Adult primary care providers (PCP’s-Family Doctors and Internists) are paid 55% of what reimbursement is typically for specialists Yet, specialists (cardiologists, radiologists, surgeons, etc.) increase the cost of care, increase the number of hospitalizations, and utilize pharmaceuticals in greater numbers, DECREASE lifespan and quality of life. PCP’s, on the other hand, INCREASE length of life, DECREASE mortality and decrease all the other parameters I just mentioned like hospitalizations, unnecessary X-ray studies, etc. PCP’s are by consequence not as profitable for pharmaceutical companies, radiology testing facilities, laboratories, medical device manufacturers, etc. because they use less of these modalities. In the Bush administration, there was no encouragement professionally and/or financially for the lowly PCP to do his/her work. As a result, fewer and fewer PCP’s remain as medical students shy away from the underpaid and poorly respected primary care roles in training institutions. Existing PCP’s are retiring early, changing professions and leaving a vacuum that is endangering communities- urban and rural alike. PCP’s that remain and struggling to survive financially are seeing fewer poor, seniors and middle class patients by dropping participation in Medicaid, Medicare and commercial insurances to become “concierge” or cash doctors- catering to the rich only.
Sadly, the Bush administration and the Republican Party were deaf to the changes needed to protect PCP’s and halt their extinction. Now, great news! It looks like Medicare will be raising reimbursement for PCP’s while it begins to trim reimbursement for overpaid radiology, surgery and other specialties starting in 2009. In addition, funds will be increasing the training and retention of PCP’s. This will have a dramatic ripple effect within all insurance programs nationally that use Medicare as their guidepost for establishing their rates. Starting this year and looking forward the Obama administration has set in motion a striking and much needed shift in health care- bringing the status and the pay of the PCP in line with what should be. Congratulations!
Archive for the 'Dr. Benjamin's blogs' Category
ATTORNEY GENERAL CUOMO ANNOUNCES HISTORIC NATIONWIDE HEALTH INSURANCE REFORM; ENDS PRACTICE OF MANIPULATING RATES TO OVERCHARGE PATIENTS BY HUNDREDS OF MILLIONS OF DOLLARS
Industry-Wide Reform of Reimbursement System Will End Conflicts of Interest and Create Fair Rates for Consumers Nationwide
NEW YORK, NY (January 13, 2009) – Attorney General Andrew M. Cuomo today announced historic reform of the nationwide health care reimbursement system that will end conflicts of interest and generate fair reimbursement rates for working families nationwide. Cuomo has reached an agreement with UnitedHealth Group Inc. (NYSE: UNH) (”United”), the nation’s second largest health insurer, after conducting an industry-wide investigation into a scheme to defraud consumers by manipulating reimbursement rates.
At the center of the scheme is Ingenix, Inc. (”Ingenix”), a wholly-owned subsidiary of United, which is the nation’s largest provider of health care billing information. Under the agreement with United, the database of billing information operated by Ingenix will close. United will pay $50 million to a qualified nonprofit organization that will establish a new, independent database to help determine fair out-of-network reimbursement rates for consumers throughout the United States.
“For the past ten years, American patients have suffered from unfair reimbursements for critical medical services due to a conflict-ridden system that has been owned, operated, and manipulated by the health insurance industry. This agreement marks the end of that flawed system,” said Attorney General Cuomo. “As working families throughout our nation struggle with the burden of health care costs, we will make sure that health insurers keep their promise to pay their fair share. The industry reforms that we announce today will bring crucial accuracy, transparency, and independence to a broken system. During these tough economic times, this agreement will keep hundreds of millions of dollars in the pockets of over one hundred million Americans.”
In February 2008, the Attorney General announced an industry-wide investigation into allegations that health insurers unfairly saddle consumers with too much of the cost of out-of-network health care. Seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors. In exchange, insurers often promise to cover up to eighty percent of the “usual and customary” rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill.
United and the largest health insurers in the country rely on the United-owned Ingenix database to determine their “usual and customary” rates. The Ingenix database uses the insurers’ billing information to calculate “usual and customary” rates for individual claims by assessing how much the same, or similar, medical services would typically cost, generally taking into account the type of service and geographical location. Under this system, insurers control reimbursement rates that are supposed to fairly reflect the market.
Attorney General Cuomo’s investigation concerned allegations that the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits. That means many consumers were forced to pay more than they should have. The investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state. The Attorney General found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward. The creation of a new database, independently maintained by a nonprofit organization, is designed to remove this conflict of interest.
