gibbs appeared on CBS' "Face the Nation." Conrad and Shelby appeared on "Fox News Sunday." Johnson, Price and Ross spoke with "State of the Union." Hatch was interviewed on "This Week."
Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
2009-08-17 01:34:37

Friday, August 14, 2009

$1.2 TRILLION wasteful spending in our health system

Several months ago I wrote an article for a hospital trade publication about a hybrid Single Payor System. In it, I said that the amount of money generated to line the pockets of health insurance companies and pharmaceutical companies, plus the money SAVED from waste in health care spending could fund the entire single payor hybrid system that would provide quality health care for ALL AMERICANS. Below are the published findings by Pricewaterhouse Coopers at a Health Forum they hosted in Washington D.C. in April 2008. I think you will find this information staggering. We can all have health care just on the savings from waste alone.

The price of excess: Identifying waste in health care spending
Download http://www.pwc/en/healthcare/publications/the-price-of-excess.jhtml

To appropriately address waste in health spending, health industry leaders, policymakers and consumers must work together on system-wide goals and incentives. In April 2008, PricewaterhouseCoopers hosted the 180° Health Forum in Washington D.C., bringing together representatives of government, regulatory bodies and the nation’s largest hospitals and health systems, health insurers, pharmaceutical and life sciences companies to seek new, collaborative approaches to solving some of the health system’s most intractable problems.
These challenges — how to focus on prevention and wellness, how to drive greater quality and value into our healthcare system and how to ensure that our health system is resilient in the face of disaster — cut across traditional boundaries and requires that we think about our health system in new ways and consider innovative solutions.
As part of its preparation for the 180° Health Forum, PricewaterhouseCoopers’ Health Research Institute (HRI) interviewed more than 20 participants, reviewed more than 35 studies about waste and inefficiency in healthcare and surveyed 1,000 consumers to understand the public’s perception of waste and inefficiency in the system. From that research came The price of excess: Identifying waste in healthcare spending.
Key Findings
Our research found that wasteful spending in the health system has been calculated at up to $1.2 trillion of the $2.2 trillion spent in the United States, more than half of all health spending. Defensive medicine, such as redundant, inappropriate or unnecessary tests and procedures, was identified as the biggest area of excess, followed by inefficient healthcare administration and the cost of care necessitated by conditions such as obesity, which can be considered preventable by lifestyle changes. PricewaterhouseCoopers’ paper classified health system inefficiencies into three “wastebaskets” that are driving up costs:
Behavioral where individual behaviors are shown to lead to health problems, and have potential opportunities for earlier, non-medical interventions.
Clinical where medical care itself is considered inappropriate, entailing overuse, misuse or under-use of particular interventions, missed opportunities for earlier interventions, and overt errors leading to quality problems for the patient, plus cost and rework.
Operational where administrative or other business processes appear to add costs without creating value.
When added together, the opportunities for eliminating wasteful spending add up to as much as $1.2 trillion. The impact of issues such as non-adherence to medical advice and prescriptions, alcohol abuse, smoking and obesity are exponential, and fall into all three baskets.
//

Email from Congressman Waxman of California

Dear Dr. Rubin:

Thank you for contacting me to share your thoughts about comprehensive health care reform legislation. As a coauthor of H.R. 3200, the America's Affordable Health Choice Act, I appreciate having the benefit of your perspective and the opportunity to share my view.

I am a longtime supporter of efforts to provide comprehensive health care coverage for all, control medical and insurance costs, and enhance the quality and efficiency of the health care system. According to Families USA, nearly 87 million people-more than one-third of Americans under 65-went without health insurance at some point during the last two years. Uninsured patients go without the care they need and face the constant risk of ruinous debt if they contract a serious disease or have an accident. Those who have health insurance are finding their insurance plans are costing more and covering less. Furthermore, the cost of health care accounts for an increasingly large share of the economy and of government spending, and poses a fundamental threat to our economic stability and future prosperity.

