Today’s Qs for O’s WH – 5/11/2009

hey jake tapper
r you still working for the republican party. abcnews is fox news only network.

Of course Jake is a Republican I mean he never went after Bush!

Who are these “trade organizations”, these “healthcare players”, who speak for the American public? They don’t speak for me. Investigate please. Since we know that Orzag and Daschle before him were working this healthcare re-engineering long before the inauguration and from the same goofy preconception that base the practice of medicine on some mandated study conclusions (medicine by fiat) how about we start connecting the dots to inform the American public as to how we arrived at today’s dog and pony show.

Gibbs:: I hope your kidneys fail jake (laughter) from Obama

What sacrifice will the 40% who pay no income taxes be required to make?

Bob the Blogger “lets see if I can answer Jake and help Gibbs.”
TAPPER: I’m wondering if the White House is at all concerned that you’re not preparing the American people sufficiently for the fact that they, along with everyone else, will have to give something up for health care reform to happen. The President has talked a lot about everyone’s going to have to give something up, but I’m wondering — I mean, if you look at the Dartmouth study that Mr. Orszag talks about all the time, or you look at some of the cost-cutting measures that are being discussed, there are some things that patients will have to give up. I don’t hear anybody in the administration — and I know you’re not drafting the legislation — but I don’t hear anybody in the administration talk about that at all.
Bob the Blogger: Jake back in 2007 as a presidential candidate Barack Obama offered a sweeping health care plan that would provide every citizen a means for coverage and calls on government, businesses and consumers to share the costs of the program.
TAPPER: A follow up to that, sir.

Paul Krugman: Health Care Proposal “Some Of The Best Policy News I’ve Heard In A Long Time” from the Huffington Post by Rachel Weiner
- York Times columnist Paul Krugman notes today that one of the groups involved is a descendant of the lobbyists that helped kill health care reform with “Harry and Louise.” Krugman says he’s wary of the shift — he thinks industry groups will use good will created by this move to try to kill a public health plan backed by progressives). Still, he calls today’s developments “some of the best policy news I’ve heard in a long time.”
Tapper Krugman may be right about the “industry groups will use good will created by this move to try to kill a public health plan.” Only time will tell. I do believe healthy insured American workers can help this economy grow.

The Dartmouth study found that prescribing more tests and more hospital visits didn’t correspond to more wellness.
That’s great, but what has Obama suggested in the way of Tort reform? Much medicine practiced today is defensive.
So Obama plans to cut doctors’ pay and leave them with the same exposure?
Perfect.

Maybe the health care providers and insurers want some sort of bail out program of their own.. and the execs. believe they can turn this catastrophe into cash in pocket..

drjohn:”So Obama plans to cut doctors’ pay and leave them with the same exposure?”
No. Out of all the options he’s put on the table, and the white papers, and the debate questions – I have never heard him put that one forward. Please cite where he has suggested doing that.

