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.
Monday, March 30, 2009
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.
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?
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.
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.
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.
Monday, September 15, 2008
What Ever Happened To The House Call?
A recent event of a rather personal nature has prompted me to add one more essay to this series on the suggested, workable means for a reduction in the insidiously rising tide of healthcare costs in our country. A close relative is currently experiencing the terminal phase of her courageous four year battle with cancer. My wife and I have been intimately involved with the process of providing aid and comfort to her end of life care, in conjunction with some very dedicated servants in the home health and hospice programs.
In order to qualify for pain medications (narcotics) that will afford her comfort as her demise steadily and surely approaches, the law requires that she be evaluated by her attending physician on a regular basis. Because her personal physician does not routinely make house calls it has become necessary to transport this very frail, physically weak and terminally ill patient by ambulet van to her physician’s office, located less than three miles away. Her son, a highly respected professor of medicine in one our state’s finest medical schools and an individual who trains future physicians in the ethic, art and science of the practice internal medicine, has patently stated that it is quite an ordinary practice these days for physicians not to make house calls; unless he added, the patient is dying. That is apparently not high on the list of priorities that he is now teaching to these future internists. Not only does that strike me as heartless, it is also quite expensive since that transportation by ambulet will cost an extra $150 (minimum) to transport my terminally ill relative back and forth. Whatever happened to the compassion that drove physicians to the bedside of their home bound, chronically ill patients?
When I entered the practice of medicine in 1967 house calls were a routine service that a physician was expected to provide to his or her patients. Every physician I ever knew had a black leather bag in which he or she carried a stethoscope in order to listen to the patient’s heart and lungs, a blood pressure cuff and special tools for examining the eyes, ears, nose and throat. In addition there were certain drugs that were needed on an emergency basis including cardiac medications, injectable antibiotics and narcotics. A most treasured gift from my wife to punctuate and celebrate the start of my medical practice was a beautiful, engraved, black leather bag and it regularly accompanied me on thousands house calls for the next 31 years.
The house call enabled a physician to thoroughly examine the patients, assess possible changes in their physical status and adjust medication doses, or add new ones, as the case may have been. The patients, and their family members, felt a deep sense of security knowing that their attending physician was well informed about their current clinical situation and was making the proper adjustments in the delicate management of their long term care. Routine calls were scheduled on a day when we did not hold regular office hours: in my case it was Thursday. It was not at all uncommon for me to make five or six routine house calls on that day of the week attending to the needs of those patients who were home bound due to strokes, end stage cancer or other severe, physically disabling diseases. In addition to the routine house calls, I made emergency visits when a patient was too ill to be seen in my office, usually scheduled after office hours or over the lunch hour (if they could wait for a couple of hours) or unscheduled in the middle of the night. The last day I practiced I made a final regular and routine house call on a 100 year old lady who had not been in to the office for four years. There were times when my house calls took me deep into the surrounding farm communities adjacent to Poland, Canfield, Hubbard, Austintown, North Jackson, Coitsville, New Middletown, and the like. When folks could not afford to pay me they gave me fresh vegetables, canned goods, eggs, frozen meats they had previously butchered or freshly slaughtered chickens.
I recall with fond memory an elderly, black couple (probably about my age now) that lived in the lower Southside in what we now refer to as the ghetto; their children were grown, married and still living in the area. She had suffered a stroke, could not speak and was paralyzed on one side. Her loyal and loving husband had vowed to keep her at home if I would simply agree to attend to her needs on a reasonably regular basis. He was an extremely devoted husband, an immaculate house keeper (both in and outside) and a wonderful cook. I made routine visits to their home early on Thursday mornings, once a month as I was on my way to Southside Hospital for clinical rounds and a medical conference. When I had finished seeing his wife Elizabeth upstairs, George always had breakfast waiting for me in the kitchen. We sat and talked while I enjoyed bacon, eggs and home fired potatoes (or grits), embellished with toast and homemade jam from his strawberry patch and good, strong coffee. George and I became very good friends.