Under Attorney General Cuomo’s agreement with United:
United will pay $50 million to establish a new, independent database run by a qualified nonprofit organization;
The nonprofit will own and operate the new database, and will be the sole arbiter and decision-maker with respect to all data contribution protocols and all other methodologies used in connection with the database;
The nonprofit will develop a website where, for the first time, consumers around the country can find out in advance how much they may be reimbursed for common out-of-network medical services in their area;
The nonprofit will make rate information from the database available to health insurers;
The nonprofit will use the new database to conduct academic research to help improve the health care system;
The nonprofit will be selected and announced at a future date.
In February 2008, Cuomo also announced that he had issued subpoenas to the nation’s largest health insurance companies that use the Ingenix database, including Aetna (NYSE: AET), CIGNA (NYSE: CI), and WellPoint/Empire BlueCross BlueShield (NYSE: WLP). The Attorney General’s industry-wide investigation is ongoing.
Cuomo continued, “Our agreement with United removes the conflicts of interest that have been inherent in the consumer reimbursement system. This has been an industry-wide problem, and it demands an industry-wide reform. We commend United for leading the industry on this issue, and we encourage other insurers to follow suit.”
Cuomo was joined by representatives from United and from leading medical and consumer organizations in making today’s announcement at the Saint Vincent Catholic Medical Center in Manhattan.
“We are committed to increasing the amount of useful information available in the health care marketplace so that people can make informed decisions, and this agreement is consistent with that approach and philosophy,” said Thomas L. Strickland, Executive Vice President and Chief Legal Officer of UnitedHealth Group. “We are pleased that a not-for-profit entity will play this important role for the marketplace.”
President of the American Medical Association (AMA), Nancy Nielsen, M.D., said, “Today, patients and physicians prevailed over health insurance giant UnitedHealth Group when New York Attorney General Cuomo stopped the insurer from using a rigged Ingenix database that increased insurer profits at the expense of patients and physicians. The AMA appreciates the leadership of Attorney General Cuomo in initiating his investigation into the Ingenix database, and fully supports the Attorney General’s actions to have a nonprofit entity create a new, reliable database that is fair to patients and physicians.”
President of the Medical Society of the State of New York (MSSNY) Michael H. Rosenberg, M.D., said, “We thank Attorney General Cuomo for taking decisive action to finally achieve one of the major goals of a lawsuit that the Medical Society of the State of New York initiated with two other medical societies over eight years ago. Because of the thorough research and diligent negotiation of Mr. Cuomo and his expert staff, patients and their physicians will no longer be subject to inadequate out-of-network payments determined by the flawed Ingenix database.”
Consumers Union Programs Director Chuck Bell said, “Consumers Union greatly appreciates the care that Attorney General Cuomo and his staff have taken in investigating these issues, and creating the careful architecture in this settlement. This is an extremely sensible, fair solution, which will be of great benefit for consumers nationwide. We appreciate the fact that United Healthcare has come to the table to resolve these issues in a comprehensive way, and we hope that other insurance companies will quickly get on board, and strongly support this excellent plan to improve transparency for out-of-network charges.” Consumers Union is the nonprofit publisher of Consumer Reports.
Today, Cuomo also issued a report on his investigation, “Health Care Report: The Consumer Reimbursement System is Code Blue.” The report highlights the conflicts of interest and other defects in the current system and calls for the reforms announced today. It can be accessed at http://www.oag.state.ny.us/bureaus/health_care/HIT/reimbursement_rates.html.
The agreement announced today is the result of an investigation by Deputy Chief of the Health Care Bureau James E. Dering, Senior Trial Counsel Kathryn E. Diaz, and Assistant Attorneys General Brant Campbell and Sandra Rodriguez, under the direction of Linda A. Lacewell, the head of the Attorney General’s Healthcare Industry Taskforce. The Attorney General expressed his appreciation to Steven E. Fineman, Esq., of Lieff Cabraser Heimann & Bernstein, LLP, for his pro bono services in this matter.
For more information, including consumer tips for out-of-network care, or to file a complaint, please visit http://www.oag.state.ny.us/bureaus/health_care/HIT/reimbursement_rates.html
Neither Congress nor the President (as demonstrated time and time again in the last few months), AIG (which WE own and yet they spit in our faces awarding millions to their employees and partying in England and in Arizona) nor managed care companies (who have their PRIMARY loyalty to their stock holders and employers) have any real ACCOUNTABILITY to you - the rank and file of America - the shareholders in AIG and the health care consumer.
All of these failed parties have good reason to forget about you. Congress and the President (except at times of election) are in bed with special interest groups that hold the cash. Why should AIG be concerned with you OR a pathetic Congress and Executive Branch? They can conduct business as usual and answer essentially to no one. Managed care companies continue to thrive by creating the appearance of efficiency when, in fact, they have failed- health care costs soar annually and the government run Medicare program (hardly a model of efficiency) is cheaper and more efficient! Yipes!
