The Doctors State of Independence

Everything that has happened with ObamaCare since its implementation has been a good thing because we can now stop pretending that the courts or Congress will help us. If we want to take our profession back, we have to do it ourselves. It has been way past time to shift the paradigm back to the doctor and by extension our relationship with our patients.  We have been on the wrong track for many years: when we joined insurance panels; when we signed their contracts without reading them; when we added physician extenders to increase the patient volume in order stay open; when we sold our practices to the hospital in order to navigate the financial onslaught; when we let patients dictate the standard of care by requesting treatment by phone and prescriptions for the newest medication seen on TV; when we let fear control us; and when we lost our sense of value and purpose with the accompanying loss of joy, our profession was ripe for the picking.

We certainly played the game and did everything that was asked of us. Now we are being asked to become agents of the government, to give up our Hippocratic Oath and to work against the interests of our patients. We are being asked by our specialty boards which are supposed to represent us to acquiesce to the power of their cartel. We are also being asked to give up our independent streak. The spark that made us want to become doctors, to be leaders who are unafraid to do the right thing for our patient because we have worked hard to understand what needs to be done to heal them. We are also being asked to become members of the healthcare ‘team’ to move to the background and have some centralized algorithm do the thinking for us.

It stops when we move away from this system that works against the interest of the doctor and patient relationship and when we stop being the grist for this healthcare mill. The truth is the healthcare system cannot run without us. We have a great deal of power – why don’t we just take it back. Obamacare has damaged the healthcare system to such an extent that the patients are now ready to find doctors who practice medicine with empathy, compassion and competence. The amazing thing is that this is a more efficient and effective style of medicine. Our challenge is only to let patients know that we are here and how to find us.

When patients understand that there is now a two tiered system of medicine. One driven by centralized, population based medicine underpinned by evidence based decisions that rest on the cost controlled good of the many vs individualized patient care based on the art and the science of medicine underpinned by health and wellness, they will choose us. That will be the beginning of the end of Obamacare. If we build it and let the patients know, they will come.

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What the King v Burwell Decision Means for Doctors and Patients

While reading the Supreme Court’s decision on King vs. Burwell, I realized that I was not surprised by the ruling. It fits the pattern that has developed over the last several years. The letter of the law has not applied to The Affordable Care Act, this was true when it was upheld as a tax instead of an abrogation of the Commerce clause, and now the ruling has massaged the meaning of subsidies that apply to state run exchanges to apply to everyone.

The other thing that has not changed is the fact that patients will continue to find access limited by rising out of pocket expenses in the form of rising deductibles, co-insurance and premiums that are expected to continue to increase further. We can continue to look forward to patients using emergency rooms as primary care centers because they can’t afford to see a physician and independent physicians closing their practices or becoming hospital employees further exacerbating the doctor shortage. The ruling does nothing to change the reality that having health insurance in the age of Obamacare does not equal access to quality healthcare.

Finally, the winners have been rewarded. When the stock value of health related companies such as corporate hospitals rise on the news of the decision, doctors and patients should take pause. The insurance companies and hospitals have clearly figured out that business as usual can continue. In fact, it will become business as usual on steroids.  Insurance companies will be empowered to further limit their physician panels, they will continue to decrease the medications that they will cover, they will continue to decrease what they cover as medically unnecessary and experimental to limit access to physician directed care while they increase their premiums increasing their profits in the bargain. Hospitals will continue to get larger taking over the market and setting prices without pressure from honest competition from independent physicians, ambulatory surgery centers, labs and radiology centers that would encourage cost control.

The King vs. Burwell decision has answered the question of who stands to gain in the age of Obamacare. Justice Roberts in his opinion said it best “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”  With this decision medical insurance companies, hospitals and other pieces of the corporate healthcare delivery system now have the scale clearly tipped in their favor at the expense of doctors the patients – the mission has been accomplished.

 

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Healthcare Policy: Facts vs Fiction

The recent New York Times opinion piece penned by Paul Krugman exemplifies what the problem is with political discourse in our country. Under the guise of pointing out the effects of a polarized political environment that uses intellectual dishonesty by those who disagree with their point of view. He exposes himself to be like the very same people that he mocks and belittles.

