Are U.S. Doctors ‘Free’ to Practice Medicine?

The title question might seem silly, even ludicrous. It is anything but.

In the United States today, a truck driver is free to choose which gear to use going up a hill and at what speed to go down the hill. Accountants and lawyers are free to accept or refuse specific jobs and how to do their work.

Clinical physicians are not similarly free to do their work as they see fit in the best interests of the patient before them

People who never went to medical school-insurance actuaries, state insurance commissioners, and federal regulators-dictate to physicians what they can do for their patients, and especially, what they cannot. Hospital lawyers require physicians to strictly follow federal guidelines as though Washington’s advisories were stone tablets handed down from Mount Sinai. The one person not free to practice best medicine on you is your personal doctor.

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Shoot HIPAA the Hippo

If you work in healthcare, the initials HIPAA make you gag. If you are not in healthcare, you are probably unaware of this 2000-pound hippopotamus that you are supporting.

HIPAA stands for Health Insurance Portability and Accountability Act (of 1998). In the early 1990s, there was extensive corporate downsizing, reductions in force (RIF) were common events, and people lost their insurance along with their jobs. The initiating stimulus for this legislation was to make insurance portable, hence the “P” in HIPAA: you could take your insurance with you when you left your job. Gradually, the transfer of medical information became the focus. In this time of the Patriot Act, confidentiality and security were (and remain) king. Eventually, the original problem of loss of medical insurance was “lost” and forgotten.

HIPAA now sets forth guidelines about protection of personal medical data. It hints at dire consequences if medical confidentiality is broached. HIPAA produces defensive behaviors by both individuals and institutions to avoid governmental wrath. Examples include the following.

• Shields in your dentist’s office prevent you from seeing the computer screen.

• Hospitals charts have no names on outside.

• Each year, millions of useless hours are spent doing HIPAA Compliance Training.

• I am prohibited from emailing medical information to a colleague.

• It is impossible to be in compliance both with HIPAA and the Patriot Act.

In a contest between sharing medical information, and (supposed) protection of medical confidentiality, the latter has won hands down. Every hospital lawyer and a host of regulations make it difficult-to-impossible to do something that should be free, easy and encouraged: communication between medical caregivers.

Read more click here: Fixing US Healthcare

Release Free Market for Affordable, Accessible Medical Care

There are several lessons we?have?learned from the CoViD-19 experience such as: the unreliability of predictive models; the danger of depending on foreign supply chains; over-reaction can be a deadly as under-reaction; and the need for better contingency planning.

There is one lesson we have not absorbed: to get timely, affordable care, Americans need the private sector, the free market, not government-controlled healthcare.

When the CoViD-19 crisis began, it was private companies not government agencies that quickly produced diagnostic tests, personal protective equipment, ventilators, and developed ideas for both curative medicines and vaccines.

The hallmark of a free market is freedom of both buyer and seller, who interact directly. A consumer, the buyer, is free to buy or refuse, what to buy, from whom, and for what price. The seller is free to sell what he thinks consumers will want, and sets the price of products or services in competition with other sellers.

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Federal bureaucracy is hazardous to your health

Federal healthcare regulations with their attendant bureaucracies are supposed to facilitate patients getting the medical care they need when they need it. Sadly, bureaucracy does the exact opposite: it reduces access to care and can lead to needless deaths.

Creating federal rules and regulations costs lots of money. The first round of instructions for the Affordable Care Act (ACA) required more than 2000 pages in the Federal Register, with more than 10,516,000 words eight times the number of words in the Bible. To implement and oversee federal mandates requires bureaucracy and bureaucrats. This too costs money, such as $1.7 trillion for the ACA.

Spending by Washington on its bureaucracy is first dollar spent. Spending on care comes a distant second. Administrative jobs in healthcare have exploded while physician numbers haven’t. 

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Seesaw Proves American Healthcare ‘Wisdom’ Wrong

Common wisdom teaches that those who have health insurance get the care they need when they need it, and that those who don’t have coverage, don’t get care. This false “wisdom” is used by progressives to push for government-controlled, single payer healthcare.

Evidence proves that this wisdom is not wise. In fact, it is 180 degrees wrong.

Texas has the highest uninsured rate in the U.S. at 17.1 percent and a Medicaid enrollment of 16 percent. New York state has the lowest uninsured rate, 5.4 percent, and Medicaid enrollment double of Texas, 32 percent.

