American Medicine: 2044

New York, NY 3:30 AM

The Mercedes 500 glides up the ramp from the underground garage onto Park Avenue. The driver, silver-haired, in his mid 80s, enjoys the feel of the powerful car and wonders why he doesn’t drive it more often rather than having his driver behind the wheel. He looked over to remind himself that he had brought the attache case.

Overhead lights gleam off the polished exterior but the darkly smoked glass keeps the exterior dark and impenetrable. Anyone who noticed might wonder why the immaculate car has mud covering the license plate.

He turns north, makes a left heading west on 97th street. As he passes Madison he glances to his right and sees the perpetual lines outside the Mount Sinai School of Medicine and — he remembers — the Central Park West Community Clinic.

The federal government had taken over half the Mount Sinai facility when enrollment plummeted around 2013. Smart American kids had begun to shun medicine early in the 21st century when lawsuits soared and government control of their ability to earn money made the 10-plus year, more than quarter-million dollar investment in education not worth the effort to most of them.

Many of the teaching hospitals, especially at the great universities, had become federal facilities. They needed to, all the student loans were controlled by Washington and, really, how many parents could come up with the kind of money it took for a child to become a doctor?

Now there just weren’t enough doctors to treat everyone. He remembered the headlines when doctors started retiring, closing their practices and walking away from medicine. Around 2011, if his memory was correct.

At first the lines had started forming around 6 in the morning hoping to cut the wait after the 8 AM clinic opening. Then you had to get there by 3 AM if you didn’t want a 10-hour wait. Eventually, many just decided it wasn’t serious enough to bother and still the lines grew. He remembered when the local TV station had interviewed people who had been in line for over 36 hours…camping out. The clinic had brought in portable toilet facilities because human waste in the streets wasn’t quite the environment they wanted for their hospital.

The doctors and nurses had done the best they could, working 10 and 12 hours shifts, trying to examine, diagnose and treat as many people as they could. But, hell, there had been 30 millions more people with health insurance than the year before.

Eventually, they burned out and got out. The government started paying the entire college and medical school tuition for anyone willing to work in a community health facility. That had worked for a few years but the new crop soon were exhausted so the government turned overseas offering tuition, room, board and citizenship to anyone willing to serve for 10 years.

Enrollment boomed — and so did the drop out rate. The best and brightest weren’t interested and the standards continually dropped. Today, you were lucky if you could find a nurse in her late 60s who knew what she was doing for a simple injection. Soon she’d be gone as she neared the age of 72 and would be eligible for her Social Security benefits.

He entered Central Park taking the 97th Street Transverse, skirting the northern edge of the Jackie Kennedy Onassis Reservoir. What had it been called before? He continued west, cut south to 96th Street, got on the Henry Hudson Parkway northbound, crossed under the access roads to the George Washington Bridge.

He had the exact change ready for the toll booth. He’d been warned not to use his automated toll payer or even to be seen by an attendant. Entering Westchester County, he took the Yonkers Avenue exit made a left and another. His destination was at the end of the dead-end street.

It looked like any other manse in the well-heeled neighborhood except it was gated. Pulling up he entered the code  they’d given him, a code that could only be used once, waited as the gate swung open and pulled up to the front steps.

Almost immediately a neatly dressed bruiser of a guy came out, walked around to the driver’s side and asked, “Mr. M?” He noticed the gun peeking out from the jacket, nodded and was relieved when the man opened the door for him. “Leave your keys sir and we’ll take your luggage up to your room. Everything will be there before you’re done checking in. Don’t forget your case,” he said, nodding to the passenger seat.

As he mounted the steps the door was opened by what seemed the first man’s twin. Probably also armed, he thought. He was directed to the admissions desk where a nurse waited. It wasn’t quite 5 AM and the place was alive, ready to handle the select few who could afford the best in medical care.

She handed him the forms, indicated where to sign, pointed discreetly to the cost and sat back waiting. He snapped open the case, turned it to face her. She nodded, rang a bell and another nurse appeared to take him to his room and prep him for the procedure. He was confident it would be counted before they ever began his operation but it was all there…all $110,000.