One summer’s evening in 1969, during a period of serious racial tension in Youngstown, I received a call from George saying that Elizabeth was burning up with a fever and coughing up blood. I had been watching the evening news and folks were being advised to stay safely in their homes in order to permit a state of martial law to quell the disturbance. The Governor of Ohio (James Rhodes) had called out the state militia and there were National Guardsmen on many of the Southside street corners. As I remember there was a curfew every night and the racial tension followed for some time. George asked apologetically if I would come to his home and examine Elizabeth. I agreed, much to the chagrin of my family.
As I approached the corner Market Street and Falls Avenue I was greeted by a Staff Sergeant, Ohio National guardsman who held up his hand in a halting position. Behind him was a military truck and sitting in the bed of the vehicle facing me was a guardsman armed with a fifty caliber machine gun. Parenthetically, I have since been told that none of the weapons used that night contained live shells; I am not certain how true that is. At the time I had an orange colored, 1968 Buick, Skylark convertible with a white “rag top” and white leather seats; hardly an inconspicuous (stealth) mode of travel on such a precarious evening. The sergeant approached my car, its top down, and asked me where the BLANK I thought I was going (his superlative deleted for the readers’ sake). Holding up my black leather house call bag, I told him about my gravely ill patient and said that I needed to proceed into the ghetto. He said that I was crazy, being white and sitting in a bright colored vehicle that offered no protection, and he was certain that I would be drawing rioters like ticks on a hound dog. I then asked for a military escort. He called his commanding officer and got permission to accompany me to the house where Elizabeth and George lived; I led the way.
When we arrived at the humble residence the military escort departed and I went in to see Elizabeth. As I had suspected from some questions I had earlier posited to George on the phone, my physical examination revealed pneumonia: her temperature was over 105 degrees F, her breathing was markedly labored and she needed to be hospitalized immediately. I called Gold Cross Ambulance. The dispatcher knew me and asked where I was. When I told him he said, “You’re where? Dr. Mc Gowen, are you out of your mind?” I assured him of my sanity and informed him that his ambulance crew would find a willing escort at the corner of Market and Falls and because of my gravely ill patient they should proceed without delay. They did, we got Elizabeth to Southside Hospital for a one week stay and she lived four more years while I enjoyed George’s fabulous cooking, some of which I purposely planned for lunch time visits.
Please believe me when I say that I have not said all of this in any boasting manner. I merely did what most primary care physicians did in those days; it was expected, it was the right thing to do and it was only one part of our total responsibility to our patients. I am simply pointing out the fact that it will be one more cost saving measure that should once again become part of the American medical scene. When I graduated from medical school on June 10, 1961 I raised my right hand and took the Oath of HIPPOCRATES. It reads in part, “Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption.” The house call was not a badge of courage it was merely a sign of commitment; a promise kept.
A hands on approach will spare many people from making costly and unnecessary visits to the ER. When a physician cannot decide over the phone as to the need for a patient’s hospitalization he or she must see and examine the patient. When that patient is too weak or ill to come to the office (such as my terminally ill relative), but they are not in need of immediate hospitalization, the physician should see them in their home. Currently many medical communities have physicians known as “hospitalists” who staff the general hospital and obviate the need for the private physician to make daily hospital rounds. It may come to the point where we will need a special breed of physicians who only make house calls and nursing home rounds. Be that as it may, it will be one more vital step, a patient friendly way, to reduce the rising cost of medical care.
In order to qualify for pain medications (narcotics) that will afford her comfort as her demise steadily and surely approaches, the law requires that she be evaluated by her attending physician on a regular basis. Because her personal physician does not routinely make house calls it has become necessary to transport this very frail, physically weak and terminally ill patient by ambulet van to her physician’s office, located less than three miles away. Her son, a highly respected professor of medicine in one our state’s finest medical schools and an individual who trains future physicians in the ethic, art and science of the practice internal medicine, has patently stated that it is quite an ordinary practice these days for physicians not to make house calls; unless he added, the patient is dying. That is apparently not high on the list of priorities that he is now teaching to these future internists. Not only does that strike me as heartless, it is also quite expensive since that transportation by ambulet will cost an extra $150 (minimum) to transport my terminally ill relative back and forth. Whatever happened to the compassion that drove physicians to the bedside of their home bound, chronically ill patients?