You are a complication, but not the real customer. Managed care administrators figure out how to squeeze YOU, the health care consumer, not with efficiencies, but with cost cutting in the wrong places (like shafting primary care doctors who could actually save money or nickel and diming docs on immunizations so that many lose money) and increasing deductibles and co-pays so that you will be less inclined (let alone in these economic times even able) to buy the life saving services that you and your family might need..
Is it any wonder then that you are treated so poorly as a managed care insured? Are you really surprised that your already disenfranchised doctor feels less accountable to you and more a shackled servant to the myriad of rules, paperwork and bureaucracy that managed care insurance companies have sewn into a noose and slipped around his/her neck?
They are all accountable to more powerful forces than just you alone - your life, family and soul. They answer to cash. And you??? You are a nuisance, a vehicle to facilitate greed and incompetence - not the master as you should be. You are to be herded through the health care system and managed care- totally ineffective to begin with- is using the cattle prod. This is why UNLESS health reform addresses the imbalance, it WILL fail America and fail you. Whether you are to the left or right, whether you believe in a national health care system or purely a private enterprise model, you must fight to gain control of your own body, your mind and your health. This could be THE epic struggle.
An estimated 38 percent of U.S. adults and 12 percent of children use some type of complementary and alternative medicine, a new U.S. government survey finds.
Complementary and alternative medicine (CAM) — is an umbrella term for a collection of wide-ranging medical and health care systems, practices and products that aren’t generally considered conventional medicine. It includes herbal supplements, homeopathy, herbal treatments, meditation (mind-body interventions), chiropractic treatment and acupuncture.
“If you are going to use CAM, you should always let your conventional [health care] provider know about it,” said survey co-author Richard L. Nahin, acting director of the U.S. National Center for Complementary and Alternative Medicine’s division of extramural research.
This is a great pie in the sky notion but the truth is that most conventional doctors are sooooo brainwashed by pharmaceutical companies and often arrogant professors at medical schools who may be on the payroll of the pharmaceutical and medical device companies that if you tell them, they either know nothing about CAM, care nothing about CAM or are so prejudiced against CAM that it is impossible for a patient to talk intelligently with these providers and actually get useful information and guidance about CAM.
There are a small but increasing number of physicians who are integrating conventional and CAM medical care. Seek them out because it shows that they care enough to implement whatever will help you and that they still have independent minds - not white washed by the “mainstream” that has bankrupted health care in this country.
The survey found that the most popular alternative techniques are deep breathing exercises, meditation, chiropractic or osteopathic manipulation, massage and yoga. However, the survey is absurdly flawed because functional foods (e.g. eggs that have omega-3 fatty acids in them), organic and preservative free cosmetics, cleansers and the like need to be included as part of CAM because people use this as health tools.
In addition, the study did not include those who use vitamins routinely. If it had, the percentage of Americans using CAM would be much greater and the list of popular CAM therapies and products would have been much larger.
In the study, adults use CAM most often to treat pain, including back pain, neck pain or problems, joint pain, arthritis, and other musculoskeletal conditions. I think that again the study missed an important area - disease prevention, looking better and maintaining an acceptable quality of life.
Below is a copy of an e-mail alert sent to my patients with hypertension. It might apply to you! Check with your doctor.
If you have hypertension (HTN, high blood pressure), diabetes (IDDM, NIDDM) or congestive heart failure (CHF) with or without coronary artery disease (atherosclerosis) and with or without elevated cholesterol or triglycerides - LISTEN UP!!!!!!!!!
After careful consideration, I am NO LONGER recommending ARBs (angiotensin- renin blockers), EXCEPT in certain instances and these must be considered on a case-by-case basis.
This class of drugs, while helpful for some and even though it lowers blood pressure, may NOT actually prevent one of the major complications of high blood pressure - cardiovascular disease (heart attacks) and in fact may INCREASE the risk of having a heart attack! Here are the most common brands of this class of pharmaceuticals - none of which are generic and all of which are quite costly even with the co-pays of most insurance coverage:
candesartan (ATACAND), eprosartan (TEVETAN), irbesartan (AVAPRO), telmisartan (MYCARDIS), valsartan (DIOVAN), and losartan (COZAAR)
PLEASE remember some of you now using these drugs may STILL need to remain on them because of renal (kidney) disease associated with diabetes, congestive heart failure therapy or adverse reactions like an intractable cough, headache and allergies associated with another class of drugs (ACE inhibitors) typically used instead of ARBs.