It was a lot of money, probably about 50 percent more than it should have been but what could he do. He’d been turned down by the government’s review panel. If he wanted to live to see his granddaughter married he needed the operation and the intensive follow-up treatments. So he’d made the decision, sold the necessary stocks and bonds and accumulated the cash.

The doctors here — and he was sure at the 60 or so other facilities around the country — were among the best in the country. They’d gone “underground” in 2014 when they’d “retired” and virtually disappeared off the grid……………

Prophesy or fiction? You decide.

Let’s Create the People’s Health Care Bill

NOTE: Bold sections are the proposed People’s Healthcare Bill. Italics are comments on the proposed legislation. Regular type is the original blog posting.

The other day on Twitter someone suggested we should write our own health care bill and I responded that I’d bet we could do it in understandable English and less than, I don’t know, 100 pages.

Have to admit it got me thinking. Now, I don’t suffer from quite enough hubris to think I, myself, a lay person could actually accomplish this feat. But, perhaps, if I laid out a few basic principles, a whole bunch of people could contribute a little bit here and a little bit there and, perhaps, we’d actually come up with something that resembled legislation.

The most fun of all would be to pass it along to a whole lot of people in Congress and see how they screwed it up and, we could hold a lottery on how many pages it would wind up. Use the proceeds to pay off the national debt. Okay, one-millionth of one percent of the national debt.

* * * * *

So, here are the first of my goals for The People’s Health Care Reform Act of 2009.

Anything in this bill shall pertain only to citizens of the United States of America or a duly documented and approved alien.

Health care is neither an entitlement for the citizen nor a constitutional obligation of the government.

Goal 1: To reduce fraud in the existing Medicaid and Medicare programs so that citizens and taxpayer monies are not wasted.

HEALTHCARE FRAUD

Government Programs

The first step in saving money, both for the government (Medicaid and Medicare) and for citizens covered by private insurance is to correct the problems within the current reimbursement system.

The Federal government should sufficiently fund the necessary departments to assure that payments are not made to unqualified providers and/or to individuals for services not warranted, not properly ordered and/or not delivered.

[NOTE: A GAO Report (Jan, 2009) found that during 2007 the Centers for Medicare and Medicaid Services (CMS) issued over $32.7 billion in improper payments.

CMS itself, in a Nov, 2008, report showed improper payments thusly: Medicare fee-for-service - $10.4 billion in FY 2008; Medicare Advantage in CY 2006 - $6.8 billion; Medicaid - $32.7 billion in FY 2007; SCHIP - $1.2 billion in FY 2007.

Another GAO report (July, 2008) estimate almost $1 billion in annual Medicare payments for durable medical equipment were improper. Just 55% of the durable medical equipment suppliers in South Florida -- just one region -- were compliant with the rules.

The Senate Permanent Subcommittee on Investigations (September, 2008) reported that from 1995 though 2006 over $4.8 billion in payments were made for durable medical equipment under claims with diagnosis codes that were invalid, blank or unprocessable -- that's almost $440 million per year.

The same group showed that of bills submitted by medical suppliers from 2001 though 2006, over $1 billion were questionable. There were hundreds of thousands of claims for diabetes-related glucose test strips for patients diagnosed with bubonic b=plaque, leprosy and cholera. The study also showed that claims for walkers were paid for patients whose diagnosis code included sinus congestion, paraplegia and shoulder injuries.] Information obtained from Center for Health Transformation.

Estimates of fraud and waste in these programs run into the hundreds of billions of dollars annually yet funds allocated by Congress are insufficient to catch and prosecute those perpetrating the fraud.

An investment of even $100 million dollars in additional equipment and staff to catch fraud should show an incredible return on investment to the government.

Defrauding a government healthcare program should be a Class A felony punishable by 5 years in prison per count and restitution to the government at the rate of 5 times the amount of the fraud.

A government employee who uncovers a conspiracy to defraud shall receive 10 percent of any fines assessed against the parties convicted as a bonus. This will not apply to simple errors made by the provider and which are corrected in a timely fashion resulting in no charges being brought.