When I entered the practice of medicine in 1967 house calls were a routine service that a physician was expected to provide to his or her patients. Every physician I ever knew had a black leather bag in which he or she carried a stethoscope in order to listen to the patient’s heart and lungs, a blood pressure cuff and special tools for examining the eyes, ears, nose and throat. In addition there were certain drugs that were needed on an emergency basis including cardiac medications, injectable antibiotics and narcotics. A most treasured gift from my wife to punctuate and celebrate the start of my medical practice was a beautiful, engraved, black leather bag and it regularly accompanied me on thousands house calls for the next 31 years.
The house call enabled a physician to thoroughly examine the patients, assess possible changes in their physical status and adjust medication doses, or add new ones, as the case may have been. The patients, and their family members, felt a deep sense of security knowing that their attending physician was well informed about their current clinical situation and was making the proper adjustments in the delicate management of their long term care. Routine calls were scheduled on a day when we did not hold regular office hours: in my case it was Thursday. It was not at all uncommon for me to make five or six routine house calls on that day of the week attending to the needs of those patients who were home bound due to strokes, end stage cancer or other severe, physically disabling diseases. In addition to the routine house calls, I made emergency visits when a patient was too ill to be seen in my office, usually scheduled after office hours or over the lunch hour (if they could wait for a couple of hours) or unscheduled in the middle of the night. The last day I practiced I made a final regular and routine house call on a 100 year old lady who had not been in to the office for four years. There were times when my house calls took me deep into the surrounding farm communities adjacent to Poland, Canfield, Hubbard, Austintown, North Jackson, Coitsville, New Middletown, and the like. When folks could not afford to pay me they gave me fresh vegetables, canned goods, eggs, frozen meats they had previously butchered or freshly slaughtered chickens.
I recall with fond memory an elderly, black couple (probably about my age now) that lived in the lower Southside in what we now refer to as the ghetto; their children were grown, married and still living in the area. She had suffered a stroke, could not speak and was paralyzed on one side. Her loyal and loving husband had vowed to keep her at home if I would simply agree to attend to her needs on a reasonably regular basis. He was an extremely devoted husband, an immaculate house keeper (both in and outside) and a wonderful cook. I made routine visits to their home early on Thursday mornings, once a month as I was on my way to Southside Hospital for clinical rounds and a medical conference. When I had finished seeing his wife Elizabeth upstairs, George always had breakfast waiting for me in the kitchen. We sat and talked while I enjoyed bacon, eggs and home fired potatoes (or grits), embellished with toast and homemade jam from his strawberry patch and good, strong coffee. George and I became very good friends.
One summer’s evening in 1969, during a period of serious racial tension in Youngstown, I received a call from George saying that Elizabeth was burning up with a fever and coughing up blood. I had been watching the evening news and folks were being advised to stay safely in their homes in order to permit a state of martial law to quell the disturbance. The Governor of Ohio (James Rhodes) had called out the state militia and there were National Guardsmen on many of the Southside street corners. As I remember there was a curfew every night and the racial tension followed for some time. George asked apologetically if I would come to his home and examine Elizabeth. I agreed, much to the chagrin of my family.
As I approached the corner Market Street and Falls Avenue I was greeted by a Staff Sergeant, Ohio National guardsman who held up his hand in a halting position. Behind him was a military truck and sitting in the bed of the vehicle facing me was a guardsman armed with a fifty caliber machine gun. Parenthetically, I have since been told that none of the weapons used that night contained live shells; I am not certain how true that is. At the time I had an orange colored, 1968 Buick, Skylark convertible with a white “rag top” and white leather seats; hardly an inconspicuous (stealth) mode of travel on such a precarious evening. The sergeant approached my car, its top down, and asked me where the BLANK I thought I was going (his superlative deleted for the readers’ sake). Holding up my black leather house call bag, I told him about my gravely ill patient and said that I needed to proceed into the ghetto. He said that I was crazy, being white and sitting in a bright colored vehicle that offered no protection, and he was certain that I would be drawing rioters like ticks on a hound dog. I then asked for a military escort. He called his commanding officer and got permission to accompany me to the house where Elizabeth and George lived; I led the way.
