Archive for September, 2009

September 30, 2009

Baucus Tells America: No Public Option, Horatio Alger is Role Model

Long live Horatio Alger, the Congress said yesterday.  The Senate Finance Committee, by its vote against a public option in health reform legislation,  told the American people  that  if you can’t be Horatio Alger–if you can’t suffer and persevere and make it on your own when it comes to health care– tough luck.  Senate Finance Committee Chairman Max Baucus lives too much on the frontier.  He  obviously still believes in the Horatio Alger myth–that is,  that America can be sustained by  rugged individuals who, like the boys glorified by the 19th century dime-store novelist  Horatio Alger,  can go from rags to riches on their own solely by hard work and clean living. 

Without a public option, Baucus is saying that if you get sick, don’t have a job, lost your job, can’t pay your bills, get insurance coverage, figure out the insurance system, there must be something  wrong with you.  You’re not living right. You didn’t follow the Alger rules. The government will not help you.

 Shame on Senator Max Baucus. Shame on the Finance Committee. Shame on President Obama for letting the Congress act on its own on health care.  Shame on  America for not protesting in favor of a public option.

 This is the 21st Century.  Horatio Alger is not the role model we should be admiring. Did Horatio get an inherited form of cancer? Did Horatio lose his job because thieves on Wall Street were “too big to fail?”  There are forces at work beyond the control of any one person.  No one can make it on his  own these days—and no one should be blamed for that.

Horatio Alger  can no more protect his health in the modern world than he can provide for his own defense with a musket in the corner of his room in the boarding house!

 The government should protect its people with a health care program just as Horatio Alger –in the end– was saved from poverty with the help of a wealthy benefactor.

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Posted in American culture, Health Reform, News, Policy | 1 Comment »

September 17, 2009

Insurers Celebrate Baucus Health Reform Proposal

Wake up America!  Now you can learn who controls the U.S. health care system. Read the provisions of the  new health reform proposal by Senator Max Baucus (D-Mont.) and you will understand why for months there has been a smear campaign against the U.S. government promoting the myth that the federal government will control access to and dictate  choice within the health care system. While America was diverted in a riotous way from a rational approach to health care reform, the insurers were busy making hay with Senator Baucus to ensure that they maintained their stranglehold on the health care sector, the American taxpayer–and, of course, the U.S. Congress.  

With the Baucus proposal, we can truly say that  the federal government does not control health care but the insurance industry does? When and how often you see a doctor–and whether or not you get the necessary lab tests you need–and even which provider you see—are all determined–and will continue to be determined– by the insurers. 

Yesterday, I heard about a patient who was on the verge of a heart attack.  He saw his cardiologist who determined he needed a nuclear stress test immediately.  Did I say immediately?  According to  a top cardiologist he did?  According to his insurer, he had to wait two weeks for the test. Was this the government intruding in health care?  No, way. 

The government is not in your doctor’s office–but the health insurers are.   And now they will be in every house in America–like roaches, they are taking over.  Break out the Combat.

 Insurers broke out the champagne last night, knowing they succeeded in getting Senator Baucus  to allow them to make a killing with provisions for  U.S.  families to pay 13% of their income for healthcare coverage or pay a fine. A family of four with annual income of $65,000 would be asked to spend $8,450 on health insurance premiums before receiving any federal subsidy.  

 Certainly, Senator Baucus has been receiving too much  money from health insurance lobbyists to be in touch with the reality of the average American who cannot pay out 13% of their income on health insurance premiums.  The insurers are already raising premiums to cushion any blow that would come from doing away with non-payment for preexisting conditions.  After all, who is there to stop–or regulate– them?  The government?  With leaders like Baucus, I doubt it.

Where’s the reform?  Where’s the coverage?  Where’s the safety net? Where are the promises of President Obama?  The rising stock prices tell us who is benefiting from reform.  Perhaps Wall Street is also telling us that we learned nothing from the scandals of last year.  If the profits are only benefiting some big companies, something is very wrong.  It is time for Senator Baucus to recuse himself from the debate given that the first reaction to his health reform bill was mild pandemonium on Wall Street.

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Posted in Health Reform, health economics, health insurance, president Obama | 3 Comments »

September 10, 2009

The Time for Games Has Passed, Says Obama on Health Reform

The President  brought new energy and enthusiasm  to Congress last night as he tried to reignite action on health care reform.  Overcoming my anger at a joint session of Congress during a  BIG GAME –a quarterfinal match at the U.S. Open with 1 of only 2 Americans left in the tournament — the speech showed the President taking a firmer stand on reform, attacking the false claims on reform options, and talking of “my plan.”

Obama exhorted Americans to believe in their power—and the power of government—to do good.  He called on Americans to address health care as a moral issue, emphasizing that social justice and the character of the nation are at stake.

