Saturday, October 4, 2008

Link NCFE to Financial and Healthcare FRAUD!

All you have to do is go to the trial currently in Colimbus Ohio, NCFE>
You can verify the link between the financial and healtcare industries.

No doubt one of the leading issues in this election is the question of health care coverage. For working Americans apart from losing their job there is no greater fear than inability to pay for their health care costs. Each year the number of working Americans who are uninsured gets closer to 50% and even for those that have some form of coverage it is often inadequate to their needs. The Democratic and Republican Plans are significantly different in their ways to address this issue. Which is better prescription for America?

First lets clarify what are the current problems?

Note enough people are currently covered by any plan.Any solution has to significantly include basically the whole of the population. We can longer have a system of “charity’ that assumes that providers and hospitals will donate to the needy. This system assumes the old concept of ability of pay based upon an individuals income is still in place. By definition for it to work requires that those who can pay more will pay higher prices to subsidize the care of the uninsured or under insured. This has created a disaster in health care because it makes it impossible to know what are the real prices in health care. How did it ever occur that private payers, Medicare, and health insurance can pay very different fees to the same provider for the same service. Most of the people who have health insurance are over the age of forty. The system will always be under capitalized unless the vast majority of young workers begin paying into system which is the major problem with a program that leaves too many not participating. For this reason the concept that Hillary Clinton recommended of “pay or play” is a sound construct.

Coverage varies widely too much between plans. Consumers cannot compare pricing of insurance plans because there is no real standard for what the term ‘insurance’ means. The reality is that none of us can ever be correct about what predicting our future medical expenses will be. Opting for a ‘cheap’ high deductible plan even for a healthy 20 year old can be a nightmare if out of the blue he or she is suddenly involved in a major automobile accident or delivers a premature baby. To call something a legal medical insurance plan means that it has to cover major conditions reasonably well within the income of the individual covered. Who is going to oversee this to prevent another crisis similar to the subprime loan fiasco?

Making health insurance job based limits the consumers options for alternatives and creates problems when there is a change in the job status.
The current system of job based insurance began during World War II as a simple way to give the public coverage who mostly worked in large war related industries. It did not envision that a majority of Americans would be working for small business or that adults may change jobs seventeen times or more in a lifetime. Labor unions played a great role in advocating the need for health care of their workers and often health care benefits become the key point of corporate-labor negotiations. But now it plays too much of role in the fight of whether labor should be unionized or not. The American auto industry has been rendered severely non-competitive by high health care costs which would be lower if they were shared in a larger risk pool than just one company or industry. McCain is right in not making health insurance job based.

The economy is weak and there is limited funds for health care. Every year our society gets older and our medical technology gets more expensive. Although health care is a necessity for a civilized nation it is not an industry that really improves the overall production of wealth. We can only expend so much of our overall budget as a nation on health care. Expense or overpriced treatments that are not proven to be clearly of value cannot be afforded. We have to mandate more complete coverage for proven effective treatment of conditions which are life threatening and minimize or exclude coverage of unproven treatment of conditions which are unlikely to benefit from such treatment. While many people cannot get enough coverage for the treatment of cancer, billions of dollars are wasted every year in operations and treatment of chronic pain conditions that are likely of no real benefit. However, one cannot be an advocate for health care without understanding that the most important single factor in determing whether health care is affordable is the health of the economy.

There are conflicting reports from recognized “think-tanks” about which plan would be best.

To evaluate the candidates’ proposals, the Commonwealth Fund Commission identified “several key principles for moving the health system toward high performance. They include:provision of equitable and comprehensive insurance for all;provision of benefits that cover essential services with appropriate financial protection;premiums, deductibles, and out-of-pocket costs are affordable relative to family income;health risks are broadly pooled;the proposals should be simple to administer, with coverage that is automatic and continuous;dislocation should be kept to a minimum—people could choose to keep the coverage they have; and financing should be adequate, fair, and shared across stakeholders.” Measured against these broad principles,they continue, Obama’s proposal for mixed private–public group insurance with a shared responsibility for financing has” greater potential to move the health care system toward high performance than does McCain’s proposal to encourage individual market coverage through the use of tax incentives and deregulation. Compared with McCain’s approach, Obama’s approach could provide more people with affordable health insurance that covers essential services, achieve greater equity in access to care, realize efficiencies and cost savings in the provision of coverage and delivery of care, and redirect incentives to improve quality. In the absence of a requirement that everyone has affordable coverage, however, the proposal is likely to fall short of achieving universal coverage.”

Robert E. Moffit, Ph.D., is Director of the Center for Health Policy Studies at The Heritage Foundation says the Obama Plan is “Not the Right Prescription”. He states “Proponents of government competition in a “national health insurance exchange” claim that it would enhance personal choice and health plan competition. That is highly unlikely. Rather, such a system would impose federal control over virtually every aspect of private health insurance, rendering it virtually indistinguishable from government insurance except for its direct financing. Congress would become increasingly prescriptive over benefits, the adoption of medical technology and new medical procedures, the pricing of these items, and the mechanism that plans may or may not use to manage health care risks. In other words, hardly any aspect of private health plans’ business operations would be free from government regulation and control. That is not a prescription for health care choice or competition.”

In my opinion, there is good and bad in both the McCain and Obama plans. Unfortunately, neither plan really addresses the most important issue of determining how much money will be paid for what. The medical system as it is currently structured is filled with waste and maybe some fraud. The Wall Street financial crisis may be a mouse compared to the elephant of the health care industry. Many health care insurance CEOs are actually even better paid that Wall Street executives. These days the most expensive car in the “doctor’s parking lot” does not belong to the heart surgeon but usually the hospital administrator. Even if you believe that physicians are over paid, many studies have shown that given the number of years of training and hours worked they are not, there is no doubt that nurses are severely underpaid. Yet some of the fastest growing salaries in America are those of health care executives at every level which more often than not have nothing to do with performance. Physicians must be allowed to develop appropriate standards of what care should be covered in the same manner that has resulted in the Veteran’s Hospitals going from once being thought of as substandard to now being leaders in the care of chronic conditions such as diabetes.

At the same time I agree with Dr. Moffit that making the government a competitor against insurance companies will serve no purpose.The biggest obstacle to private health care is the fact that it is appropriately a right. Mandated services to the public such as fire departments, schools, and garbage disposal must be highly regulated and overseen if they provided privately. For these types of services there is a very real issue as to whether competition is necessary or functional. Health care by definition cannot really be a “profitable” venture because it does not produce wealth it is a social good. Fostering competition in the American health care community has resulted in too many hospitals being too close together with many redundant services. Does it make sense for every doctor’s office to have its own office equipment, waiting room, and billing staff which add significantly to their overheads. False notions about competition make it very difficult for doctors to deal with insurance companies because of anti- trust laws.These types of administrative costs add trillions to the overall cost of health care and tend to make hospitals general centers of overall care but limit the possibility of creating real regional center of expertise.

Finally as Sarah Palin said in the recent Vice-Presidential debate, there is the issue of personal responsibility. As a retired physician who has practiced not only in the United States but visited in other countries I have seen that Americans are unique in demanding often unnecessary services. Injured workers go to court to ask for thousands of dollars for massage treatments that no one really feels will be of any benefit. Many chronic conditions are treated with drugs and therapy treatments which are no more effective than placebos. Obesity, smoking, alcohol abuse, and reckless behavior are more than just a drop in the bucket of overall health expenditures. Americans have to think of themselves as being members of a large extended family with only one budget that needs to be used for the good of us all and not the gluttony of one.

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