Real Healthcare Reform
Changing Priorities, Incentives and the Rules of the Game; Creating an Electronic Health Record for Every Citizen Who Wants One
If you have the financial resources of Bill Gates or Warren Buffett you needn’t pay money to a health plan each month, since if you get sick or injured – even very seriously – you have more than enough money to pay all your medical bills yourself.
But those of us who have significantly less financial resources must find some other means of dealing with the thousands or even hundreds of thousands of dollars or more of medical expenses that we might incur should a serious illness or injury be our fate.
Enter the concept of “health insurance”.
Large numbers of individuals and/or their employers pay some money each month into one or another big pot called a “health plan”. Those individuals who remain essentially very healthy for many years and then suddenly die or perhaps leave a particular health plan for some other reason – if they have put more money into the pot than was taken out to pay all their medical expenses – wind up helping to pay the medical bills of those members of the health plan who become seriously ill or injured and incur a lot of medical expenses.
Many Americans covered by some form of health insurance don’t seem to fully understand or perhaps choose to ignore the fact that if they become seriously ill or injured, for the most part their medical bills will be paid by the members of their health plan who have remained healthy. Keeping members of a health plan healthy by preventing illness and injury is critically important, but is something not currently given the high priority and attention it deserves.
Some Americans believe that healthcare should become a “right” of every American citizen. If a nationalized single payer health plan were enacted, every American citizen who became ill or injured – for any reason whatsoever – and incurred significant medical expenses would for the most part have his or her medical bills paid by U.S. taxpayers. Many Americans oppose such a system for America recognizing that significant difficulties such as long waiting periods and rationing of care exist in such types of government healthcare systems that currently operate in other countries such as Canada and the United Kingdom.
For any health plan to work which has a large number of people pooling their money to essentially pay the medical bills of whichever members of the plan become seriously ill or injured, rules must be established as to when and how much money may be taken out of the pot e.g. “legitimate” doctor bills and hospital bills. Equally important is keeping track of the amount of money that is being put into the pot each month in premiums paid by health plan members or their employers. If too much is being paid out in expenses as compared with the amount being received in premiums, the pot will soon become empty and the health plan will go broke.
As previously mentioned, the monthly premiums paid by individuals or their employers go into a health plan’s big pot from which “covered” healthcare expenses are paid. But also from this pot are paid all the health plan’s administrative expenses including what may be big salaries and golden parachutes for CEO’s and other “healthcare executives” – individuals who may be paid to find technicalities of one sort or another in the health plan’s agreements so the health plan can deny or reduce payments, raise premiums, cancel insurance, or in one way or another minimize or exclude “bad risks” from the health plan. All such questionable business practices are done to enable the health plan to make a profit and remain in business.
Currently we are experiencing continual increases in healthcare costs that are unsustainable and which, if unchecked, will soon seriously threaten the future of the entire American economy. Healthcare costs must be controlled, but how? If a healthcare system made up of health plans is going to have a chance of both meeting the needs of health plan members and simultaneously develop the ability to keep costs under control, priorities, incentives, and the rules by which the game is played all must be changed.
The good news is that a lot of illnesses and many injuries are actually preventable. But how will prevention ever become a top medical priority when doctors, hospitals, and other providers get paid largely for diagnosing and treating illness and injury, not for preventing it?
Although health promotion and disease and injury prevention receive fashionable and socially acceptable lip service, the fact is that most of the participants in what should be more appropriately called our “sickness and injury care system” actually have no significant financial incentive whatsoever to spend any significant time and energy in genuinely promoting health and helping to prevent disease and injury.
Much to the contrary. Other than the actual members of a health plan – patients and potential patients – and their employers and perhaps the employees of some health plans, most participants in our sickness and injury care system – because of the way they are paid – have an enormous (if unspoken) financial incentive for massive amounts of disease and injury – much of which is preventable – to continue to occur in America. Strictly from a financial point of view, for those whose incomes come solely from the treatment – not the prevention – of illness and injury, the more illness and injury that occurs, the better. And if the illness or injury is serious and requires perhaps many expensive tests, multiple surgical procedures, and other very complicated prolonged treatment in an intensive care unit, so much the better; just as long as those unfortunate individuals who happen to be ill or injured are “covered” by “good insurance”, i.e. health plans that are reliable bill payers.
