Monday, April 20, 2009

When N.I.C.E. Became Hideous

Nice is synonymous with pleasant, good, kind and enjoyable. The British Health control system for which that acronym stands cannot be defined by any of those words; in fact just the opposite could be said. Hideous, on the other hand means repugnant, repugnant or dreadful.

The National Institute for Clinical Excellence (N.I.C.E) which is part of the UK's National Health Service (NHS), is merely one layer of a bureaucratic, government run collection of organizations that tells Great Briton’s doctors how to practice medicine and it is the kind of system which the Obama administration wants to use to tell you and your physician when, where and how your health issues are to be handled.

Not too long ago the N.I.C.E. released a consultation document regarding the treatment of people diagnosed with Alzheimer's disease in England, Wales and Northern Ireland. Although the document reverses some of its earlier negative recommendations to completely withdraw anti-dementia drugs from the National Health Service, it now proposes to limit treatment to the moderate stages of the disease and to exclude people with Alzheimer's disease in the mild and severe stages. If that dreaded disease is not “nipped in the bud” it will not be nipped at all.These proposals are based on cost-benefit reasons, not the acrimonious misnomer “Clinical Excellence.” True excellence in the practice of medicine is based upon the axiom, PRIMUM NON NOCERE, first do no harm, not “What is this going to cost.”

It was that same political organization, originally established in 1999, which recently decided to withhold a cancer chemotherapeutic agent from a relatively young man who had a malignancy of the kidney that had metastasized to his lungs. The patient/doctor unfriendly decisions made by N.I.C.E. The unfriendly decisions made by that government agency over the past ten years would fill a tome too voluminous to read were I to list them, but I do believe that the reader gets the point; we don’t want that type of system installed in the US.

Whether C.S Lewis was highly prescient, or it was by mere chance that he used the same acrostic in his 1945, science fiction novel entitled That Hideous Strength, the devastating effects of England’s N.I.C.E over the past decade and the tremendous power and gruesome effects of the National Institute of Coordinated Experiments in the Lewis work of fiction are too closely aligned to be comfortable. Some two years before writing his own Nineteen Eighty-Four, George Orwell reviewed That Hideous Strength for the Manchester Evening News, commenting: "Plenty of people in our age do entertain the monstrous dreams of power that Mr. Lewis attributes to his characters [the N.I.C.E. scientists], and we are within sight of the time when such dreams will be realizable"

Monday, April 6, 2009

Dear Doctor: You’re fired

I am not a big fan of Donald Trump’s TV show known as The Apprentice, nor have I actually sat listening to the business spoof all the way through, but because of the commercials which advertise the program I am familiar with the ominous words shouted out by the dramatic host Trump, “You’re fired.”
Recently our federal government, now under the leadership of the Obama administration, fired General Motors’ chairman and chief executive Rick Wagoner. As The Chicago Tribune put it that move was “part of a sweeping plan to reshape the American auto industry and extend additional money to GM and Chrysler to give them more time to restructure.” Part of the reshaping process will be an “auto czar.”
Another brainstorm of the Obama administration is a “sweeping plan to reshape the American” medical care delivery system, as they move to nationalize the country’s health care and set up the bureaucracy to micro-manage every step that your doctor takes in trying to improve on your state of physical and emotional well being.
We have already tasted the bitter pill of bureaucratic medicine over the past twenty-five years with insurance company managed care organizations known as the HMOs. As the years have passed our hospitalization premiums have had an insidious rise while the HMOs have siphoned off 25% of the dollars spent on healthcare to run their medical administrators’ multilayered system.
If and when Obama succeeds in a government takeover of healthcare in the country, there will eventually be a rude awakening when the bills begin to arrive at the Congressional Budget office. Just as the makers of Medicare underestimated the price of that program ($66 billion in 1990 vs. the estimate of $9 billion), so too they will have fallen short of the actual cost of socialized medicine. When they do realize the price, tax increases, rationing and limited access to care will ensue and sweeping regulations regarding how and when your physician manages your care will be put into law. If your primary care physician, a government employee, puts your welfare above those regulations he or she will receive a letter from a Washington, DC healthcare czar saying, “Dear doctor: You’re fired.”