H.R. 3200 is designed to reduce health care costs, protect and increase consumer choice, and guarantee access to quality, affordable health care for all Americans. The House Energy and Commerce Committee reported the legislation on July 31 and the full House is expected to take up the measure this fall. I hope you will visit http://energycommerce.house.gov/index.php for details about the bill, and you can count on me to keep your concerns in mind as the legislative process moves forward.

Thank you again for writing and please keep in touch on matters of concern.

With kind regards, I am

Sincerely,

HENRY A. WAXMAN
Member of Congress

Thursday, August 13, 2009

8 Reasons We Need Health Insurance Reform Now
1) Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/denied_coverage/index.html

2)Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html

3) Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more: http://www.healthreform.gov/reports/women/index.html

4)Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes

5) Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline

6)The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction

7)Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov/reports/inaction/diminishing/index.html

8)The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf

Wednesday, August 12, 2009

Tuesday, August 11, 2009

My most recent post on this blog has been censored by Facebook. The post was my reaction to an interview this morning on CNBC. I received the following message when clicking the "share" link on Facebook. "Some content in this message has been reported as abusive by Facebook users."

I guess the first amendment doesn't apply to Facebook
Listening to Larry Kudlow interview a spokeswoman for the health insurance industry on CNBC this morning. She was defending the health insurance industry anti public health care plan position. Her main premise was that health care providers and hospitals would go BK if a public health care plan was created. When asked why, she danced around the question and finally stated that a public plan would not reimburse providers and hospitals enough to stay in business.

There is an interesting implication to her response. That is, insurance reimbursement is enough to keep providers and hospitals in business. This could not be further from the truth. In Southern California we have experienced a number of acute care and community hospitals closing its doors. We have experienced doctors and other providers leaving the state because they couldn't make ends meet. This is with health care insurance reimbursement, not a public health care plan.

Fact is the health insurance industry must protect their profits in order to satisfy shareholders and pay the salaries noted in previous posts. If the health insurance industry had to compete with a public plan, they would experience a tremendous drop in revenue in order to compete. In other words, perhaps her comments are a self fulfilling prophecy. If health insurance companies had to compete with a public plan, maybe they would go BK.

Providers and hospitals are NOT afraid of a public plan as this woman alleged. Providers spend an extraordinary amount of money working through the existing system controlled by the health insurance industry. We must have resources dedicated to verifying benefits, certifying procedures, appealing denials, and fighting for reimbursement. This craziness MUST STOP. The resources used to fight with insurance companies should be redirected to providing health care.

The health insurance industry would have you believe that a public plan is socialism, that a public plan will cause providers and hospitals to go bankrupt, and that a public plan will create death squads for the elderly. These scare tactics are designed to defeat "Medicare for ALL." Truth is, these scare tactics are designed to protect insurance company corporate profits and executive salaries. Don't be fooled by this greed driven industry. A public plan that allows patients and providers to make health care decisions and negotiate balances is the hybrid system that will result in immediate reduction in health care costs and BETTER HEALTH CARE.

Sunday, August 9, 2009

Letter to President Obama re: Health Care Reform

July 27, 2009

President Barack Obama
The White House
Washington, DC

Dear Mr. President:

It is with great admiration and respect that I write you this letter regarding the state of health care and access to health care in our country. As you are well aware, this issue is of utmost importance and very complex. I am extremely supportive of health care reform and access to health care for those who can and those who cannot afford it..

I have been a health care provider since I completed my training at Cook County Hospital in 1972. I am currently the CEO of Museum Center Surgery Group, Inc., and the Chief Administrator of National Stand Up Imaging, LLC in Los Angeles. I am a certified medical psychologist and a Fellow and Diplomate of the American Academy of Pain Management. As a medical and behavioral health care provider and health care administrator for over 35 years, I believe I have the knowledge base and a somewhat unique perspective on health care delivery.

My primary concern relates to the state of the health insurance industry, the pharmaceutical industry, and the actual delivery of health care. Health insurance companies do NOT provide health care. They are in business to make money. In fact, they refer to claims as medical losses. They have an inherent conflict of interest in that they currently determine what can or cannot be provided to their policy holders. This is done even though there are laws that prohibit the corporate practice of medicine.