This is not to say that there are not some excellent very dedicated and hardworking doctors and other health professionals – although they are paid on a fee for service basis to care for illness and injury – who nevertheless attempt to essentially work themselves out of a job by making health promotion and disease and injury prevention a top priority with their patients.
It should also be recognized that some existing health plans – e.g. Kaiser and Group Health – combine insurance, doctors, and hospitals into a single entity in such a way that provides everyone – including all the health plan’s doctors – a real incentive to spend time and effort with patients on health promotion and disease and injury prevention as well as on early diagnosis and treatment.
But unfortunately the above examples represent only a small part of the sickness and injury care system that currently exists throughout America.
For the most part – because of the way they are compensated – the majority of doctors and other professional providers, acute care hospitals and long term care facilities, pharmaceutical manufactures and pharmacists, medical and surgical equipment manufacturers and personal injury and malpractice attorneys – among others – depend mightily on massive amounts of disease and injury occurring in America; and these participants in our sickness and injury care system would be significantly negatively impacted if a lot of the preventable illnesses and injuries were actually prevented. This must be changed.
Unless the incentives and rules are changed to give as many participants as possible a real financial stake in health promotion and disease and injury prevention, in early diagnosis and treatment, and in maximizing health and minimizing disease and injury, healthcare costs in America will never be brought under control. Making appropriate changes in the incentives and the rules of the game is the real task and challenge of “healthcare reform”.
What about financial incentives for individual health plan members? Should individuals receive a financial incentive to be healthy? It is well recognized that engaging in regular exercise, abstaining from tobacco, and eating moderately so as to maintain a reasonably normal body weight are all significant factors in helping to promote an individual’s health and wellness. These healthy behaviors can all be confirmed by simple tests performed or ordered in a doctor’s office. Why shouldn’t those individuals who practice these health promoting behaviors and comply with recommended immunization schedules and appropriate preventive screening examinations such as for colon cancer and breast cancer pay significantly less in premiums to their health plan each month than those who don’t?
To really reform healthcare we must find ways – through changes in incentives and the rules of the game – to actually prevent what is preventable, to maximize early diagnosis and treatment, and minimize disease and injury with all its associated cost. We must find ways for participants to be part of our “healthcare system” and not just a part of our “sickness and injury care system”.
Significant changes in the rules of the game for our legal system – tort reform – is also critically important so that the gaming of the system now being done by personal injury and malpractice attorneys and their clients can be ended and so that the exorbitant costs to physicians and other professionals for malpractice insurance can be dramatically reduced.
Truly transforming our “sickness and injury care system” into a “healthcare system” by making significant changes in the incentives and the rules of the game may seem to be a formidable task and one that probably has never really been done before on a large scale anywhere in the world. But it is a worthy task and a critically important task for the future of America and its people.
One significant part of this process is developing the capability of creating an electronic health record for every American citizen who wants one. We need a standardized framework that will allow every American citizen to have an individual electronic health record – a computerized medical record – that can be accessed by all the doctors who care for a particular individual, regardless of wherever on the planet the doctors or the patients happen to be. It would be like having your own personal online banking account that only you have the password to, but which you can share with the doctors who are caring for you, wherever you or they may be.
I applaud those who are using their energy and expertise to upgrade our deplorable current paper medical records system and bring medical records in America into the 21st century. Developing a standardized framework for an electronic health record – for every citizen who wants one – created by your doctor with your assistance, with proper security and safeguards – is something that our national government can and should do as a part of healthcare reform.
If done well, electronic health records will be transformational in helping doctors efficiently and effectively care for patients and will save an enormous amount of time, effort, and money which is currently wasted on needless and frequently inaccurate duplication. And having an accurate electronic health record for an individual will also facilitate appropriate health promotion and disease and injury prevention for that individual. Like the telephone and the computer, someday we will all wonder how we ever got along without individual electronic health records.
All this requires action, not just words. Now is the time for Americans and their leaders and doctors and other health professionals to step up to the plate and begin the process of transforming our “American Sickness and Injury Care System” into an “American Healthcare System” that is worthy of our great country.
Robert Westafer M.D.