The “policy success” of ObamCare that he paints flies in the face of reality, and anyone who is not a practicing physician cannot truly understand how policy affects the practice of medicine and the delivery of healthcare.  Patients are finding out what practicing physicians have known all along – that having health insurance does not equal access to quality healthcare. From the beginning the proponents of The Affordable Care Act used the argument that having health insurance equaled access to healthcare. However, the existence of The Emergency Medical Treatment and Labor Act (EMTALA) passed by Congress in 1986 guaranteed that anyone who needed emergency medical care whether they were a US citizen or not would receive it despite their ability to pay.

Just because you say it doesn’t make it so

Healthcare spending is down, but it isn’t because the cost of health insurance has dropped. It is because access has become increasingly limited.

  • Insurance companies have limited covered services for patients and they have limited their panel of physicians thereby making it harder for patients to find a physician.
  • Patients have found that their ability to keep their doctor has decreased because private physicians have increasingly stopped accepting ObamaCare thereby limiting their choice.
  • Healthcare costs have dropped not due to a decrease in premiums, but because patients have had a sharp increase in their out-of-pocket costs (deductibles and coinsurance) which have led them to delay or forego care or increasingly go to the emergency room to receive care.
  • Enrollment numbers in ObamaCare have failed to take into account the human costs of those who had health insurance that they liked, but were forced off of their policies onto a more expensive plan with coverage that they neither wanted nor needed.

Living in America is about having the freedom to choose and the right to have a difference of opinion, but using political doublespeak and ridicule in attempt to shut down opposing opinion and an honest debate is about control.

 

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The Devaluation of The Doctor and Its Effect on The American People

The announcement by the Centers for Medicaid and Medicare Services (CMS) to move 50% of its non-managed care spending into Accountable Care Organizations (ACOs) and bundled payments coupled with the recent passage of Medicare Access and CHIP Reauthorization Act (H.R.2) the repeal of the so called ‘doc fix’ will lead to the end of private healthcare, narrow the range of medical services offered by physicians, and increase the cost to patients and taxpayers.

It will not accomplish the goal of improvement of outcomes or increase access to healthcare for Americans. Instead, these changes will likely further decrease access for the sickest patients and decrease the quality of care for patients overall. If physicians and hospitals are now to be rewarded for positive outcomes, they will skew their services to healthier patients if for no other reason than to remain open. Under the ACO model members will receive a prescribed amount of money each year. The organization will access this ‘pot’ to deliver all medical services – tests, admissions, procedures and office visits. At the end of the year, members will share in the money left over. This model will inevitably put pressure on clinicians to avoid providing costly services and steer sicker patients to palliative care (hospice), and will most assuredly discourage doctors and hospitals from offering care that will be considered expensive. Doctors who work in this model will be in the business of acting as agents for a system that is driven by external dictates that place an artificial value on an individual and will destroy patient privacy. What was initially billed as a choice is now the law under H.R.2. It sounds good until it hits home when a patient needs the service that is denied because he/she is too old, too sick or otherwise is not deemed worthy because of a dire and/or costly diagnosis.

There are many truths about The Affordable Care Act that can no longer be denied: It is not affordable; it is not patient centered; it limits access to care; and it has not decreased medical costs.  The one constant to date has been the pain inflicted as it continues to unfold. For those who think that the changes in our healthcare system are unintended, they only need to look at the law to figure out that the ACA is the final piece of a very large puzzle of a movement that has been relentless in its goal to move the US healthcare system into the larger centralized socialized global healthcare system where healthcare is delivered by committee and payments are doled out on the largess of the government – de facto single payer.

Coercive healthcare system based on pay-to-play

One of the casualties of this paradigm shift will be the heart of the American healthcare system – the independent physician. Over the past 10 years the number of physicians in private practice has decreased from two-thirds to one-third of practicing physicians. This decimation has been tied to government regulations such as the mandate of electronic medical records (HITECH), compliance mandates for privacy of medical information (HIPAA), and the ruthless and relentless move to decrease reimbursements to physicians. It has gotten so bad that only 17cents of the healthcare dollar is now spent on care given by physicians. The rest of the healthcare dollar goes to the pharmaceutical industry, hospitals, administrative fees generated by government and commercial insurance companies, and to trial lawyers caused by the practice of defensive medicine.