When we arrived at the humble residence the military escort departed and I went in to see Elizabeth. As I had suspected from some questions I had earlier posited to George on the phone, my physical examination revealed pneumonia: her temperature was over 105 degrees F, her breathing was markedly labored and she needed to be hospitalized immediately. I called Gold Cross Ambulance. The dispatcher knew me and asked where I was. When I told him he said, “You’re where? Dr. Mc Gowen, are you out of your mind?” I assured him of my sanity and informed him that his ambulance crew would find a willing escort at the corner of Market and Falls and because of my gravely ill patient they should proceed without delay. They did, we got Elizabeth to Southside Hospital for a one week stay and she lived four more years while I enjoyed George’s fabulous cooking, some of which I purposely planned for lunch time visits.
Please believe me when I say that I have not said all of this in any boasting manner. I merely did what most primary care physicians did in those days; it was expected, it was the right thing to do and it was only one part of our total responsibility to our patients. I am simply pointing out the fact that it will be one more cost saving measure that should once again become part of the American medical scene. When I graduated from medical school on June 10, 1961 I raised my right hand and took the Oath of HIPPOCRATES. It reads in part, “Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption.” The house call was not a badge of courage it was merely a sign of commitment; a promise kept.
A hands on approach will spare many people from making costly and unnecessary visits to the ER. When a physician cannot decide over the phone as to the need for a patient’s hospitalization he or she must see and examine the patient. When that patient is too weak or ill to come to the office (such as my terminally ill relative), but they are not in need of immediate hospitalization, the physician should see them in their home. Currently many medical communities have physicians known as “hospitalists” who staff the general hospital and obviate the need for the private physician to make daily hospital rounds. It may come to the point where we will need a special breed of physicians who only make house calls and nursing home rounds. Be that as it may, it will be one more vital step, a patient friendly way, to reduce the rising cost of medical care.
Tuesday, September 2, 2008
Who Can Change the Trends in the Rising Cost of Healthcare?
The onus for converting our failing, mismanaged and costly healthcare system back to its roots in the good old, American, consumer driven, free market, economic paradigm falls squarely on our elected officials. Unfortunately they are for the most part politicians, not statesmen; this is more than just a distinction, it’s a difference. The difference between the two designations for our elected government leaders (statesman vs. politician) is demonstrated by their willingness to make changes that are tough to bring about yet obviously essential. A statesman is enthusiastic about making policy that will affect the next generation, even if it is unpopular or considered by some to be politically incorrect or political suicide; such as the proverbial “third rail“ called social security. A politician, on the other hand, possessing mostly self interest, is only eager to make changes that will effect his or her next election. Those of us now experiencing this failed health care delivery experiment may never live to see it overturned but we should be concerned with what our children and/or grandchildren (the next generation) will face whether national health care is instituted in America as is wished for by Democrat, Presidential hopeful Senator Barack H. O’Bama or if the status quo (the lesser of two obvious evils) is maintained by the Republican Presidential candidate, Senator John McCain. A country preacher once defined status quo is “a Latin expression for the mess we’s in.”
The current saddistressing state of affairs regarding our failing healthcare system did not arise over night (it began in 1965 when Medicare began) and getting it back to normal may take even longer. In the first place, the men and women we send to Washington who legislate all matters concerning the health and welfare of us and our families do not feel the same economic crunch as we do when it comes to the rising cost of health care. Their medical care is absolutely free and paid for by each of us; the tax payers. Instead of the American worker shouldering the burden for health insurance for all members of our United States Legislature, why don't we put the onus on their backs? Maybe then they will see that something needs to be done to eliminate the middle man (spelled HMO) who siphons off much of the money allegedly spent on the health of the U.S citizens.
The return of the current, failed system of healthcare delivery back to a free market, with costs determined by what the patient is willing to pay for necessary care, will take the combined ingenuity and tireless efforts of patients, physicians, hospital administrators, employers and legislators. Each of us is a highly critical entity in moving the system rearward to where it should have been all along. It will not be effortless and thus a joint cooperation between all concerned is the only way it can work. When a patient is faced with a critical, complicated illness that is associated with many clinical manifestations in multiple organ systems, a team approach often becomes necessary. For example, diabetics often need the care of a primary care physician who quarterbacks the total management, a podiatrist for foot care, a nephrologist if kidneys begin to fail, an ophthalmologist to treat retinopathy, a cardiologist when the heart begins to fail and a surgeon to manage surgical emergencies that are common to diabetics. Our ailing healthcare delivery system also needs a team approach to affect an ultimate cure.