It is obvious that, given the lure of the incredible amounts of money being disbursed by the government, it will take almost draconian punishment to take the luster off the opportunity. Falsify 100 claims for $1,000 each and face 500 years in jail (with time off for good behavior you should be out in, say 200 years) and forfeiture of $500,000 in fines. Sounds like a deterrent to me.

Imagine giving government employees an incentive to go beyond just pushing paper and collecting a paycheck from the taxpayers. Seems worthwhile to give it a try.

Private Insurance Programs

(still in mark-up)

Goal 2: To protect citizens who have health insurance (80%+) from paying extra because of the choices made by citizens who do not have health insurance and utilize emergency rooms, etc., as primary care facilities.

First, anyone who has access to health insurance through their employer or who has income sufficient to obtain same and freely chooses not to exercise that opportunity shall be personally responsible for all medical costs incurred on their behalf. They may not pass that cost off to their fellow citizens by utilizing the Bankruptcy Laws or any other means of avoidance of their obligation.

Goal 3: To initiate tort reform so that frivolous and nuisance claims against doctors and medical facilities can reduce the cost of malpractice insurance and lower the cost of medical treatment for all.

TORT REFORM

Punitive (noneconomic) damages shall be capped at $250,000 per defendant or up to $1,000,000 per incident. There shall be no cap on the more easily identifiable economic damages such as loss of wages, the actual cost of corrective medical care or continuing care required by the incident.

Plaintiffs must provide expert witness reports to support their claims within four months of filing suit or the case is dismissed with prejudice.

The above two provisions are based on the Texas legislation passed in 2003. The results, according to Texas Governor Perry, is that insurance rates for physicians in Texas have declined by 27 percent, over 10 insurance carriers not doing business within the state prior to the legislation entered the market increasing competition and further lowering costs. There has been an increase in the number of doctors applying to practice in Texas, around 15,000 or an increase in excess of 50 percent.

Specialties which have been subjected to large numbers of negligence suits are also benefiting from the legislation. Rural Texas has seen an increase of 27 percent in the number of obstetricians practicing in their areas — including 12 counties that previously had no obstetrician.

Lowering insurance costs to physicians and medical facilities should lower costs for everyone. Doctors have an obligation to provide good medical care and the information necessary for patients and families to make sound decisions regarding medical care. Health care facilities must be clean, safe and staffed with trained professionals. Patients have an obligation to educate themselves about the risk, rewards and costs of all procedures and medications.

Goal 4: To make health insurance more affordable for all by allowing greater competition between the 1,300 private health insurance companies. There should be no government run insurance to unfairly compete.

Here’s a problem for constitutionalists. Greater competition between private insurance companies is controlled by the individual states who license issuers and control what they offer to citizens of their states. New Jersey, for example, requires so-called “soup to nuts” plans which drives the cost of insurance for residents of the state higher. Tenth Amendment advocates want to preserve states rights but the only way to open states up to more competition is with a federal mandate. A conundrum!

Goal 5: To make health insurance providers responsible for meeting the commitments the policy holders have paid for by severely penalizing denial of coverage and delays in honoring the insurance contract.

Time is money — especially when every day you delay paying it out earns you more on it. Insurance companies and the individuals responsible for the timely honoring of insurance contracts must be held accountable for any and all unreasonable delays and denials of coverage.

* * * * *

That’s a start. I’m certain their are more goals and more details to be filled in under each of these goals. I’ve got a few myself but don’t want to push the People’s Health Care Bill in such a personal direction (after all I’m not up for re-election anytime soon).

Something like this just doesn’t work in a 140-character tweet so please post your additions, arguments, deletions and the like in a comment and we’ll see how good we can be at writing a health care bill that does better than HR3200.

Send all the RTs you like, spread the word and we’ll see what “we the people” can come up with.

An Open Letter to Senator Ben Cardin

I’ve singled you out, Senator Cardin, because a long time ago we had a personal relationship when I published a weekly newspaper that served some of your constituents when you were a member of the Maryland House of Delegates. Believe I may have even endorsed you for re-election on more than one occasion.

Although we haven’t spoken in 30 years, I still fondly remember when you and your wife Myra served as judges for my “Best Corned Beef Sandwich in Baltimore” article in Chai magazine.

