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More E-mails From Docs Opposed To Obama/Pelosi/Reid Rationing

Thursday, May 7, 2009  |  posted by Hugh Hewitt

From Dr. O in Sacramento:

I can hardly believe there are that many doctors who want a single
payer system. IMO, the only doctors that would want this are either
lazy, or do not have what it takes to make it in private practice.

A national health care system WILL BE a nightmare and complete
disaster. It will be inefficient on a scale yet not even imaginable.
Americans will also be shocked at how poor, rationed, and delayed their care will be. There will be many people who will be permanently injured or allowed to die because the government will establish some bul**hit evidence based criteria on allowing certain treatments.[# More #]

I have personal experience. As a 10 year old boy living in
Czechoslovakia, my mother would have to bribe a doctor just to be seen and the care flat out sucked.

I would also like to mention the issue of physician quality and
quantity. I believe that my desire for truly helping my fellow man is
shared by the vast majority of my colleagues. That said, the suffering that you have to endure; physically, mentally, emotionally, and financially, to make it through the training process will be too much to endure and too much of a deterrent should they arbitrarily cut and determine our pay. So get ready for the lowest caliber of physicians, mainly foreign grads, and huge shortages of doctors, especially specialists.

I for one am ready to take my wife and 2 small children and relocate elsewhere, as my mother did in 1976 to escape the misery of socialism. To see it happen here is truly mind numbing. Consider me one specialist who will likely not stick around to participate in the forthcoming rationed misery-care.

I am a Board Certified Othropaedic Spine surgeon. I have a busy solo practice in the Sacramento area.

From Dr. E in Omaha Nebraska:

Our current standard of care is to use any treatment any treatment that is both safe and effective for the condition. The new proposed standard is to provide “cost-effective” care. This is nothing but a euphemism for rationing of care to favor those whose contributions to society are most highly valued by society. In a young executive, heart surgery may be economically justified, while the identical procedure cannot pass the test to benefit a senior retiree.

From Dr. G in Northeast Ohio:

First, let’s understand what is wrong with the current system. I believe that a key component to the “health care problem” is that physicians have given over too much control to insurance companies. This is obviously not a ground-breaking observation, everyone knows this, but let’s explore this a little further. Doctors sign lop-sided contracts with insurance companies for the “privilege” of joining their networks. Now the doctor’s training does not go to waste (or does it?), and s/he can now treat in-network patients in exchange for insurance hassle and underpayments. What a deal. Not only are we told what and how to treat, but then we have to deal with denials, downcoding, delays, bundling, preauthorizations, and referrals. We have to pay staff members $30 to chase down and collect $20, the so-called “negotiated fee” which is a misnomer, of course, as there is rarely any negotiation. There are even insurance contracts that are proud to boast that they pay 50% or 75% of the submitted charge. What are we forced to do in response? We raise our fees. Who gets punished? The uninsured, who do not benefit from “negotiated fees”. In essence, the uninsured are forced to pay for the losses incurred by (mis)managed care. The uninsured usually can’t afford to pay this difference, so the doctor must eat the loss. This is why doctors are fleeing primary care and practices are going bankrupt. It is not a viable business model.
So what is my idea? Abolish the concept of the “insurance network”. What does that mean? Let me explain…
The power of the dominant health insurance companies in a particular market lies in the existence of their networks. Doctors need patients, and patients need doctors. If insurance companies only provide adequate coverage when both parties are in the network, both parties become obligated to join. Doctors sign unfair contracts to join, and patients pay high premiums to join. Can a member (patient) see an out-of-network provider (doctor)? Sure, but benefits are substantially reduced. In addition, there is usually a SEPARATE out-of-network deductible that is usually TWICE that of the in-network deductible, so out-of-network benefits rarely kick in.
So how would this no-network thing work? A patient would continue to purchase insurance coverage from any commercial insurance company, but could see ANY licensed physician s/he wants. The physician could then choose, on a visit-by-visit basis, whether or not to “accept assignment” from the insurance company when submitting the claims. If the physician accepts assignment for the claim, then any insurance reimbursement is paid directly to the physician, the physician is bound to accept the insurer’s “standard fee” as payment in full for the service, and must also accept any denials, downcodes, bundling, etc., that the insurance company deems appropriate. All standard fee schedules and policies would need to be fully available on the insurance company’s website. (This would also necessitate that all doctors and practices be treated equally with regard to pay rates, which is not currently the case.) If the physician does not accept assignment for the claim, then the physician would collect the full charged fee from the patient at the time of service, and any insurance reimbursement would be paid to the patient. The actual insurance payment would be the same in both cases.
Example: Doctor’s charged fee for a visit is $100. Insurance “standard fee” is $80. Insurance pays at 80% of “standard fee”.
If physician accepts assignment, insurance pays physician $64 and patient pays physician $16, total reimbursement is $80.
If physician does not accept assignment, insurance pays patient $64 and patient pays physician $100 (net $36, or $20 more), total reimbursement is $100.
This relatively simple system has the power to significantly transform the healthcare landscape. What this system does, in effect, is force insurance companies to finally become accountable to both patients and doctors in classic free-market fashion. If a company pays quickly, fairly, and offers good customer service, doctors will routinely accept assignment and more patients will use that company. If not, the opposite will occur. The insurance companies would still be able to legitimately deny inappropriately submitted claims (abuse) without fear of backlash, as this situation would more than likely backfire for the doctor. If assignment was accepted, the claim was denied. If not, there would be angry patients to deal with.
Without the existence of networks there would be a level playing field for the smaller insurance companies to compete in the market, which would drive down the cost of premiums. To further reduce the number of uninsured there could emerge very low cost insurance plans with “standard fees” well below the average, but that pay very quickly and without hassle. There would certainly be numerous doctors that would accept a reduced fee in exchange for efficient payment and a large patient base.
With this system access to health care across the board would increase, as doctors would be able to afford to return to primary care and be doctors again. With reduced overhead from more efficient payment, combined with the ability to ensure more consistent and fair payment when necessary, the cost to DELIVER health care could actually decrease, so doctors would no longer be forced to “punish” the uninsured with higher fees. Imagine that.
That’s my idea. It’s not perfect, and it would need to be modified for hospital care and other services such as diagnostic testing, but I think it’s a good start. Ponder this: You’d think that insurance companies would lobby vehemently against this system, but given the looming threat of singer-payer, they might ironically offer their reluctant support.