ACE inhibitors (angiotensin converting enzyme inhibitors) are an older class of prescription medication that have been used worldwide for close to 30 years. Most of the brands can be purchased as generics and some are available at Wal-Mart. Costco, Safeway and Fry’s pharmacies for $4 a month or $10 for a three month supply which is most often better than your insurance copay. They treat hypertension, slow progression of renal (kidney) failure in diabetics, are used in congestive heart failure (CHF) and are associated with a DECREASE in the occurrence of heart attacks and strokes. Here are the brands and their generic names in the U.S.:
benazepril (LOTENSIN), captopril (CAPOTEN), enalapril(VASOTEC), fosinopril (MONOPRIL), lisinopril (PRINIVIL, ZESTRIL), moexipril(UNIVASC), perindopril(ACEON), quinapril (ACCUPRIL), ramipril (ALTACE), trandolapril (MAVIK).
Because these drugs (ACE inhibitors) are now off patent protection and available as generics, drug companies have been pushing ARB’s (much more profitable) and combinations of ARB’s with other meds that are already generic- sporting new names so that your doctor and you think one is really different from another and worth the high price which they are not.
WHAT TO DO IF YOU ARE ON AN ARB? CALL MY OFFICE. MAKE AN APPOINTMENT. LET’S REVIEW YOUR NEEDS AND MAKE A CHANGE IN DRUGS IF APPROPRIATE. DO NOT FREAK OUT!!!!!!!!!!! I HAVE BEEN ON AN ARB FOR A DECADE. I AM STILL BREATHING, BUT, BECAUSE I AM AT RISK JUST AS YOU ARE, I AM CHANGING TO AN ACE INHIBITOR JUST AS YOU MAY.
DO NOT STOP YOUR ARB UNTIL WE HAVE SWITCHED YOU BECAUSE THIS COULD BE VERY DANGEROUS!!!
I am NOT about to enter into the philosophical/scientific/religious fray about whether there is or is not a God - no way! I know that research until present has not shown us clear evidence that there is a creator who gives order to the universe and summons chaos theory for more sophisticated phenomena of the universe. I believe in science. I believe that there are other dimensions and I sort of understand string theory, Heisenberg’s uncertainty theory and how light could be bent in space and time. I fantasize how we could one day travel through time and dimensions and I wonder if there is another me, say, some 300 meters from where I write this at this very moment.
But there is something about being a human that is very special - something IRRATIONAL and inexplicable about our very substance that is so admirable and marvelous and that is admittedly IRRATIONAL (even chaotic) behavior!
Just last week, a heroic Indian woman in the Chabad House under terrorist siege in Mumbai escaped with a two-year-old Jewish child, saving his life no doubt before he would have been executed, as were his parents. The act was at once impetuous, heroic and IRRATIONAL. Why did she risk her life to save the life of another? Because she is a human and we are a noble species! We fall helplessly in love, dance in the streets after last year’s Super Bowl win of the Giants, sing our hearts out in churches and talk awfully silly to babies who may not have a clue about what the heck we are saying. Yet, there is meaning in these acts - sometimes inexplicable. They help define who we are as humans - often IRRATIONAL- NO rhyme or reason - just human! So is it with me and God. I can’t swear there is a God, but I talk to him (her?) everyday. I pray at home. I pray with my patients. I pray with my children and sometimes in public places. When I am around those who pray I feel good inside - secure. I love prayer when accompanied by music, whether it’s a Baptist choir, a Jewish cantor chanting or the haunting drumming and prayers of Native Americans. I am not a fanatic! I can’t say that I am a terribly religious man. I just believe and I just pray.
This might be IRRATIONAL, but it works for me and apparently for others because it seems that those who pray and participate in some form of religion live nearly 20% longer than those who do neither - at least according to one study.
It appears that rational scientific thought allows little or no place for religion, prayer and belief in God. I do not reject science but what’s RATIONAL got to do with it? Thank God that I was born IRRATIONAL! God bless!
A Danish study links high levels of the blood fats called triglycerides with an increased risk of stroke. The 31-year study of almost 14,000 Danish men and women found a direct association between higher triglyceride levels and the risk of ischemic stroke, the most common kind that occurs when a clot blocks a brain blood vessel. Those with triglycerides above 443 milligrams per deciliter [of blood] have a three- to four-fold higher risk of ischemic stroke, compared to those with the lowest levels, less than 89 milligrams per deciliter. And the new study did not measure triglyceride levels in the usual way — after an eight- to 12-hour fast. Instead, blood readings were taken at any time, regardless of when the last meal had been eaten. These no-fasting readings are better for two reasons:
First, they are simpler for the patient, and second, they are better at defining people at higher risk of stroke and myocardial infarction [heart attack].