During all those years I’ve observed your steady rise to Speaker of the House of Delegates, to the United States House of Representatives and, now, to the Senate.

We have never been on the same side of the political spectrum but I always respected your opinions and felt that you were a straightforward, stand-up person. Yesterday, when I heard on WBAL that you had limited your town hall meeting in Towson to ticket holders (whom, one could make the assumption, were going to be carefully chosen) and that all questions would have to be submitted in advance…well, that opinion took a sharp downturn. That’s a schonda, Senator.

Ben, Senator, even in overwhelmingly Democrat Maryland, you need to understand that many people are very, very upset about the course the current administration has set. Healthcare is just one of the issues.

What bothers me is not that we disagree on the matter — as I said, we’ve always be at different places in the political spectrum — but that you are actually going out there to defend a bill that hasn’t been written.

Unless the usual unreliable media sources are even more unreliable than one is used to, what are you asking the people…of Maryland and the United States…to sign on to?

Are you one of the extremely few in Congress who has actually  read the House proposals? Do you believe that seniors, a group you have long championed, are going to be better off under the current proposals than they are now?

I just passed my 70th birthday, Senator, and I would have been subjected to my second end-of-life counseling session. Yet, here I am putting, I hope, cogent thought to digital paper, working a full time job, riding the tractor to do the lawn and scraping by.

In five-plus years of paying Part B Medicaire and more recently Part D Drug payments I’ve never, not once, collected a penny. Yet, should I need some medical procedure done, something I and a doctor choose, do you think I want anyone in the government deciding that I’m too old to warrant the expense?

Here’s an analogy everyone should be able to understand. Recently, my car began to cut off when it got warm. Took it to my local mechanic who diagnosed the problem, replaced the faulty parts and put me back on the road.

What Congress is doing is disassembling the car first. Then trying to put it back together without any idea whether it is actually going to work or not and handing an enormous bill to the American public. Oh, and we shouldn’t forget, advancing a far, far left political agenda in the process.

Anyway, Senator, Ben, I don’t expect actually to change your mind. Really what I wanted to accomplish is to get you to listen to the angry voices that would come to your town hall meetings to express their outrage and their frustrations. They have a right to be listened to — not just heard. And, if they shout you down, boo you, don’t seem to want to have a real dialogue…well, you’re a big boy and you’ll survive and continue to be a senator from Maryland for as long as you choose. We both know that.

Come on Senator. It’s time to be a mensch. Listen to the angry folks not just the ones who agree with you.

Oh, one more thing. A previous blog contained 19 questions requiring just a Yes/No answer I wanted the president and all the members of Congress to answer. Care to give it a try? http://asonofliberty.wordpress.com/category/health-care-reform/

Obama on Healthcare: Disingenuous or Outright Lies?

Writers love to wallow in the connotative meanings of words; they provide the nuances that give our language the ability to sing. So, while both words involve deceit, concealing the truth, we’ll grant that being disingenuous is a bit less formidable a crime than outright lying.

President Obama has been active 24/7 pitching his health care reform plans to a very skeptical populous. In town hall meetings and national press conferences he has tossed the blame for any problems onto the insurance companies who while providing a service also want to make a profit, the medical professionals who he charges order tests and procedures that aren’t necessary in order to boost their personal incomes, on greedy small business employers who while providing the overwhelming percentage of jobs in the country aren’t willing to go bankrupt providing medical coverage for their workers and, of course, on former president Bush.

That his explanations and arguments have shifted as public sentiment has changed isn’t surprising. A good salesman always takes the first…and the second…and the third “no” as another opportunity to close the sale.

Now, as a trained lawyer, a graduate of an extremely prestigious law school, I’m certain President Obama knows the value of asking the Yes or No Question. No explanation needed, no opportunity to obfuscate the answer, no opportunity to ameliorate any problems with the answer.

Here are some basic questions I’d like the President to answer. Simple “Yes” or “No” will do, thank you. Of course, it might require him to actually read the bill being proposed by his own party — something some of the Democrat members think is a really laughable idea.

