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
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