The obvious conflict is the entity that is to pay for the health care determines what health care is to be provided. This context has an immediate and negative impact on the decision making and relationship between the provider and patient, while ensuring the profitability and viability of the insurance company. This conflict places all health insurance policy holder’s health and possibly their lives at risk.

During your campaign, you mentioned your own personal family experience fighting with your health insurance company. You are a highly educated person with skills of persuasion that most Americans do not have. If you and your mother had difficulty with your insurance company, what possible chance does the average American have fighting their insurance company for necessary treatment?

The financial motives and greed on the part of the health insurance industry and the pharmaceutical industry are expensive and places lives at risk. There cannot be real and significant health care reform without insurance reform. In fact, if the health insurance company was removed from the equation, the amount of money generated from industry operating expenses, obscene salaries to executives, and corporate profits would go a long way in paying for a hybrid single payor system.

I understand that removing the “middle man” from the health care equation is a very difficult proposition. The insurance companies pour millions and possibly billions of dollars into the campaigns of their selected legislators in state and federal government. Motivating legislators to pass a reform bill that is opposed by their campaign contributors is highly unlikely. However, if you add the campaign contributions to the obscene profits generated by the insurance industry and pharmaceutical industry, we could go even further in covering the expense of a hybrid single payor system where health care decisions are made between provider and patient. As I mentioned earlier, there can be no real health care reform without insurance reform. It is time to remove special interest from the health of our citizens.

I have been an advocate of a hybrid single payor system for years. We all ready have Medicare in place, and an expansion of the Medicare system would suffice to provide basic health care for all.

There needs to be some changes in the current Medicare system to make this work for patients and providers. Currently, CMS determines the value of the health care service and the provider must accept that value unconditionally. Medicare then pays 80% of the reimbursement and the patient is responsible for 20%, independent of the patient’s economic status and the provider’s fees. If the rules were changed to allow the provider and patient to negotiate balances, the health care decision making would be where it belongs; provider and patient. That decision includes who the patient chooses as their providers. Currently that choice is only available with PPO plans. HMO, IPA, and other managed care programs limit the patient’s access to providers participating in those plans. These entities take from the system. They add nothing nor do they actually provide care. Many patients choose to go out of network and are financially “punished” by the insurance company. This would all end if health care reform resulted in a hybrid single payor system. The model for this system is New Zealand where they have basic single payor coverage and the balances are dealt with separately.

Another change in Medicare that would better the system is how individuals contribute to the funding of the system. Currently, employees have money deducted from their paychecks that is contributed to Medicare. All working Americans understand that they are contributing in the present to pay for health care in the future. We all must realize that health care reform will change the way we think about health care. For example, since their will be no premium payments for basic health care under the reformed system, an increase in the deduction for government sponsored health care would be necessary. Since this increased deduction (I believe we could manage with a 15% increase over current Medicare deduction) will be far less than the insurance premiums paid for by individuals and employers, Americans would experience the satisfaction of access to health care of their choice and determining what the expense of their health care will be (in advance).

It is also important to consider the provision of and costs of catastrophic disease, hospitalization, rehabilitation services and end of life health care. These issues are complex and can be very expensive. The hybrid single payor system encourages negotiating the difference between the providers fees and the CMS reimbursement. This would result in an immediate incentive for providers to compete for patients. That includes hospitals, hospices, step down facilities, nursing homes, assisted living facilities, surgery centers, diagnostic imaging centers, behavioral health care facilities, rehabilitation facilities, in addition to individual providers. This competition will have an immediate effect of lower health care costs. Further, if the pharmaceutical and medical device industries had to compete in an “open market,” the cost of pharmaceuticals and medical devices would plummet. Of course, there is the same “special interest” problem with the pharmaceutical companies as there is with the health insurance industry that must be addressed by you and our legislators.