As Congress moves toward its August recess, thankfully/hopefully without passing a health care “reform” bill that throws out the finest health care in the world (the baby) in order to correct some problems (the bath water), these same questions should be put to every member of the House of Representatives and the Senate whenever and wherever they meet constituents.

Since the bill is still being debated, new sections added, others deleted, please, Mr. President, don’t be disingenuous because a page number has changed.

Over and over again we have heard that if you have health care insurance and are happy with your plan you can keep it. Mr. President, Congressperson, Senator:

Under the proposal now before Congress (see pages 84-85), does the government assume any control over the benefit packages offered by private health care plans? A simple Yes or No, please.

If a person changes jobs, goes into business for themselves or retires will they be able to keep their existing private health care plan? Yes or No.

If No, will they be forced to enroll in the government plan? Yes or No.

Will the Federal government have the power to override (see page 111) state-based health care programs? Just a Yes or No, please.

Does the bill (page 121) give the Federal government the right to set payment rates for all items and services? Yes or No.

Does that mean that the best surgeon, with say 20 years experience, for a particular operation will not be paid more than the doctor doing the procedure for the first time? Yes or No, please.

Does the bill (page 124) exempt the government from any price fixing lawsuit and include a provision for “no judicial review” of any decision? Simple Yes or No answer, please.

In an effort, Mr. President,  to make this bill “revenue neutral” you have talked about the creation of a board which will gather information and make a determination of the best medical treatment options.

Would this board have the right to refuse payment to a doctor or hospital for any procedure the medical provider feel is in the best interest of the patient? Just a Yes or No, please.

Could this board deny any treatment or procedure to a Medicare patient based on the age of the person? Yes or No.

Would citizens reaching the age of Social Security eligibility be required to participate in end-of-life planning (page 425) including but not necessarily limited to living wills and powers of attorney? A Yes or No answer would be nice.

Does this bill (page 429) give the Federal government any control in end-of -life planning, medical orders written for a patient, the choice of doctor handling end-of-life actions or inaction and treatments? Real simple. Yes or No.

Everyone agrees, Mr. President, that health care and the discussions and decisions reached between doctors and their patients are private.

Would the Federal government have access to the medical records, tests, conditions or any other personal and private matter previously  protected under doctor/patient confidentiality? Oh, hell, the answer is Yes so don’t bother.

Does the proposed health care bill also give the government (see page 58) access to an individual’s finances? Yes or No.

Would a national health-care ID card be issued–something Americans have resisted overwhelmingly when not tied to health care issues? Yes or No.

Will the Federal government have direct access to a citizen’s bank account for electronic fund transfer? A really simple Yes or No would be appreciated.

In tough economic times, Americans are aware of every dollar they spend, where it goes, what value it has to them.

Mr. President, will the proposed health care reform bill provide medical treatment to all non-U.S. citizens whether they are legally or illegally in the country? Yes or No, sir…please.

One of your arguments for passage of this bill, Mr. President, is that duplicate testing — you call it unnecessary — would be eliminated with computerized medical records sharing.

If you were a doctor, Mr. President, would you risk your medical practice, your livelihood and the support of your family, your entire personal wealth, accepting the fact that a) a test given by someone else was properly administered and b) that nothing had changed with the patient between the test and the time you were seeing and treating the patient? Yes or No, please.

If you were a patient, Mr. President, would you let the doctor write a prescription based on the cost of the drug, rather than its efficacy? Yes or No.

Based on your press conference use of a child with chronic sore throat, would you want a doctor to prescribe a drug for either of your girls that was “only 10 percent” less effective but was half the price? Hell, I’ll answer that for you. No…you wouldn’t.

Special thanks to Peter Fleckenstein who managed to read the entire House bill and provided the page references used.  http://blog.flecksoflife.com/2009/07/19/the-hc-monstrosity/

Truthfully, my head exploded on about page 500 of the more than 1,000 pages in Pete’s complete work.

So, now it’s up to us. Ask the questions and demand Yes or No answers. Oh, and you might tell them that if they vote for this destruction of the American medical system they should enjoy their remaining time in office because you intend to do everything in your power to make certain it’s their last term.