There are some that require extensive therapy – even a blood exchange-like technique to lower triglycerides. However, the majority of people will respond well to fish oil and dietary changes - cheaper and safer than medication rife with side effects. I use fish oil myself. I still check fasting blood sugars (glucose) which combined with a hemoglobin A1C gives me a picture of the patient’s glucose metabolism (diabetes, metabolic syndrome), but I prefer non-fasting studies of serum triglycerides to give me an idea of actual risk.
If you are a listener, then you know that I am frightened about the safety of you and your family with regard to ANY product that comes from The Peoples Republic of China- foods, teas, toys, jewelry, furniture, sports equipment, etc. The U.S. government for what I believe is political and economic reasons has downplayed the transcendence of this issue in our daily lives and has done essentially nothing to insure the safety of your family in this regard. No medical show (radio or TV) has truly divulged the extent of this danger but I will and I will not stop exposing the dangers and helping you avoid them.
1. What really is poisoned milk?
It is the milk powder mixed with ‘MELAMINE’
What is melamine used for? It is an industrial chemical used in the production of melawares. It is also used in home decoration. ‘US resistant board’ melamine is used in industrial production & it cannot be eaten.
2. Why is melamine added in milk powder?
The most important nutrient in milk is protein. And melamine has a comparable protein that contains ‘NITROGEN’. Adding melamine to milk is cheaper and more profitable. It doesn’t have any smell, so cannot be detected and it looks like milk and can pass simple screening tests for milk.
3. When was it discovered as a contaminant?
In 2007, US cats and dogs died suddenly, they found that pet food from China contained melamine. Starting 2008, in China, an unusual increase in infant cases of kidney stones was noted. In August 2008, China Sanlu Milk Powder was tested for Melamine and found to contain it and at very high levels. Chinese children started being admitted to hospitals with kidney disease. In Sept. 2008, the New Zealand government asked China to check this problem as Chinese products that were contaminated appeared in that country. On Sept. 21, 2008, lots of food products in Taiwan - imported from the Peoples Republic of China tested positive for melamine.
4. What happens when melamine is digested?
Melamine remains inside the kidney where it forms stones. Typically, there is excruciating pain, there may be obstruction of the ureters with subsequent inability to urinate and what is termed hydronephrosis of the kidneys (swelling) and ultimately kidney failure. This can lead to dialysis for the rest of the individual’s life! This occurred to babies in China. There are currently a reported 13,000 babies hospitalized with various stages of kidney disease in China. Who knows how many are really affected and how many have died because there is no real unbiased and uncensored information from either the Chinese press OR about Chinese health agencies.
5. What are the foods to be avoided?
Foods that contain dairy products should be avoided. Remember: foods with creamer or milk should be avoided.
6. Which companies are affected?
Anything that says it is from China must be avoided. Your retail outlet has NO idea of what is safe and what is not! Next, products that you take for granted everyday and that may not say that they have milk products from China: Starbucks ,Coffee Mate, Nestle, Maxwell House, Unilever, Pizza Hut, Dove Bars, Snickers- to name but a few products..The extent of the possible danger is far greater than we have been led to believe and it is a sign of the continuing safety issue that we face from the Chinese (lead, mercury, dangerous construction of consumer products, botanical supplement contamination, etc.)
7. What do we do next?
If you eat in snack bar, restaurant or coffee shops (and who doesn’t?), stop buying foods if they use CHINESE goods. Make them nervous! CONSTANTLY ask them. Do not be afraid to be repetitious or feel that you are being obnoxious, this is your life and the lives of your families. Put the store owners on notice that you will hold them responsible if anything happens to your family as a result of contaminated goods from China (or elsewhere for that matter). Call and write your Congressmen, Senators as well as Arizona state officials with letters of concern.Most are afraid to”upset the apple cart” what with China being our major creditor.Tell your school district that they MUST screen food products for your kids. Buy milk and milk products made right here in Arizona. This is safer and helps opur economy. Times are tough and we should not pay for products with our hard earned money that is contaminated.
BUY AMERICAN WHENEVER AND WHEREEVER YOU CAN!
You can you differentiate which products are made in the USA, Philippines, Taiwan or China. Let me tell you how… The first 3 digits of the bar code is the country code wherein the product was manufactured.
ALL barcodes that start with 690.691.692 until 695 are all MADE IN CHINA.
471 is Made in Taiwan. Nowadays, Chinese businessmen and those who do business with China (EVERYONE - WHAT HAS HAPPENED TO US?) know that consumers are more concerned about products ‘Made In China’, so they carefully avoid displaying where their products are produced! However, you may now refer to the barcode, remember if the first 3 digits are 690-695 then it is Made in China.