The vox populi (voice of the people) has done much in the past to change the course of history and influence legislation. The American Revolution (1775 to 1781) erupted when the King of England (George III) adopted the view that the colonies should pay a substantial portion of the costs associated with keeping them in the British Empire. As a result of that exorbitant price tag Britain imposed a series of taxes followed by other laws that proved extremely unpopular. As a result the people spoke and declared independence from the crown of England. We the people should not await the rise of additional “taxes” and “other laws” that will be certainly be imposed upon us if the liberals in Washington and their current choice for President (Barach H. O’Bama) and Vice President (Joe Biden) have their way and establish a national healthcare system. The supplementary taxes will be needed to defray the increased costs and the added laws will be essential to impose rationing of our health care. We can each speak by means of the press (letters to the editor), the media (talk shows) and the telephone (by calling our representatives). The Roman Catholic organization founded in 1945 called The Christophers’ champions this motto: “It’s better to light one candle than to curse the darkness.” Instead of merely complaining about the rising cost of health care let us each vow to speak up; our collective voices can make a huge difference. We can also articulate our opinions effectively at the ballot box by eliminating those legislators who favor a national health care system or the status quo and by replacing them with those running for office who favor free enterprise and patient driven health care.
Physicians can play an essential role by submitting to congress, through their local elected representatives and medical societies, a workable, practical plan for reducing their fees, partnering with local business people in patient friendly, entrepreneurial pursuits and committing to a practice of being careful to order only what is essential to the benefit of the patient. The fee reduction would be commensurate with what the HMOs and Medicare are currently paying them (a 30% to 70% reduced percentage of what they actually bill) and which would not reduce their income at all. They could show that they have plans to create easily accessible health care facilities and will lobby pharmaceutical companies to lower their prices. The American Medical Association will be of no help here as they have done nothing in the past to stem the tide of managed care. Individual, articulate and well informed physicians representing county medical societies should be ready and willing to testify before Congress about this critical situation and what can be done to alter it. Recently retired physicians who have the time, the knowledge and the ability to logically present the case would be perfect candidates for this role.
Hospital boards and administrators can delineate the needless rules and regulations that have required them to add administrative staff and clerical paper shufflers to their pay rolls and show how eliminating certain unnecessary regulations that have nothing to do with quality care will reduce their costs by eliminating such additional personnel and how those savings can be passed on to the patients. Nurses who were trained to care for the needs of patients that are currently burdened down with pointless paper work will be able to provide more personal care and afford a hands on approach that will ensure a patient‘s well being while in the hospital. Instead of seeing to the requirements of the patient they are currently forced to sit around the desks and fill out numerous forms in the patients’ charts. Documentation of patient care is one thing, worthless form completions are quite another: the latter does nothing to reduce morbidity and mortality rates.