Mr. President, I am proud of the way you have taken on this issue. I am proud of you for your stance against undue influence by special interest in your administration. I am proud to say I voted for you and I wish you and your family wellness. Health care reform is a necessity. Instituting a hybrid single payor system would put free enterprise back into health care, and would provide every American with access to the health care they require. Thank you for listening.

My best regards,


Howard Stanley Rubin, MP, PhD
Los Angeles, California
www.mmosc.com

Saturday, August 8, 2009

Welcome to Health Care Now. This Blog is dedicated to fixing a very broken health care system in the USA.

There can be no real health care reform without insurance and pharmaceutical industry reform. Health Insurance and Pharmaceutical Companies DO NOT PROVIDE HEALTH CARE. These companies are in busines to make money for their shaeholders and executives. Check this out!



UnitedHealth CEO
Stephen J. Hemsley
2007 Compensation
$13.2 million
2008 Compensation (Forbes)
$3,241,042
Former Managing Partner and CFO of Arthur Andersen (BusinessWeek)
Total Value of Unexercised Stock Options (Forbes)
$744,232,068
2009 Options Exercise
$127,001,281
Value of Wayzata, Minnesota Home (Hennepin County Assessor)
$6,640,000
Articles:
Hemsley returns $190 million in stock options acquired as a result of practices found to be fraudulent by the SEC (American Medical News)

CIGNA CEO
Edward Hanway
Five-Year Compensation, as of April 30, 2008 (Forbes)
$120.51 million
Total Value of Unexercised Stock Options (Forbes)
$28,881,000
Value of New Jersey Beach Home (Cape May County Assessor)
$13,607,400
Articles:
The family of a 17-year-old girl who died hours after CIGNA reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday.
Hundreds of entertainment industry workers in California and New Jersey who buy health insurance as a group are being hit with a rate increase that will raise some family-plan premiums to more than $44,000 a year.

Humana CEO
Michael McCallister
2007 Compensation
$10.3 million
2008 Compensation (Forbes)
$1,017,308
Five-Year Compensation Total (Forbes)
$15.1 million
Total Value of Unexercised Stock Options (Forbes)
$60,865,194
2006 Options Exercise (SECForm4)
$22,294,710
Value of Park City, Utah Home (County Assessor)
$6,978,380
Articles:
Humana abandons senior citizens in Florida, returns after Republicans pass new Medicare law, upping HMO payments by ~ 25% (NY Times)

Aetna CEO
Ronald A. Williams
2007 Compensation
$23 million
2008 Compensation (Forbes)
$24,300,112
Total Value of Unexercised Options (Forbes)
$194,496,797
Williams is in the top ten of Forbes'"$100 Million CEO Club."
Articles:
Health insurance giants Aetna and CIGNA, along with others, became the latest targets of a wide-ranging probe launched by New York Attorney General Eliot Spitzer, according to USA Today. (source)

Coventry CEO
Allen Wise
CEO from 1996-2004, and from January 2009-Present
2004 Compensation (Forbes)
$13,052,799
2006 Sale of Stock
$14,458,251
2006 Options Exercised
$2,895,000
2005 Sale of Stock
$46,410,695
2005 Options Exercised
$6,709,564
2004 Sale of Stock
$12,826,756
2004 Options Exercised
$4,798,000
Value of Hilton Head, SC Home (Beaufort County Assessor)
$3,275,500

WellPoint CEO
Angela Braly
2007 Compensation (secinfo)
$9,094,271
2008 Compensation (Forbes)
$9,844,212
2006 Sale of Stock (SECForm4)
$4,858,585
2006 Options Excerise (SECForm4)
$4,566,124
Value of Indianapolis Home
$1,987,700

This is just a handful of health insurance executives. None of these people have ever diagnosed or treated any patient in their executive capacity. In fact, they participate in developing company policy that limits health care to their policy holders and in many cases deny health care to their policy holders. Withholding funding for health care is how these obscene salaries are paid.

Remove health insurance companies from the equation and all this money could actually be used to provide health care for those in need.