Monday, March 30, 2009

What If We Had A Food Maintenance Organization (FMO)?

What if your employer reduced your monthly paycheck by the amount of dollars he or she sent to a FMO the way employers now perform regarding your family’s healthcare? Healthcare dollars sent to Health Maintenance Organizations by employers average $1000 per month. Just take the average dollars you now spend monthly for your family of four and do the math. Let’s just keep it simple and figure $2,000 per month to feed a family of four.

HMO’s siphon off 25% of the money they receive to pay their employees in the multiple layers of that bureaucratic organization. The FMO would do the same, leaving $1500 per month to purchase you groceries. However, the provider in this system (analogous to your primary care physician) is your local grocer. He has had to hire a crew of clerical workers to handle the paperwork generated by the FMO that need filled out for every purchase that every customer makes.

Another group of new employees work the telephones getting permission from the FMO to sell you the food you want to purchase; type and amount. If the FMO agrees they will reimburse the grocer 30 to 50% of the price he has set for the food you buy. The FMO keeps the difference to satisfy their stock holders by sending annual dividends and give bonuses to their top managers at the end of the year. Every three years they negotiate an increase in the dollars they receive from your employer for the purchase of your family’s food.

In order to keep afloat financially your grocer has had to raise his prices and buy inferior food products that are less expensive (I.e. generic canned foods in white labels with black block letters that spell CORN, BEANS, etc.). The meat you used to get was prime but he has had to settle for USDA inspected meats. Because he has had to procure cheap vegetables from Mexico that are grown in fields irrigated with less than pure water, your grocer has had to acquire liability insurance to cover the costs of being sued by sick customers who became ill when eating the tainted onions, tomatoes, etc; which recently caused the demise of a famous chain of Chichis Mexican Restaurants. Eventually the grocer takes an early retirement because and sells the store he can no longer afford to stay in business. You initially pay nothing for the food, but soon the FMO requires a co-pay so that they can keep even more of the money they received from your employer.

All the while the cost of purchasing food products rises (a fact noted by the federal government), FMOs grow richer and the country’s grocers poorer. Before long grocers all over the nation fall prey to the FMO fiasco and close up shop. Potential grocers are afraid to start new businesses. The federal government informs us that food prices are far too high. The administration declares a national food emergency and comes to the rescue by setting up national food banks in every major city; but not the small towns because of the cost. Though groceries are free, access to food is limited and soon rationing becomes necessary. Those in the senior age category will receive limited amounts because they have out lived their usefulness to society as a whole. When the cost of supplying free food to the nation exceeds the federal government’s ability to cover the cost, taxes will rise.

If you think this allegory is a pipe dream, just wait until Obama-Care becomes the law of the land and then put you doctor in the place of your friendly grocer; that is if you can find one, most having retired or switched professions out of frustration.

Friday, March 20, 2009

There’s an Elephant in the Room but the Donkey Doesn’t Care

Our Democrat controlled House and Senate are about to ram national health care down the throats of the citizens of the United States whether we want it or not. If enacted it will have been passed with no opportunity for public hearings or debate. The Obama administration has added it as a sort of “earmark” to the bundle of laws to be voted on by congress. The ears on that healthcare bill are bigger than those of either the donkey (Democrat) or the elephant (Republican) which were part of the recently passed $413 billion package recently signed into law by the president. The amount asked for is called a “down payment” on the actual total dollars needed to cover the healthcare costs of every US citizen and illegal alien.

They have grossly underestimated the price of this universal healthcare but it matters not to them, they will just send us the bill; in the form of increased taxation. When the Medicare legislation was enacted in 1965 it was estimated that the annual bill would rise to $9 billion by 1990. The actual cost that year was $66 billion. In 2007 the cost of Medicare was 3.2% of the GDP. The GDP that year was $14 trillion. 3.2% of that is $448 billion. Medicare recipients account for 15% of our population. To cover the other 85% of our citizens will run up the cost of healthcare to two and one quarter trillion dollars.