00 ~ 13 USA & CANADA
30 ~ 37 FRANCE
40 ~ 44 GERMANY
49 ~ JAPAN
50 ~ UK
57 ~ DENMARK
64 ~ FINLAND
76 ~ SWITZERLAND AND LICHTENSTEIN
628 ~ SAUDI ARABIA
629 ~ UNITED ARAB EMIGRATES
740 ~ 745 – CENTRAL AMERICA
480 - PHILLIPINES
There are six great pleasures that I must have a “fix” of just about every day: my phenomenal family and friends, great patients, incomparable shows and hosts on KTAR-FM, a small piece or two of dark (70% cacao or more) chocolate, laughter and music before retiring each night. They contribute to well-being and optimal health.
Throw on a little Handel, Bach, Beatles or even Beyoncé, and then sit back and relax in the knowledge that your blood vessels are expanding wide open, letting the blood flow freely. Add a few pieces of dark chocolate and in just 30 minutes blood vessels dilate even more in your heart and even neck-feeding your brain. The rhythm and rate of your heartbeat will often synchronize with the cadence of the music you select. Nothing could be healthier for your mind and body.
This is not just my opinion, medical data worldwide is supporting the notion that laughter (the hosts and team on KTAR and KTAR.com make me think AND laugh), social gatherings with family and friends, listening to relaxing music and enjoying a bit of dark chocolate may provide cardio-protection and immune system support while improving blood flow throughout the body.
This holiday season, with all the economic pressures that now affect all of us every day, these tips provide powerful but very inexpensive tools that can take the edge off the stressors and possibly keep you out of the doctor’s office. What could possibly be the downside of listening to KTAR today and then snuggling with your significant other while enjoying Isaac Watts’ Joy To The World ? Doctor’s Order: A Little JOY in your life - DAILY!
We are facing some very tough times and health care will not be immune from changes dictated by economic necessity. Drastic macroeconomic revisions need to be made in our health care system soaring in cost (nearly 20 % of the GDP-gross domestic product so far) and coupled to a rapidly growing ageing population that will require increasing increments of care on the one hand and some *49 million uninsured and underinsured , in effect, without access to care.
*This number is going to increase dramatically as our economy continues into an even stormier economy while businesses fail- leaving employees with no medical coverage. The number underinsured will skyrocket as those companies that survive the financial crisis struggle with plummeting revenues and are saddled with rising benefit costs that they can no longer sustain. Insurance companies will (as they have been doing) engineer new plans that attempt (unsuccessfully may I add) to control unbridled medical costs. Managed care will show its ugly head again, deductibles and co pays will continue to increase and the percent of coverage as well as what is covered will decrease. All of this will add up to worse health care in the U.S.
How medicine will and should be financed aside, I am quite concerned about how effective any of the changes that might come down the road will be if we do not commit to more than a economic restructure of medicine (i.e. single payor, tax credit based, etc.), but a paradigm shift in how medicine is practiced in the U.S. I am not suggesting that we should throw out the baby with the bathwater. There are some things that are simply outstanding about U.S. medicine:
1. U.S. diagnostic technology (lab testing, radiology, etc.) is the world leader.
2. U.S. trained specialists and primary care providers are beyond reproach, and,
3. U.S. medical standards and health facilities are the best in the world.
However:
1. U.S. medicine is the most expensive in the world (even when adjusted for currencies). Yet, we have some of the worst health care statistics- shamefully comparable to the health in a third world country.
2. In countries that spend a fraction on health care, you would live longer and arguably enjoy a much better quality of life.
3. We have been adversely affected by a legal system that encourages “defensive medicine” whereby physicians in order to avoid often frivolous lawsuits and awards that are excessively high for medical negligence; over utilize testing, specialty consultations and therapies. The resultant misuse of resources plus the outrageous cost of medical malpractice for health care providers as a consequence has contributed to elevated medical care costs.
4. Pharmaceutical, medical device and diagnostic testing equipment companies have unduly influenced medical training, research institutions, faculty members and their students creating a cadre of professionals virtually brainwashed in the over use of unproven and unnecessary technology that itself is one of the key causes of morbidity and mortality and escalating health care costs in the U.S.
5. These same, powerful companies have successfully driven a disinformation and marketing campaign that has reached almost every segment of our society- selling Americans on often unneeded tests, medications, tests, etc.
6. The major source of drug addiction in the U.S. is not from Latin American “cartels” but, in fact, from prescriptions written by doctors.
7. Resource allocation in preventive services is relatively limited because treatments and testing is much more profitable (if not as practical and cost effective as prevention).
8. Very little has been done to address clear environmental dangers that impact directly on the health of American families and their children.
9. Regulatory agencies such as the FDA (Food and Drug Administration) and the EPA (Environmental Protection Agency) have dangerously conflicted relations with the very industries that they are charged to oversee- receiving funds from private industry, often exchanging employees and allowing industry and lobbying representatives to write and/or influence public policy.