Thus, Texas and New York are polar opposites with regard to health insurance. One-Texas- has the most uninsured and the fewest individuals with government supplied, no-charge health insurance. New York has the fewest uninsured and the most Medicaid enrollees.

How successful are New York and Texas in providing care?

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Funding the Unfunded, and Their Mandate

The Unfunded Mandate is a legal contradiction and humanitarian nightmare that is also antibusiness. It needs a permanent fix, not a modification, adjustment, reconciliation, and most definitely not Washington style “reform.”

What is the Unfunded Mandate?

In 1986, Congress passed EMTALA (Emergency Medical Transport and Active Labor Act), colloquially called the anti-dumping law. Its ostensible purpose was to prevent one hospital from “dumping” (transferring without medical justification) a critically ill patient or women in labor to another hospital because the patient has no money or insurance. Dumping would allow the first hospital to avoid paying the costs of very expensive care for which it will get no payment.

EMTALA created a new class of patients called the Unfunded Mandate. These patients receive very expensive care for which neither hospital nor providers will be paid. Of course they — institution and physicians — must still pay their own expenses, from nurses’ salaries to electric bills.

Very, very large sums of money are involved. Four years ago at my own medical center, the cost of uncompensated care for the “unfunded” was $233,000,000, which represented one quarter of the Hospital’s entire annual operating budget. Can you name any industry where federal law requires individual businesses to give away 25% of their goods and services, and stay in business while prohibited from raising prices?!

Hospitals are forced to do whatever they have to in order to keep their doors open: over-charge insured patients, $2 per aspirin, double billing, creative accounting, up-coding, cherry picking patients, etc. Many are illegal and yet are done every day. Further, hospitals aggressively go after insured patients who have unpaid bills — the underinsured.

Who are the “Unfunded”?

Most assume that “unfunded” is synonymous with uninsured. While unfunded certainly includes the 45-50 million Americans who have no health insurance, there are tens of millions more who are also unfunded or underfunded–the underinsured for whom insurance doesn’t protect.

Contrary to public belief, health insurance is not supposed to pay for care. It is intended to protect the families from financial disaster in the event of a very large medical bill, one they cannot afford to pay. The millions of Americans who signed up for ACA Bronze level insurance are part of the unfunded. They have a 40% co-pay which makes them under-insured in the event of any illness that requires hospitalization.

According to the Commonwealth Fund 2012 Biennial Health Insurance Survey, as many as 84 million Americans who are insured through their employers do not sufficient coverage to avoid bankruptcy in the event of major illness.

Do not forget our veterans. They wait forever to see a doctor because they are “unfunded.” VA hospitals have insufficient funds as well as inadequate systems and culture to provide care in a timely manner to those who need it now.

When you include all the groups above, “unfunded” refers to essentially every American.

Funding the Unfunded

Systems thinkers say the best way to “fix” a problem is to dissolve it: change the system so the problem ceases to exist. We can dissolve the unfunded mandate — by funding it.

Create Health Savings Accounts (HSAs) for all 320,000,000 Americans, whether citizen or not. Fund these HSAs out of tax dollars, and allow people to put in more if they wish without limit.

Allow the money to accumulate over time: no use-it-or-lose-it. HSA funds can only be used for medical expenses and health insurance. Mandate that every American purchase at least catastrophic health insurance that pays out when some upper limit of dollars expended is reached, for instance, a sizeable fraction of the total amount in the HSA.

There is ample precedent for such a mandate. First there is Medicare, which for decades has been taking out a certain amount each month for medical spending after age 65. Then there is the ACA penalty tax for not purchasing insurance. Other countries have similar mandates.

In Germany, the government takes money out each month from every citizen to pay for health insurance that the individual chooses. If the person is working, it comes out of payroll. If unemployed, it comes out of unemployment benefits. If retired, it comes out of pension distributions. By law, every German citizen must have insurance. Non-citizens are not included.

The Budget

Conservatives will instantly react: where is the money coming from? How will we fund it? That is actually the easy part. Consider how much money Medicaid, Medicare, and ACA subsidies expend through insurance intermediaries and don’t forget to include the cost of their massive bureaucracies.