“The US is more likely to have some of the best medical treatments based on just it’s size alone.”
The US has the best healthcare in the world, period. Size has nothing to do with it. Nice try.

“Is that what you consider the best healthcare in the world?”
What country has better healthcare?

Sigmonde:”What country has better healthcare?”
When assessing the level of health of the population as a whole, pretty much every other first world nation. Every Canadian I know prefers their healthcare system, including the one who went through extensive treatment for a brain tumor (in Canada of course – although he went to University in the US, there was no question where he wanted to be treated). My sister was born in the UK primarily because my parents did not trust the US healthcare system so they move back for a year (they had more money by the time I came along). Finland looks good, but is a smaller nation. France isn’t a bad model with a few tweaks.
Our current method of rationing healthcare is broken and inefficient. Turning ER’s into the insurance of last resort for over 10% of citizens is horribly wasteful and does not produce the best outcomes.

. My sister was born in the UK primarily because my parents did not trust the US healthcare system so they move back for a year
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So your parents got jobs in England and moved over there for a year to work and have their baby, then got jobs in the US and moved back?

“Yeah, sure. lol…So, let me ask you then – what country has better health care?”
I don’t care, except for comparison purposes. I’m only interested in making our healthcare system better.

In California, one of the primary problems with emergency room overuse and closure are the low Medi-Cal (State Insurance) reimbursement rates.
Primary doctors don’t want to accept Medi-Cal, so there are not enough of them serving communities. People on Medi-Cal then end up going to emergency rooms for non-emergency care.
The emergency room physicians can’t legally turn away emergency patients, and so end up poorly compensated when they treat the Medical patients.
The hospitals can’t afford to run these emergency rooms, so they are closing.
All of this in the name of the government “cost cutting” by low-balling reimbursement rates to doctors. We can’t afford to do this on a national basis.

“Yet my sister also has no health insurance; being a widow with twins in grade school makes it tough to pull off a full time job to get insurance and she can barely afford state health insurance for the kids.”
Why can’t you just come right out and say it: You and your sister want someone else to pay for her health care? Is that too hard to acknowledge?

Sigmonde:”So, you are saying that the US has the worst health care of all first world nations??”
I thought I was pretty clear here – I wouldn’t put the absolute of worst, there is always some country going through a period of ineptitude it seems, but certainly in the bottom quarter. Although if you just went by life expectancy, yes we’re pretty much last.

jwh:
Why is Nanny Pelosi obstructing the bipartisan effort to reform SS, Medicare, Medicaid?

Not entirely sure what my biography has to do with this though…
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You brought it up.
I was just trying to figure out if your parents paid into the NHS system before the baby was born, or if they went to England to get free care. I wouldn’t have used your parents as an example if you hadn’t brought them up.
If we end up with single payer, we certainly can’t afford to pay for every American citizen living abroad to fly in to have their births in US hospitals paid for, and whatever other treatments they need.
Although US citizens in other countries do pay some US taxes, so I’m not sure how that would work….

skip- I had the impression Cheney was trying not to say anything specific about Bush, because there are groups out there still pushing for trials.

I guess you’re taking a brave stance against widows with kids having health care. You want them to gamble on being healthy, or beg in the streets and at church doors. Or… Well why won’t YOU come out and say what you want done?
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But again, it’s what we can afford and how we can afford it.
With 40% of children born out of wedlock, we can’t afford to assume single mothers can’t work long enough hours to hold down a job with benefits, and so provide the family with health insurance.
Can we?
Someone has to pay for it. If cutting the defense budget is going to pay for it, let’s hear that proposal put on the table by the politicians.
(I will use the story about jhw’s unfortunate sister to remind people to carry adequate life insurance)

TAPPER: I’m wondering if the White House is at all concerned that you’re not preparing the American people sufficiently for the fact that they, along with everyone else, will have to give something up for health care reform to happen.
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Gee I’ll give up worrying about loosing a job and the health insurance that goes with it.

“Gee I’ll give up worrying about loosing a job and the health insurance that goes with it.”
Then go out and purchase your own. If you “can’t afford it,” take a hard look at where you choose to live and how much rent you pay, what kind of car you drive, and how many and what kind of TV’s you have. Try economizing there instead of looking for productive people to buy your health insurance for you.