10. Federal government officials enjoy excellent health insurance, available to them for life- even if they are no longer a government employee so they are immune to issues of affordable health insurance and insurability- problems for most Americans.
11. Specialists spend most of the dollars in health care on testing, treatments, procedures and drugs and yet the more specialists in a community, the HIGHER the mortality because more technology bears NO relationship to better health. Yet, specialists are the heroes of medicine- paid the most and the most influential politically within the medical profession.
12. Specialists, as a rule, earn much more than primary care providers (family physicians, general internists, pediatricians) and yet communities that enjoy a greater number of primary care doctors have LESS mortality and less expensive care. Modern medicine in the U.S. does not reward cognition (thought and reasoning) as much as it prizes procedures, testing and medications. Why? Thinking might cause health care to be more rational, more cost effective and therefore- LESS PROFITABLE!!! Primary care doctors who think utilize fewer resources and contribute positively to the length of life as well as its quality. (There are few who perceive of medical care today as contributing substantively to quality of life. There are few who see their physicians as even interested in the quality of their lives.)
The answer clearly requires creative and clever financing that can drive a paradigm change that favors optimal health for Americans first- not maximizing profits for health care related industries as the first priority. But, much more is needed when we talk of real change:
1. First, income of specialists should be substantially reduced while the incomes of primary care providers should be proportionately increased so that more young physicians will be encouraged to enter primary care careers which support cognition, caring and commitment to patient care. This would allow primary care providers to afford to spend time with patients, listen to patient needs and devote more efforts to empowering patients and decreasing their dependence on drugs and tests.
2. Immediately, all physicians and their staffs should be freed from the overwhelming burden of having to fill out different forms for different insurance companies on a daily basis. The amount of paperwork is overwhelming and absurd- adding to practice overhead which is passed on to the health care consumer and taking precious time away from patient care.
3. All administrative physicians working in federal, state and private for and not for profit companies such as insurance companies should be required to return to the practice of medicine full time in their specialty periodically so that :
a. They help out with a national physician shortage and
b. They become more sensitive to the actual needs of patients and health care providers. (Perhaps managed care medical directors would not be as insensitive were they reminded periodically of their responsibilities in actual patient care.)
This is entirely justifiable and not a form of forced servitude (Docs can and should be paid for their services) because all physicians have willfully been trained in programs funded by federal and state dollars (all public funds). Their personal loans that in some cases paid for part of their medical school education covered only a fraction of the actual cost of their education. In essence they owe the taxpayer! Both their employers and the communities they serve as part of their rotation should reimburse them while engaged in clinical care.
4. All members of the federal and state governments should NOT be guaranteed health insurance that is any different that that available to the American public while employed or after employment. A Congressman, for example, should be no more privileged with regard to health care benefits than anyone else. This would light a fire under bureaucrats to truly address our health care crisis since then they and their families might actually be affected by coverage issues.
5. The FDA should not be able to accept any funding from the very same private industry that it regulates and its employees should be required to have longer periods of time once they leave government employment to work within the pharmaceutical and medical device industry or related political action groups designed to lobby in behalf of these industries.
6. EPA operations should be restructured so that it is a regulatory agency governed by science and much better insulated from politicians and lobbying groups such as the chemical industry.
7. Americans should have a choice with regard to the kinds of practitioners they choose and the kinds of medical care they seek. Funding whether single payor or private insurance based should not discriminate against some forms of complementary and alternative medicine (CAM) and qualified medical doctors(M.D.), osteopaths (D.O), naturopaths (N.D.), chiropractors (D.C) and licensed acupuncturists (L.Ac.) as bona fide providers giving reimbursable care. Although called “unproven medicine” many CAM therapies (such as acupuncture, nutritional medicine, etc.) can be supported by a credible body of literature and have never been demonstrated to be anywhere near as harmful as conventional medicine ( Remember Vioxx?) and yet enjoys more outpatient visits annually and more out of pocket patient expenditures. The American public has expressed its desire for more CAM, but, conventional medicine politics has kept it in abeyance. This is not acceptable any longer. However, national and/or state standards credentialing alternative providers must be put in place and strictly enforced and the scope of practice of each class of provider should be clearly defined.
8. More safeguards should be placed on claims made by pharmaceutical and natural remedy producers and the quality of production should be improved by funding regulatory agencies to adequately enforce codes already on the books.
9. The U.S. Department of Agriculture (USDA) in collaboration with the FDA, EPA and U.S. Customs should be adequately funded, better organized and better insulated from the politics of beef growers or dairyman (for example) so that our food supply can be better protected and that children and pregnant women are not subject to the dangers becoming increasingly prevalent in domestic, but especially imported foods.