Now imagine that we place $5000 per year in personal HSAs. With 320,000,000 Americans, that equals $1.6 trillion. According a newly released Deloitte study, in 2012 the U.S. spent $3.4 trillion on healthcare when our population was 313 million. Thus, two years ago, before the ACA was implemented, the U.S. spent $10,863 on every man, woman, child and baby in this country, more than double what a “Universal HSA” Plan would cost.

And, oh by the way, that $5000 would pay for health care not healthcare BARRC-bureaucracy, administration, rules, regulations, and compliance.

What about the poor?

In 2012, the U.S. spent $8290 for every Medicaid enrollee ($415 billion÷50 million people). Putting $5000 per person into HSAs to cover their insurance and medical costs would save $165,000,000,000 dollars a year.

While certainly there is a primary altruistic purpose to pay for medical care for the poor, there are also practical, fiscal advantages. A healthier populace is both less expensive and will generate more GDP, whether citizen or non-citizen. Further, there is the personal responsibility that comes with managing one’s own health care dollars.

What about illegal (“undocumented”) residents?

At present, illegal residents comprise a major portion of the cost of the unfunded mandate. They are not eligible for either Medicaid or ACA subsidies and typically are uninsured. Yet they need medical care and end up generating large uncompensated costs that force the hospital to “get creative,” or close their doors. The Census bureau reports that at least 59% of illegal residents pay taxes.

For ethical as well as practical reasons, the undocumented should get HSAs like citizens, and then they should pay for their own insurance and their own care just like everyone else. Those who might balk at paying $65 billion a year ($5000*15 million people), keep in mind you are paying more than that right now because of the Unfunded Mandate with illegals showing up in ERs.

In universal health care countries, the undocumented are generally excluded from the national mandate to provide care. Go ask two million Turkish guest worker, non-citizens in Germany where and if they can get medical care.

At present, the issue of mandated care without compensation for people who are in the U.S. illegally is unfair, unethical, inconsistent, and avoidably expensive. Let’s discuss it openly and decide what to do by consensus.

What about seniors?

Most seniors have paid in to the Medicare Trust for 40 years. They should be bought out, i.e., the amount they put in plus some nominal growth factor should be placed in individual HSAs. The cost of care for seniors would plummet, as Medicare would cease to be controller of our health care and return to its original model–a mandatory savings account for retirement. Medicare fraud would cease to exist as the individual carefully watches his or her own funds, and no one is billing the government.

Fully insured yet unfunded!

This is certainly the most worrisome group – those who have full coverage but cannot get the care they need.

Government has only one way to “cuts costs” – by medical rationing. Thus, ACA’s IPAB (Independent payment Advisory Board), tasked with cutting costs, will make certain high-dollar items like chemotherapy, kidney dialysis or heart surgery, unavailable to people over certain ages or possibly with genetic disorders. That will cut costs by denying care. Their catch phrase could be dead patients are cheap patients.

person’s insurance might be fully funded; the patient might even have a well-funded HSA; but if the care is not funded (authorized), then effectively, that patient is unfunded. He or she will not receive necessary, even life-saving, care. This is happening right now in Great Britain.

Conclusion

Funding the Unfunded Mandate with some Universal HSA Plan would dramatically reduce spending on healthcare and would be self-sustaining. Neither of those statements is true for our current healthcare system. Universal HSAs would eliminate a massive, inefficient, and wasteful federal (and State) healthcare bureaucracy. The Plan would restore economic (buying) power to the consumer and thus infuse free market forces into healthcare. There would be strong buyer incentives to economize as well as competition among sellers, neither of which exists at present.

I often use the phrase We The Patients to emphasize our commonality: we are all patients or we will be. Unfortunately, We The Patients are also We The Unfunded. We must fund ourselves.

Read More click here:- Fixing US Healthcare 

You can see Related blog on Tumblr: – Affordable Healthcare

Attending Doctor Should Decide Life or Death-No One Else!

Elected officials such as New York and Atlanta mayors as well as clinical physicians, viz., in Maryland and Colorado, are projecting there will be more patients who need life-saving CoViD-19 services than there are facilities–ICU beds and ventilators–available. Such an imbalance between the needs of critically ill patients and healthcare capabilities requires triage, deciding who gets care and who waits.

Who should do the triage? Who should make the life or death decision?

Triage of the sick or injured started on the battlefield probably during Napoleon’s 1799 siege of the ancient city of Acre in northern Israel. Many of his troops became ill from poor sanitation and inadequate food. The soldiers were separated or “triaged” into those fit to fight and those who were not.