That said, what did we learn?  The President said that if we do nothing to slow the costs of Medicare and Medicaid, they will eat up the entire budget.  On the other hand, Obama made of point of saying that if you’re enrolled in Medicare, Medicaid, or the VA, or have employer based health insurance, nothing will change. Does that mean that the government will not cut Medicare and Medicaid payments? 

 The President’s plan will provide more security and stability to those who have insurance, provide insurance to those who do not, and slow the growth of health care costs.  His plan is to “make insurance work better for you.”  Will the insurers just pay for less (especially since they will have to cover pre-existing conditions)? How much will insurers change their pricing with academic health centers?

For those individuals without insurance, they will be required to get insurance (like auto insurance, said the President). The interesting thing is that some states do not make motorists show proof of insurance on routine traffic stops. Insurance is required, but only in the event of an accident. While fines can run to $5000, most are in the $500 range and only a few states impound your car—or send you to jail.  How will the government enforce the mandate?

As for the new insurance exchanges to be established, “customers will have leverage with the insurers,” said the President, who added that he will hold insurers accountable. The President did not say how that would happen.  I hope you’re right, Mr. President, but it sounded a bit like Shangri-la.  

Most importantly, the President will end fraud and abuse in Medicare.  While a worthy goal, it raises concern for academic health centers. The government does little now to evaluate providers (many fraudulent) who apply for a Medicare provider ID and run off with millions of dollars in payments for services never rendered.  So where is there money to be found?  The government is able to collect money by establishing Recovery Audit Contractors and other vehicles to search for supposed billing errors by academic health centers.  Is this the “fraud” the President is talking about?  Will we see some RAC clones established or a new wave of billing regulations? 

The President said the details of the plan are yet to be worked out.  The coming days will show the true impact of the speech and whether we see any change in attitude or action on Capitol Hill.

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Posted in Health Reform, Policy, health insurance, president Obama | No Comments »

September 8, 2009

Baucus to Uninsured: Pay Up or Face Fines

According to reports about  Sen. Max Baucus’ latest plan for health reform, fines would be imposed on those individuals and families who do not buy health insurance–$950 for individuals and up to $3800 for families.  Senator Baucus, what kind of reform is this?   Talk about wasting resources.  How will the plan be monitored and enforced?  Maybe the U.S. Department of Homeland Security and the Transportation Security Administration can add insurance surveillance  to their duties.  As you are screened at airports, you have to show your insurance card.  Will Senator Baucus create the insurance police or just ask the OIG to create a new department?  Will neighbors be asked to report on neighbors and become insurance spies with some incentive program for reporting?  What happens  if you pay the fine and still don’t buy insurance?  Will you just pass GO and head directly to jail?

I can’t understand such a proposal.   Is Baucus worried about not throwing enough business to his backers–the insurance companies?  Reform should be so good that everyone wants “in.”   Something tells me that Baucus is not offering much if he has to fine the non-participants.   Sounds like our current system where people, mostly for financial reasons, do not buy insurance.   Today, many people say, “OK, I’ll pay the medical bills for my post-college age kid because health insurance premiums are either too high or don’t provide decent coverage.”

In Baucus’ plan, we see he penalizes the victim–adding insult to injury to those people who cannot afford insurance–even with a government subsidy, which will amount to peanuts.  So we make the non-insured pay a fine–and then what?   Do they still go the emergency room of an academic health center hospital to get care?  Will Senator Baucus pay for that?

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Posted in Health Reform, Policy, health economics, health insurance | No Comments »

September 3, 2009

Obama Trying to Salvage Match Point in U.S. Health Reform Open

What should have been a “love game,” with Obama easily cruising to victory in the U.S. Health Open, has now turned  into a grueling last set, last game battle, with the President having to save match point.  The President will address a joint session of Congress next Wednesday night to add specifics to his vision of health reform, according to media reports.   If conversations with White House health advisors are any indication, it is difficult to discern anything new in the messaging.  If the President tells the nation we need more primary care, health IT, and research to find out what treatments work and don’t work, America will not be enthused.

 America wants to know what systemic changes the President wants in a health reform bill. Will he stand for a strong public option?  Will he provide the roadmap and transition time for changing the current health insurance industry? Will he ensure that the health workforce is a priority and address workforce issues now—not later?  Will he go beyond primary care—and provide a new vision for how to deliver primary and specialty care to all segments of society or will he be satisfied with a 19th century view of the primary care doc going off alone to the rural regions of the country to solve the workforce crisis? 

Will the President explain to the nation that whatever happens in the delivery of services will ultimately affect  the nation’s research enterprise because of the unique  role that academic health centers play in the nation’s health system?  Will he explain how health reform must take account of how the clinical monies help to support the nation’s biomedical research through these institutions?  If the answers to these questions are what is meant  when the White House says  “specifics,” then America will listen.  If not,  the  President will be forced to make a quick exit from Center Court.

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Posted in Health Reform, News, Policy | 1 Comment »