10. Much better collaboration between agencies is required to especially monitor products arriving from countries such as China, Mexico, India, etc. which have consistently and adversely affected the health of Americans (e.g lead laden toys, melamine contaminated candies, lollipops with lead, unsanitary and mislabeled pharmaceuticals such as heparin etc.)
11. A national commission should be convened to explore the extraordinary implications for our nation of what many believe to be the excessive use of behavioral pharmaceuticals- which I believe has established a level of drug dependence (anti anxiety, sleeping and anti depressant pills that could affect national productivity, political and military decisions. Recently, it has come to our attention that many of the national leaders who have promoted these drugs have received large financial rewards from the very companies that produce the drugs and yet have not disclosed their conflicts of interest to the public or other health care professionals. This, at the very least, makes one wonder about the credibility of their research which has influenced physicians and nurse practitioners across the nation. In the military alone it has been suggested that nearly 20% of our armed forces engaged in active duty in Iraq and Afghanistan are using such drugs. College students seeking help at student health centers are routinely prescribed these drugs because of convenience and the decreased intensity of resources required when compared to group and/or psychotherapy. The effectiveness of these drugs when compared to placebo, exercise, dietary changes, some nutritional supplements, psychotherapy and group intervention is questionable at best. Health insurers have found it expedient to pay for drugs rather than psychotherapy which is more costly. Yet, both in the U.S. and around the world warnings related to increase suicide risk with these drugs and possibly an increased rate of cancers with prescribed methamphetamines, for example, has been described. We need objective clarification- free of pharmaceutical company interests before an entire generation end up using possibly unproven mind altering drugs without a clear long term track record.
12. The cost of drugs must be addressed. Americans should be allowed to purchase prescription and over the counter drugs from other countries- especially Canada where the quality of production is as good (if not better than) ours. Vehicles must be established to allow for inspection of pharmaceutical manufacturing facilities in other countries so that we can open up yet further the doors of free trade and competition for these products. The notion that by so doing we will discourage R&D (research and development) for new drugs is ludicrous. Most research supported by drug companies is to replicate the product of another company already under patent and so to compete they must develop a similar family of product but different enough so that there will be no patent infringement. This is called a “me too” drug research program and does not necessarily add incrementally more to public health- just to drug expense. Yet other research is to find another use for an already existing drug so that it will have new indications. This allows the pharmaceutical company to milk more money from an already existent product. Since the majority of new drugs annually approved by the FDA fall into these categories, one could hardly argue that the exorbitant cost that we pay for drugs as a result of this research is justifiable. Truly new drug development that can benefit society will not be inhibited by competition.
13. The ethics of advertising of pharmaceutical and natural product manufacturers as well as corresponding service providers needs to be explored. National and regional standards should be developed to protect the consumer and they should be enforced. The public needs to be protected against false claims and misrepresentations in advertising. The health care consumer needs more, objective and understandable information in order to make wise choices that effects the health of themselves and their families and more often than not this is just not the case right now. Consumers need to know a lot more about risk/benefit, cost and side effects.
14. State professional licensing agencies should become more insulated from local and regional political influences and the undue influence of attorneys representing professionals who slow down the process of protecting the public. Alternative and conventional medicine licensing boards should be streamlined, possibly merged and at the very least have close coordination to ensure public safety. Continuing education requirements must become more stringent and the number of hours increased. More public funds should be made available for this purpose.
15. Hospitals need to be better regulated. Regional planning must once again be instituted to avoid replication of expensive services such as heart surgery, gamma knives, etc. Hospitals should receive financial incentives for providing services that are needed in their communities – rather than choosing clinical services needed by their doctors to increase income which leads to duplication. In other words every cardiologist (heart doctor) in Phoenix might want to do heart catheterizations in the hospital- rather than travel to a regional center of excellence. The hospital wants to fill its beds and keep the doctor (who admits patients) happy and increase revenues and so a new catheterization center is born. In fact, it would be more cost effective and efficient to have but a few centers of excellence regionally for heart caths. They become more efficient and have better quality because of well trained teams, handling higher volumes of patients and practice does make perfect generally speaking.
16. Doctors and hospitals should be subject to competitive government and consumer scrutiny. Healthgrades.com is a good first attempt at ranking doctors and hospitals by both consumers and in this case CMS (Medicare) rankings of hospitals for certain procedures and diseases. This concept of transparency needs to be enlarged and made more available to the public.
Money and effort expended in the “right” directions can contribute to the kind of changes in health care that we all seek. Just changing how we finance health care alone will not achieve our goals. The upcoming months after the elections (whomever is elected and whatever their political philosophy) will bring health care yet further in our sights. You should be thinking about health care because it affects you and your family and just getting “covered” is simply not enough!
Latest Comments