So, We must protect the direct fiduciary connection between doctors and individual patients. There should be no other person or group making these Solomon-like life or death decisions. The only person who should triage you is the doctor on the scene.

Read More:COVID19

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CoViD-19 Cost/Benefit Analysis Concludes: Let My People Go

When the CoViD-19 (Corona Virus Disease, 2019) first broke out, there was little-to-no data. Without factual evidence, medical advisers had to depend on mathematical models such as the MRC Centre for Global Infectious Disease Analysis from the Imperial College in London. With an estimate of more than 2 million American deaths, a draconian response was instituted with a nearly-complete cessation of social and commercial interactions. Most people are now functioning under a lock-down, travel ban, and infringement on civil liberties analogous to martial law.

With five months data since the virus was identified in Wuhan, and with the entire globe focused on one subject only, there are now reams of data on CoViD-19, from its genome to its behavior and clinical consequences as well as daily reports of infected cases and deaths. With volumes of evidence now available, it is time to reconsider what we are doing. A cost/benefit analysis can help advise whether we should stay the course or change.

Costs

The most important cost is not quantifiable–lives lost because of our response to CoViD-19, not because of viral illness. The healthcare system is overwhelmed with CoViD-19 patients. People with other ailments have great difficulty getting care or even medical attention. How many will die because of delay in either diagnosis or treatment of a non-CoViD-19 condition? The number of needless deaths could easily exceed CoViD-19 related deaths.

In 2018, 48,344 Americans committed suicide at a time when the economy was booming and personal incomes were rising. At present, with great economic hardship due to government enforced unemployment and social isolation, people are depressed, and many more may take their own lives. That number alone could exceed the number of CoViD-19 deaths read more…

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Colorado Took Healthcare Out of Washington and Implemented Medicare-for-All “Lite.” Good Move or Bad?

Supreme Court Associate Justice Louis Brandeis famously urged the states to become “laboratories of democracy” (New State Ice Co. v. Liebmann, 1932) by testing new, alternative ideas of governance. Colorado is heeding his advice. With their Governor Jared Polis’ leadership, the 2019 Colorado Legislative Session passed a number of bills that increase state control of healthcare.

The purpose of Governor Polis’ reforms is clear from his Executive Order to establish the “Office of Saving People Money on Health Care.” Will his plan, called the Colorado Affordable Health Care Option or CAHCO, save money for consumers? Will it reduce state spending? What will be the effect on access to care?

CAHCO has financial controls similar to federal Medicare-for-All bill, H.R. 1384, and could be called Medicare-for-All “Lite.” HB 1174 puts caps on Emergency Room charges. HB 1216 places price controls on insulin and potentially other medications. SB 5 allows government to undercut American drug manufacturers by purchasing pharmaceuticals from Canada. HB 1168 creates a re-insurance fund to pay insurance companies when patients have very expensive claims. SB 238 increases payments to home health workers, assuming the state can squeeze money from Washington. And there is HB 1004.

Colorado’s HB 1004 creates a public insurance option and claims it will “compete in the market against private plans.” This public option produces an uneven playing field, pitting an insurance company backed by taxpayer dollars with commercial enterprises that must balance their budgets from premiums paid by rate-payers.

Read More: Fixing US Healthcare

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“And this, too, shall pass away…” Lessons from CoViD-19

In a Wisconsin speech before the 1860 presidential campaign, Abraham Lincoln quoted a Persian parable ending with, “And this, too, shall pass away.” His words apply to the CoViD-19 (Corona Virus Disease, 2019) outbreak.

At the moment, fear of contagion and death (blown out of proportion) dominate public consciousness. The news cycle is filled with constantly changing statistics, wild predictions, and the inevitable blame game.

Six months from now, with CoViD-19 in the rear-view mirror and more than 99.99 percent of Americans alive and well, there are lessons we can and should learn.

Various nations have addressed the CoViD-19 crisis in different ways medically, financially, even politically. There will be different outcomes from these diverse approaches. The world can learn useful lessons based on analyzed experience.

For instance, South Korea implemented very early, extensive testing and contact charting. Italy chose limited, targeted testing. More than 4800 people have died with CoViD-19 in Italy. South Korea has reported just more than 100 deaths. The two countries have comparable population numbers: 60 million in Italy and 51 million in South Korea.

Read More: Lessons From COVID19

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