It is estimated that in the next 25 years healthcare costs will amount to 30% of the GDP or nearly $5 trillion if the national healthcare legislation passes; and don’t forget that the government’s figures were way out of line when estimating the increase in the cost of Medicare over 25 years. Government needs to get out of the business of healthcare and preserve and protect our nation’s sovereignty and the constitution that has held sway for over 200 years.

Call you congressman and senators and tell them to vote no on the bill containing healthcare or they will have to find a private sector job when the next election finds them out of Washington and paying taxes for their fool hearty legislative acts like the rest of us do.

Sunday, March 15, 2009

Why Did the Cost of Healthcare Become So Inflated? #3

Another one of the costs of operating HMOs that use up healthcare dollars is an entity known as a physician database; something that would have been considered strictly Orwellian in the years prior too 1965. The attorney general of the state of New York has managed to rid that state of one such system only to replace it with another; all at the expense of healthcare dollars.
United Health Group (UHG), the nation’s foremost health insurance company, recently settled a suit filed by the American Medical Association against that particular HMO for $350 million; money that could have been used to cover some of the uninsured in our country. The suit, pending since 2000, was based upon the HMO’s unscrupulous methods of reimbursement, whereby the organization grossly underpaid physicians for services. They refused to pay the nationally recognized standard of “usual and customary and reasonable” charges for medical care and also undercut the nationally acceptable reimbursement for patients who had obtained medical services outside of that HMO’s network. NY Attorney General Andrew Cuomo said that many insurers were underpaying their groups of client/consumer’s out of network medical expenses by 10 to 28 percent. Physicians, hospitals and ancillary service units (labs and X-ray), not in the HMOs select group (where their fees are fixed by the HMO), are called “out of network.”
UHG is now ordered to shut down its national physician database and pay $50 million per year to the state of New York in order to help defray the expense of starting a new physician database that will be used to determine reasonable reimbursements to out of network physicians, ancillary establishments and hospitals. Aetna, the nations 2nd largest HMO will contribute $20 million per year over the next five years. Those companies will undoubtedly pay for those expenses by reducing care or reimbursements to physicians and consumers.
If these HMOs were eliminated altogether the money spent by employers to buy health coverage for their employees from these big time bureaucracies, only 75% of which actually goes into paying for healthcare, the removal of those multiple, expensive bureaucratic layers would go a long way to give our nation’s employed better coverage at a lower cost.
Attorney General Cuomo called the collective insurance industry’s Health Management Organizations a “conflict ridden system that has been owned, operated and manipulated by the health insurance industry.“ That multifaceted combined insurance industry (which includes auto, home, fire and theft, life, malpractice, liability, etc) is the largest industry in the world. Can we expect less unprincipled activities if our healthcare is taken over by a group of medically ignorant politicians in Washington?

Monday, March 9, 2009

Why Did the Cost of healthcare Become So Inflated? #2

When the government Medicare managers noted that the cost of healthcare was rising far above the levels they had originally projected (as pointed out in the previous article) they again erred in their diagnosis by blaming physicians, not the free access model they had invented: Thus they set about to curb those rises by bringing Health Maintenance Organizations-HMOs into play. The Nixon administration had looked at the Kaiser-Permanente model and noted efficiency, favorable patient outcomes and cost savings. What they failed to perceive however, was the fact that the administrators were following the sage advice of their physicians; a bottom up approach, rather than a top down method where a lot of administrators who knew nothing about the practice of medicine were calling the shots; the model currently followed by all HMOs today.
As a result the present, Nixonian, multilayer of bureaucratic control provided by insurance companies began to tell us doctors how and when to treat our patients and to selectively assign physicians to their panel of providers who kept the rules established by the HMO and who willingly acquiesced to their reduced reimbursements. Those organizations began to practice medicine by telling physicians when and if they could admit patients and when they should be discharged. They were allegedly doing that to lower the cost of healthcare while at the same time they were paying their CEOs huge salaries. I.e. the CEO of United Healthcare was drawing an annual salary of $250 million while continually reducing physician reimbursement and curtailing patient access to proper care. It is little wonder that 25% of every dollar paid to an HMO by a private citizen or his/her employer for health coverage goes into paying the HMOs exorbitant administrative costs.