Employers can help by putting all HMOs on notice that in a short time the money now being sent to their huge bureaucracies will soon cease and instead it will be placed in the employees’ paychecks where it can be efficiently and prudently used to manage their own less expensive care. They must also convince union leaders that the free market, patient driven system will be of greater benefit to their rank and file members than the current negotiating schemes they (the union heads) have put forth in meetings with the employers and the HMO representatives. The shifting of dollars to the employee and away from the big business heads at HMOs will cost the companies nothing in expenditures or tax deductions. The only ones to suffer in the transfer of funds will be HMO CEOs like the one pointed out in the article dated July 31, 2008 where in I identified that former physician’s CEO income at $124 million per year. I think they will survive
Finally our representatives in Washington (congress persons and senators) must institute tort reform that will lower the cost of malpractice fees and produce savings to the physicians that can be passed on in a lower fee for service schedule to their patients. Congress must also see to it that the increased wages that are placed in HSAs (health savings accounts) and used for catastrophic health insurance premiums are not taxable. They must rescind the HMO acts of previous administrations and encourage free trade in the medical system within our borders; the way they did when they passed the (bipartisan) NAFTA legislation and encouraged trade beyond our borders with our neighbors to the north and south. Free enterprise within our medical system will be of much greater benefit to our citizens than NAFTA has proven to be. The first order of business will involve the Health Maintenance Organizations and when they are excluded from the healthcare system then Medicare (the managed care that started the insidious, proverbial snow ball rolling down the metaphoric economic hill in 1965) needs a second look. By that time it may be out of funds anyway. Conservatives argue that we need to move away from a third-party payer system to a health care structure that stresses individual responsibility so consumers can better understand the problems of high cost medicine and respond with more personally beneficial, lifestyle choices. HSAs and catastrophic health insurance will ensure that kind of individualism. Liberals favor national health care such as the Canadians now have; a system which teaches nothing about individual responsibility and costs so very much
When people are allowed to be back in charge of their own medical care and their own decision making regarding their personal and family health and welfare, it will be a positive impetus to take better care of themselves through the avoidance of bad habits (I.e. tobacco abuse and excessive alcohol intake), by keeping body weight at an ideal level (through increased exercise and prudent diets) and by way of attending to preventive medical practices such as proper immunization, avoiding crowds during flu and cold seasons, washing hands frequently and seeing a physician when warning signs of cancer or other diseases appear. Warning signs of numerous conditions are available on the internet as are preventative measures to avoid infections. Visits to a physician’s office or an emergency room, currently quite capricious, will then be based upon real need not a mere whim. Legislators in the state and national realms must take a second look at the cost to small business of what 50 years ago would have been an unheard of, unwarranted paid leave for certain minor illnesses, personal days (whatever that may be) and pregnancy leave for BOTH new parents.
Employees will think twice about calling off sick if they have to appear with a note from a physician that declares their inability to work and for which they had to pay. The extreme minority of physicians who make a habit of allowing employees to miss work can be monitored to ensure that they have not joined forces with a free loader. Those cases would indeed be rare given the work ethic of 99% of this nation’s honest, ethical and fully dedicated physicians. Ohio is recently anticipated having citizens vote for or against an increase in sick leave benefits; fortunately it was removed from the November ballot. That would have only added to the cost of goods and services as employers would have been forced to raise their prices to maintain financial solvency. A mandatory sick leave policy is not desirable in any form because it would be a disaster for the Ohio economy and force more companies, particularly small businesses with 25-50 employees, to reduce their work force or leave the state. This is just one more intrusion of government into the health care system.
Over the past several weeks in writing this series of articles I have taken up my former roll as an internist by (1) attempting to identify and describe the offending disease (a failing healthcare system), (2) pointing out the etiology of that disease process (managed care from HMOs and Medicare plus the rising malpractice fees in a litigious society) and (3) suggesting what form of treatment plan or prescription is needed to induce a cure; namely a surgical excision of the offending agent (the HMOs) and a return to a free enterprise market, consumer driven system and tort reform. (4) I have identified the purveyors of the cure which include the joint efforts of patients, physicians, hospital administrators, employers and elected government officials. Hopefully, in our state congressional districts we will soon see some worthy candidates running for Congress (the 2011-12 terms) who will take the first step toward affording us that cure. Our current representatives in our contiguous districts (17th District Tim Ryan and 6th District Charlie Wilson) belong to a party and support an Obama/Biden ticket that favors the institution of national health care. Senator Sherrod Brown also supports such a move. If the reader wants to see our nation reposition into a National Health Care (Socialized Medicine) delivery system, then those are the kind of people you should retain in their respective offices. If you have become convinced that we should return to a system of free enterprise, see to it that those in your congressional districts are replaced by others who have a conservative or moderate mindset which favors free enterprise.
The current saddistressing state of affairs regarding our failing healthcare system did not arise over night (it began in 1965 when Medicare began) and getting it back to normal may take even longer. In the first place, the men and women we send to Washington who legislate all matters concerning the health and welfare of us and our families do not feel the same economic crunch as we do when it comes to the rising cost of health care. Their medical care is absolutely free and paid for by each of us; the tax payers. Instead of the American worker shouldering the burden for health insurance for all members of our United States Legislature, why don't we put the onus on their backs? Maybe then they will see that something needs to be done to eliminate the middle man (spelled HMO) who siphons off much of the money allegedly spent on the health of the U.S citizens.