“I guess you’re taking a brave stance against widows with kids having health care. You want them to gamble on being healthy, or beg in the streets and at church doors. Or… Well why won’t YOU come out and say what you want done?”
I want every person who feels he “can’t afford” health insurance to explore diligently all the various forms of coverage availble, then take a look at where he chooses to live, how much he pays in rent or for his mortgage, what kind of car he drives, how many and what kinds of televisions he has, and a host of other things that he has determined he can, indeed, afford. If health insurance is important to him he should be prepared to realize economies in his life in order to pay for it.
And if he doesn’t do all these things, and he still accepts insurance at the expense of others, he should feel a profound sense of shame. Not long ago he would, but we have now substantially become a nation of freeloaders.

Fascist Hyena:”I want every person who feels he “can’t afford” health insurance to explore diligently all the various forms of coverage availble, then take a look at where he chooses to live, how much he pays in rent or for his mortgage, what kind of car he drives, how many and what kinds of televisions he has, and a host of other things that he has determined he can, indeed, afford. If health insurance is important to him he should be prepared to realize economies in his life in order to pay for it.”
You have no idea what health care costs if you are not covered by an employer. And if you have parents who had a heart attack before 60 – forget about it.

First off, Thank you to Jake for continuing his excellent questions of Our President and his spokesman, Mr. Gibbs. Jake, i read your blog b/c you ask fair yet tough questions. I liked the tone of your questioning today.
Onto the healthcare debate: Obama is smart in targeting healthcare for reform. He’ll likely more to a single payer format down the road b/c in the end, he does have left leaning tendencies, although i don’t think he’s a socialist. It just feels like the country is moving in that direction, for better or worse. He’s for the “common person and not for the wealthy as far as i can tell. It’s a challenging time. At least we’re still solvent at this time. Health care has a few main factors that lend towards significant costs to the economy. The baby boomers are getting old. We already spend ~14% of GDP on healthcare. For things to continue as status quo, the % of GDP would likely rise. I agree wholeheartedly with “drjohn” in his comments that defensive medicine leads to excess costs. Dr. Westafer made reference to this as well. Dr. Westafer makes additional solid comments on electronic health records. I like the idea of an individualized one, but some folks won’t be sophisticated enough to follow this. Many patients aren’t capable of bringing a list or a bag of their own medications into clinic. For now, institutions are moving forward with electronic medical records (EMR). I think all the hospital systems i’ve worked at during training or moonlighting now have them. The VA system is great, but has too much info to weed through. One problem is hospitals and systems work in islands. Kaiser, each UC system i’ve been in, and private hospitals all have their own systems, so there is redundancy to getting things done. Credit the VA for their national system, although it’s far from perfect. We have great tools in medicine to aid in patient care, and they keep improving. These tools cost money. Look at testing for patients with chest pain. You’ve got plain old stress treadmill, stress (ekg or pharmacologic) with echocardiogram, stress with nuclear, coronary CT, MRI modalities, angiography. Soo much to choose from…and so much to pay. It’s true that we are paid to do. I agree with Dr. Westafer; pay docs not solely to do, but reward thinking and making diagnosis (and reward more for less testing), for prevention.
My father is an internist who makes a good living. He’s never been one to practice to make money, just to care for people. He’s seen the whole fee for service to HMO transition. He’s never been sued and doesn’t do tests for the sake of doing them. His experience and knowledge guide has guided his patient care for the past 38 years. He advised me to not go into medicine. In his mind you make every dime in this profession. And for docs of his generation, MD satisfaction certainly hasn’t increased with HMOs. MD satisfaction even in the younger generation isn’t all that great. One survey a few years ago found >50% of MDs would choose another profession if they had to do it over again. It still takes sacrifice to do this job.
Yet, i digress. In addition to the previously made points about defensive medicine, and electronic records, i have a few others to make.
1. Prevention-Yes! Key to reduce costs, and there’s definitely more work to be done here. I believe in evidenced based medicine and follow it as best as i can. But, it’s not just for physicians to follow. It’s for everyone. How many diabetics blood sugars are adequately controlled? Look at obesity. I’m overweight. 2/3 of the country is overweight or obese. I’ve been trying to lose 10 pounds for a few years. Obesity is linked to many disease states. Obesity affects, for example, heart disease and cancer, the 2 main killers in the US. Yet the trends for obesity are getting worse, much worse, in time. We have kids getting type II diabetes!
2. We want the best care, but can’t pay for it in the long run. Our system is flawed if you look at certain metrics; for example, lifespan and neonatal mortality at the time of birth. It’s somewhat hard to compare the US, b/c of it’s heterogenous society (ie versus Japan). But, when i’m sick, where would i want to be for care. Here, at an academic center in the US. However, here’s a scenario to think about. 91 year old in the ICU with multi-organ failure including renal failure needing hemodialysis…should this be done? Of course all cases and individualized for each patient’s care, needs and family imput, but health rationing will need to be looked at if cost is our primary concern (i purposefully left out if the patient has pneumonia with sepsis and may improve or has a catastrophic head bleed, end stage COPD, on a trach, with a PEG, with an MI, heart failure, and no purposeful movements for 2 weeks, as well as pneumonia and sepsis). Of note, i don’t mention these situations to advocate not providing dialysis here b/c it would be life sustaining. The current MO is to care for patients as long as possible and keep them alive for as long as possible, unless the patient/family/DPOA (in case the patient can’t speak for him/herself)/ there are no written instructions for us/ or the care is futile care by two physician consent. Believe me, we care for people for really long periods of time. I’ve been part of care for ICU patients for up to 9 months, and people have left the hospital after that length of stay.
3. Legislating MDs. Of course, i’m biased here. I think MDs should evaluate and treat patients always with the patient in mind, for the best outcome for the patient and his/her family. I’m hoping we’re not legislated against. Here’s one example of the time to train: 4 years college+ 4 years medical school + 4 years residency in internal medicine (includes chief year) + 4 years sub-specialty training in a medicine sub-specialty. Note that 8 of those years you pay for or accumulate debt (up to 100 K is not uncommon) and 8 of those years, the salary was a good living wage ranging b/t 30 to 50 K per year. I’m for evidence based MD suggested guidelines by the AMA or whatever professional society you work in, but let MDs treat and care for patients. It’s what we train to do.
Well gang, that’s my 2 cents for now. I’ve got a few more hours of work to do before another 14 hour day tomorrow. Oh, did i mention that the above salaries are based (currently) on an 80 hour maximum work week. (ie making b/t 15 K – 25 K per 40 hour work week in the above example). We were mandated to cut back to 80 hours by work hour rules. I wouldn’t trade this job for any other. Freud, i think, said it best. Love and work are the cornerstones of our humanness. Thank goodness for my wife and her endless understanding.
And Jake, i would never wish your kidneys, Rush’s, Gibbs, or Obama’s to fail. We’re busy enough in the hospital as it is. Keep up the great work.