If the CEO is paid such an excessive salary, it stands to reason that the middle managers must also be grossly over indulged financially. The bureaucratic layers beneath those middle managers are also running up the cost of managed care. Those strata include one for secretarial staff hired who handle the tons of paper work generated by the HMO and returned by physicians, one tier to hold the call screeners who receive physician’s calls asking permission to treat their patients and another level that includes nurses who screen calls for permission to perform diagnostic studies or admit one of the HMOs clients to a hospital if the first layer of non-professionals (clerical workers) cannot handle the physician’s appeal. Finally there is that layer of nurses who visit physicians offices, checking patient files for what they deem as errors in judgment, ordering what in the nurses’ minds are unnecessary diagnostics, noting patient outcomes and criticizing physicians who have failed to initial lab and X-ray reports, even if the file clearly shows that the abnormalities in those reports were addressed in further studies or treatments regardless of the lack of initialing.

Ever since the inception of HMOs, the premiums for healthcare have risen insidiously and predictably, while the reimbursement to physicians, ancillary lab and X-ray facilities and hospitals has steadily declined. It is no secret that the difference between what is paid to those treating the populace and those who manage those who perform the treatments, is a remarkable improvement in the bottom line of the HMOs. Eliminate the HMOs and the cost of medical care will drop like a rock in a vacuum.

Monday, March 2, 2009

Why Did The Cost of Healthcare Become So Inflated? #1

In the years prior to 1965, senior citizens that had lived through the Great Depression were very frugal concerning the matter in which they spent hard earned dollars; one of those frugalities involved healthcare. I know that very well because I was raised by parents who lived on a very tight budget. Those persons who reached the age of 65 in 1965 had put off seeing a physician for a whole variety of reasons which they had previously deemed trivial and which they had chosen to self manage. They considered the cost/benefit ratio of seeing the local neighborhood general practice physician and chose to retain their cash as opposed to spending some of it on the treatment of aches and pains, chronic rashes, constipation, excessive belly-bloating gas, heartburn, chronic fatigue, insomnia and other seemingly trivial symptoms. The common cold was always managed in my parent’s home with over the counter medications and our medicine cabinet was replete with Band-Aids, Vicks ointment, aspirin and various agents, such as tincture of benzoic, to be placed in a bedside vaporizer to reduce a night time cough.

When the Johnson administration implemented Medicare there were no deductibles paid to the doctor and no healthcare premiums extracted from a senior’s social security check; healthcare was essentially free. The government officials who set up the senior care system had grossly underestimated the cost of that government controlled bureaucratic system of healthcare delivery. They did not take into account the reality of all those stored up symptoms and the fact that the zero cost portion of the cost benefit ratio was sending millions of senior patients flocking into physicians’ offices for treatment. They had predicted a cost of $9 billion by 1990; the program’s actual cost that year was $66 billion. After adjusting for inflation over the ensuing 25 years, the cost of Medicare became 165 percent higher than the government had predicted. Having underestimated the cost because they had failed to consider what people will do when something is free, especially something as important as the way they feel, they made a second error and blamed the rise in expenditures on physicians who had naturally billed the government for the patient‘s visit and the diagnostic procedures need to address their symptoms. In 2008 the cost of the Medicare program was $450 billion or 15% of the federal budget. Seniors now have to pay a deductible and depending on one’s income we have as little as $90, or as much as $193, removed from our monthly social security checks and on top of that we still have to pay an additional premium for supplemental insurance.

Next week I will address the egregious error government officials in the Nixon administration made in an attempt to correct the problem. Like a doctor who errs in his or her diagnosis and therefore applies the wrong therapy to cure the patient’s alleged problem, they simply added to the insidious demise of our nation’s access to affordable healthcare: A system that had previously been the envy of every nation in the world. It is axiomatic that a misdiagnosis always leads to a therapeutic failure.