The return of the current, failed system of healthcare delivery back to a free market, with costs determined by what the patient is willing to pay for necessary care, will take the combined ingenuity and tireless efforts of patients, physicians, hospital administrators, employers and legislators. Each of us is a highly critical entity in moving the system rearward to where it should have been all along. It will not be effortless and thus a joint cooperation between all concerned is the only way it can work. When a patient is faced with a critical, complicated illness that is associated with many clinical manifestations in multiple organ systems, a team approach often becomes necessary. For example, diabetics often need the care of a primary care physician who quarterbacks the total management, a podiatrist for foot care, a nephrologist if kidneys begin to fail, an ophthalmologist to treat retinopathy, a cardiologist when the heart begins to fail and a surgeon to manage surgical emergencies that are common to diabetics. Our ailing healthcare delivery system also needs a team approach to affect an ultimate cure.
The vox populi (voice of the people) has done much in the past to change the course of history and influence legislation. The American Revolution (1775 to 1781) erupted when the King of England (George III) adopted the view that the colonies should pay a substantial portion of the costs associated with keeping them in the British Empire. As a result of that exorbitant price tag Britain imposed a series of taxes followed by other laws that proved extremely unpopular. As a result the people spoke and declared independence from the crown of England. We the people should not await the rise of additional “taxes” and “other laws” that will be certainly be imposed upon us if the liberals in Washington and their current choice for President (Barach H. O’Bama) and Vice President (Joe Biden) have their way and establish a national healthcare system. The supplementary taxes will be needed to defray the increased costs and the added laws will be essential to impose rationing of our health care. We can each speak by means of the press (letters to the editor), the media (talk shows) and the telephone (by calling our representatives). The Roman Catholic organization founded in 1945 called The Christophers’ champions this motto: “It’s better to light one candle than to curse the darkness.” Instead of merely complaining about the rising cost of health care let us each vow to speak up; our collective voices can make a huge difference. We can also articulate our opinions effectively at the ballot box by eliminating those legislators who favor a national health care system or the status quo and by replacing them with those running for office who favor free enterprise and patient driven health care.
Physicians can play an essential role by submitting to congress, through their local elected representatives and medical societies, a workable, practical plan for reducing their fees, partnering with local business people in patient friendly, entrepreneurial pursuits and committing to a practice of being careful to order only what is essential to the benefit of the patient. The fee reduction would be commensurate with what the HMOs and Medicare are currently paying them (a 30% to 70% reduced percentage of what they actually bill) and which would not reduce their income at all. They could show that they have plans to create easily accessible health care facilities and will lobby pharmaceutical companies to lower their prices. The American Medical Association will be of no help here as they have done nothing in the past to stem the tide of managed care. Individual, articulate and well informed physicians representing county medical societies should be ready and willing to testify before Congress about this critical situation and what can be done to alter it. Recently retired physicians who have the time, the knowledge and the ability to logically present the case would be perfect candidates for this role.
Hospital boards and administrators can delineate the needless rules and regulations that have required them to add administrative staff and clerical paper shufflers to their pay rolls and show how eliminating certain unnecessary regulations that have nothing to do with quality care will reduce their costs by eliminating such additional personnel and how those savings can be passed on to the patients. Nurses who were trained to care for the needs of patients that are currently burdened down with pointless paper work will be able to provide more personal care and afford a hands on approach that will ensure a patient‘s well being while in the hospital. Instead of seeing to the requirements of the patient they are currently forced to sit around the desks and fill out numerous forms in the patients’ charts. Documentation of patient care is one thing, worthless form completions are quite another: the latter does nothing to reduce morbidity and mortality rates.