Should we have a health care system that rations procedures based on age, weight and other factors as determined by government bureaucrats? For example, should an elderly patient be denied a hip replacement because they are 5 pounds overweight according to government criteria? Should someone be denied health care because they smoked for 10 years or had a diet that was inconsistent with acceptable government standards? There are no easy solutions but a government run health care system would seem to be the least desirable solution, imo.

CaliMD, thanks for adding your informed 2 cents to the discussion.
I think it’s sad that a serious discussion of health care does not get nearly the traffic, measured by the number of posts, that the discussions of Wanda Sykes or overpriced sneakers get (and yes, I confess to having contributed to both those threads).
While we are sharing personal circumstances that color our own perceptions of the health care situation, I will say that I am not impressed with the “other countries have better health care and coverage” arguments being advanced by jhw and others. JHW waxes rhapsodic that her international friends from around the world prefer the health care systems they find in Canada (with shout-outs for the UK and Finland as well). My own anecdotal evidence from a similarly wide circle of friends from around the world (mostly in academia, hardly a bastion of conservative, market-based economic thinkers) is that they much prefer the health care they receive here in america, so much so that they strive to bring family members here from China, Kenya, India, Honduras, Peru, and Japan (to name the cases I recall specifically) for treatment. Members of my extended family (relatives of in-laws) who are physicians in south america long for the sort of respect, pay, and decent working conditions they see doctors in america enjoy and insist that the medical profession in their countries does not attract the best and the brightest as it should.
Finally, jwh obviously knows a very different group of Canadians than do I. The Canadians I know are not, by and large, fans of their country’s health system and I have heard horror stories that are rivaled, usually, by those told by English colleagues. It is not comforting to hear the “I can top that” exchanges at a faculty gathering where folks from europe and canada compare health care follies.