E-mails from Docs Against The Obama/Pelosi/Reid Rationing Plan

Thursday, May 7, 2009  |  posted by Hugh Hewitt

Some e-mails from doctors clued into the fact that the Obama/Pelosi/Reid “reform” is just rationing dressed up in soothing rhetoric:

From Dr. M:

Hugh,

I am a pediatric neuroradiologist. I take care of children with severe neurological diseases, tumors, trauma, etc. I am an Associate Professor at the University of _________Medical School and practice at Children’s Medical Center in ______. I am also a researcher using state of the art MRI. I can tell you that if we go to a single pay system, it will destroy the kind of healthcare and research which has allowed us to lead the world.Currently we have the best subspecialists in the world and free access and referral for state of the art care. As an example, I was on staff at another children’s hospital in a large Midwestern city a couple of years ago and had a young boy with a large carotid artery aneurysm. We did not have the pediatric expertise in our city to treat him, but I have world class colleagues in another city who treat these things for a living, so I made some phone calls. The boy went to UT Southwestern Medical Center in Dallas, was treated and now faces a normal life. This kind of subspecialty referral care will end with rationing. This is unacceptable. Rationing would have forced that boy to “take the best available locally” or would not pay for the expensive interventional procedure which was life changing for this boy. Also, if they destroy medicine, what motivation will there be for the best and brightest to enter medicine.

From Dr. Leatherman:

Dear Mr. Hewitt,

I am a physician (M.D.) practicing geriatric psychiatry in Texas for the last 16 years. I am a member of the Association of American Physicians and Surgeons (aapsonline.org) and am so opposed to government intervention in medicine that, although all of my patients are Medicare recipients, I have “opted out” of Medicare which means that all of my patients must pay out-of-pocket to see me and I cannot bill Medicare for any services. I can work with individual patients so that they can afford my services, and I can treat some patients for free! Under Medicare I am not allowed to do that. I have been active in legislative work in Texas on behalf of psychiatrists and their patients for about the last 13 years. You can read some of my articles at www.txpsych.org.
You asked Senator Kyl why the AMA and other physician organizations had been silent on health care rationing. AAPS mentioned above has been very vocal about government-run medicine. The AMA sold physicians out long ago with their CPT coding and constant bartering with CMS (used to be HCFA) which runs Medicare. They have always betrayed physicians so that the organization could “keep a seat at the table” which to me means getting invited to Washington parties and keeping organizational power. If you look at membership of AMA, it has been steadily declining.
Medical schools are as liberal as their undergraduate counterparts. The medical schools depend on government funding to operate (and the cost of a medical education has risen as a result), research dollars are funded through the NIH (especially now that the “evil” drug companies have been curtailed in their research), and most patients who seek care at medical schools are Medicaid, CHIP, or Medicare recipients. For that reason, these students have never had to be small business owners. At best, they go into practice for huge physician groups that act as agents for the individual physicians, paying their salaries, and speaking for them. Because of all of the bureaucratic oversight, it is difficult to practice solo. Medicare regulations alone are more complex than the IRS, and CMS has more draconian enforcement authority.
I appreciate your work on this issue. I am so tired of having to explain to patients that “government health care” does not mean that they will get the same care they have now with “the government” footing the bill. It means that the government will decide what care you get and you will have no recourse. After all–you’re cheaper if you’re dead!
Sincerely,
Martha E. Leatherman, M.D

From Dr. P:

I am a 66 year old Pediatrician currently transitioning into
retirement. I echo the comments made by the Sr. VP for medical affairs. My junior associate who is taking over has already informed me that she will no longer go to the hospital – too much work, too great a risk, too little return for the effort, etc. The 200 bed hospital I attend at has 0NE Pediatrician left on staff my age who just had surgery and walks with a brace. A new Pediatrician hired by the hospital is one month from joining him but has yet to get her state license – ipso facto cannot see patients. There are three other Pediatricians in the community. None have staff privileges except for a half-timer. The hospital has about
700 births a year and a drawing area of 250,000. God help them.

The hospital has critical shortages of all primary care specialties, i.e. Family Practice, Internal Medicine, and Ob-Gyn. Why ? Two reasons. (1)The government artificially distorts the market. 75% of my patients are Medicaid in the first year of life. Who the hell would buy insurance when the government picks up the tab? Many need it, but a lot don’t. This is an industrial region, not a farming region, even if it looks rural. My parents work for large corporations. (2) Women doctors.75% of Pediatric residents and 52% of entering medical students are female. They won’t move to small towns and rural zones. They won’t work as many hours or as many years. It takes 3x as many women as 2 male doctors to do the work.

My practice is to remove identifying markers unless my e-mail correspondents specifically tell me they have no objection to being named. I’ll continue to popst as many doctor comments as possible, but the “Doctors for Obama” are clearly a vocal subset in advocating for single payer by any name.

So where’s the AMA?

E-mails from docs must contain a phone number where y staff can confirm youare who you say you are.

hugh@hughhewitt.com

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