Employers can help by putting all HMOs on notice that in a short time the money now being sent to their huge bureaucracies will soon cease and instead it will be placed in the employees’ paychecks where it can be efficiently and prudently used to manage their own less expensive care. They must also convince union leaders that the free market, patient driven system will be of greater benefit to their rank and file members than the current negotiating schemes they (the union heads) have put forth in meetings with the employers and the HMO representatives. The shifting of dollars to the employee and away from the big business heads at HMOs will cost the companies nothing in expenditures or tax deductions. The only ones to suffer in the transfer of funds will be HMO CEOs like the one pointed out in the article dated July 31, 2008 where in I identified that former physician’s CEO income at $124 million per year. I think they will survive
Finally our representatives in Washington (congress persons and senators) must institute tort reform that will lower the cost of malpractice fees and produce savings to the physicians that can be passed on in a lower fee for service schedule to their patients. Congress must also see to it that the increased wages that are placed in HSAs (health savings accounts) and used for catastrophic health insurance premiums are not taxable. They must rescind the HMO acts of previous administrations and encourage free trade in the medical system within our borders; the way they did when they passed the (bipartisan) NAFTA legislation and encouraged trade beyond our borders with our neighbors to the north and south. Free enterprise within our medical system will be of much greater benefit to our citizens than NAFTA has proven to be. The first order of business will involve the Health Maintenance Organizations and when they are excluded from the healthcare system then Medicare (the managed care that started the insidious, proverbial snow ball rolling down the metaphoric economic hill in 1965) needs a second look. By that time it may be out of funds anyway. Conservatives argue that we need to move away from a third-party payer system to a health care structure that stresses individual responsibility so consumers can better understand the problems of high cost medicine and respond with more personally beneficial, lifestyle choices. HSAs and catastrophic health insurance will ensure that kind of individualism. Liberals favor national health care such as the Canadians now have; a system which teaches nothing about individual responsibility and costs so very much
When people are allowed to be back in charge of their own medical care and their own decision making regarding their personal and family health and welfare, it will be a positive impetus to take better care of themselves through the avoidance of bad habits (I.e. tobacco abuse and excessive alcohol intake), by keeping body weight at an ideal level (through increased exercise and prudent diets) and by way of attending to preventive medical practices such as proper immunization, avoiding crowds during flu and cold seasons, washing hands frequently and seeing a physician when warning signs of cancer or other diseases appear. Warning signs of numerous conditions are available on the internet as are preventative measures to avoid infections. Visits to a physician’s office or an emergency room, currently quite capricious, will then be based upon real need not a mere whim. Legislators in the state and national realms must take a second look at the cost to small business of what 50 years ago would have been an unheard of, unwarranted paid leave for certain minor illnesses, personal days (whatever that may be) and pregnancy leave for BOTH new parents.
Employees will think twice about calling off sick if they have to appear with a note from a physician that declares their inability to work and for which they had to pay. The extreme minority of physicians who make a habit of allowing employees to miss work can be monitored to ensure that they have not joined forces with a free loader. Those cases would indeed be rare given the work ethic of 99% of this nation’s honest, ethical and fully dedicated physicians. Ohio is recently anticipated having citizens vote for or against an increase in sick leave benefits; fortunately it was removed from the November ballot. That would have only added to the cost of goods and services as employers would have been forced to raise their prices to maintain financial solvency. A mandatory sick leave policy is not desirable in any form because it would be a disaster for the Ohio economy and force more companies, particularly small businesses with 25-50 employees, to reduce their work force or leave the state. This is just one more intrusion of government into the health care system.
Over the past several weeks in writing this series of articles I have taken up my former roll as an internist by (1) attempting to identify and describe the offending disease (a failing healthcare system), (2) pointing out the etiology of that disease process (managed care from HMOs and Medicare plus the rising malpractice fees in a litigious society) and (3) suggesting what form of treatment plan or prescription is needed to induce a cure; namely a surgical excision of the offending agent (the HMOs) and a return to a free enterprise market, consumer driven system and tort reform. (4) I have identified the purveyors of the cure which include the joint efforts of patients, physicians, hospital administrators, employers and elected government officials. Hopefully, in our state congressional districts we will soon see some worthy candidates running for Congress (the 2011-12 terms) who will take the first step toward affording us that cure. Our current representatives in our contiguous districts (17th District Tim Ryan and 6th District Charlie Wilson) belong to a party and support an Obama/Biden ticket that favors the institution of national health care. Senator Sherrod Brown also supports such a move. If the reader wants to see our nation reposition into a National Health Care (Socialized Medicine) delivery system, then those are the kind of people you should retain in their respective offices. If you have become convinced that we should return to a system of free enterprise, see to it that those in your congressional districts are replaced by others who have a conservative or moderate mindset which favors free enterprise.
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