Jake,
It’s pretty obvious that the American public is in dire need of accurate information about health care, or perhaps we should more accurately say, illness care. This needs to be a daily half hour series, not merely a 90 second once a week feature. If we allow health to become politicized the nation will suffer devastating financial and physical health that will make the Wall Street real estate shenanigans look mild.
Our current system is abysmal. If you think the US system is working you’re either very wealthy or in denial. To be sure, those who have the most get the best. The rest are plundered and the hindmost are forgotten.
I’m an inventor and entrepreneur currently bringing new health care technologies to the market initially for chronic illnesses, but when our clinical trials are complete we should also have remarkably improved oncology treatment capabilities.
The secret to today’s system is called a “reimbursement code.” This is a 5 digit number that assures the doctor she’ll be paid, assures the pharmacist he’ll be paid, and assures the “health denier” that they can skim 25% off the top.
We waste 25% of every health-related dollar in useless middlemen known as “health insurers” (sic) to cover their profits, their needless paperwork, and their layers of people designed to deny coverage. That’s about $750 billion this year.
By comparison, our cost of malpractice is about 1.5-2%, or about $35-50 billion this year. You hear an awful lot about this, and when you do you should recognize the politics behind it is to change the subject away from the health deniers.
Sit down with the “health insurers” (sic), turn off your camera and mic, and you may get them to admit that their primary job is to deny coverage, not provide it, otherwise they’ll not meet their profit target and hence, miss their compensation bonus. That’s what they reveal to me, and I’m on the inside at the Board of Director level negotiating for reimbursement code coverage. Don’t believe me? I finally saw “Sicko” 2 weeks ago and it was the same story – albeit couched in different language – I have been hearing from senior management and board members for years.
The deal the healthcare deniers put on the table was to forgo $2 trillion in revenue. What they didn’t tell you was that even with their generosity they will be keeping $6 trillion in markup and profits over the next 10 years.
CaliMD, I meet people like you all the time and truly appreciate dedicated doctors and nurses like you and your father. We are all so frustrated by the reimbursement problems that get in the way of helping people stay healthy and when necessary overcome illness. Doctors and nurses simply want to help people, not fill out CPT and ICD reimbursement forms. I’ve met pediatricians who gladly provide free service to children just so they don’t have to deal with insurance reimbursement nightmares.
DrJohn, you read as very, very bitter and burnt out. If you are still practicing may I politely request you get into a different line of work for your own health, as well as that of your patients.
Also, Dr John, many, many people have “pre-existing conditions” which result in denial of coverage. I know people denied coverage for years due to a misdiagnosis when they went to a college clinic. Or they have “insurance” that doesn’t fully cover them and their chronic condition.
125 million Americans have chronic diseases, most of which are manageable with simple medication and simple guidance from a nurse practitioner.
At this moment 1 out of 3 diabetics in the US is undiagnosed. Of those 15 million who are diagnosed, sales statistics this year suggest 20% can’t afford their insulin and test strips and are going without. That’s 3 million people in danger of severe problems. Rather than spend $10 a month on a group class on obesity nutrition, or $60 a month on test strips and insulin, we’ll spend $11,000 on emergency room and hospitalization for diabetic coma.
Perhaps some actuary will tell us it’s a good financial tradeoff, but for the price of 15 F-22 fighters perhaps 200,000 Americans will be hospitalized, and perhaps 5,000 will have a limb amputated.