The control of reimbursements has led to a decrease in the scope of practice for specialists as well as a distance between the primary care physician and the patient. For example, the time a physician spends with the individual patient has decreased to seven minutes and the front line of care has shifted to allied healthcare professionals. Unfortunately, the physician has been used as the fall guy for what’s wrong with our healthcare system, when in fact he/she has had the least power over the business and now has lost the power over the practice of medicine.

These changes have been touted as a win for ObamaCare. Proponents have stated that the law is working because it is lowering healthcare costs. However, this meme has ignored the increase in prohibitive out-of-pocket costs to patients, their increased difficulty in being able to have access to physicians, a the limit in their access to treatment due to a decrease in covered services and medications, and in increase in costs to tax payers. With the passage of The H.R.2, reimbursements have been tied to the delivery of ‘value-based’ care and there is no limit to this trend. Doctors will be conscripted into this system using the yoke of Maintenance of Certification (MOC), a lucrative and questionable scheme  initiated by the American Board of Specialties (AMBS) to coerce physician members to take expensive arbitrary tests in order to maintain their Board certification forcing doctors to pay to continue to practice medicine.

If you like your doctor you can keep your doctor

There is a less well understood aspect of Obamacare which will become obvious as the law continues to be implemented. It will be the end of the independent private physician. The days of the solo practitioner and small group practice are numbered. In the shift towards empowering the healthcare team in the form of ACOs, the role of the physician has been decreased to one of an administrator for the most part. Clinically, the doctor has become interchangeable with physician extenders. In an effort to save money and to implement a system driven by algorithms and one-size-fits-all medicine, the front line of medicine has increasingly been taken over by other allied healthcare professionals. There has been a concerted effort to devalue the doctor. Medical education has shifted to a doctor being part of the healthcare team which uses central guidelines and population based Evidence-Based medicine instead of clinical judgment based on individualized patient care. Instead of having the power to make clinical decisions and lead the planning of patient care, the doctor has been relegated to the administrative task of signing off on clinical notes and writing prescriptions. One only needs to look at the electronic medical record to figure out how removed doctors have become from front-line patient care. The nursing profession has also been a casualty of these changes. They are no longer on the front line of patient care, they have also become part of the administrative process. Registered Nurses with the most experience have increasingly become case managers which are in essence compliance officers tasked with making sure that documentation is in place to ensure that the hospitals get paid by Medicare and commercial insurance companies.

The Electronic Medical Record

In the past, the doctor was involved with the patient visit from the first moment the patient entered the exam room. The physician personally entered all of the information about the patient in real-time and examined the patient. This valuable interaction allowed for subtle information to be used in forming a plan and was vital to inculcating a positive doctor-patient relationship. Now the typical “flow” of the patient visit starts with the medical assistant who takes the patient information and logs into the electronic medical record (EMR) all of the patient history, vitals, medications used, allergies etc. Most of the visit is taken up with inputting information most the time without even looking at the patient. It is all about checking the box and moving on in order to close the section of the chart. If the practice also has a nurse practitioner or a physician assistant they perform the physical examination and produce the treatment plan. The physician then will sign off on the chart and approve the plan and medications prescribed. With current and ever-expanding government mandates a great deal of the chart is spent on filling in the Meaningful Use (MU) section which asks in-depth personal questions such as – have you ever tried to hurt yourself, vaccination history, whether or not you feel depressed, how many people live in the household, and whether there are guns in the home all designed to gather personal information which can potentially be shared.  This comprehensive personal history is mandatory for Medicare providers. And for those who think that there is an option to skip over these questions, it is important to realize that the setup of the EMR does not allow the physician to close the chart until these questions have been completed, effectively mandating that the questions be asked and answered.

The toll on the physician – the rise of the Provider

The practice of medicine has changed dramatically over the past 10 years. The joy of practicing individualized medicine with autonomy has given way to apathy, a decrease in the morale, a loss of collegiality, and a mentality of go along to get along with physicians either biding their time until they can either retire, or completely submitting to a system that pits the doctor against the patient; thereby, making them part of a system that is designed to capture patient information, to control access and eventually to control outcome where “value based” medicine is determined by actuaries and government officials. The physician and nurse relationship has devolved from a collegial relationship with patient care as its center into one where the nurse makes sure that the doctor inputs the proper information to reconcile the chart so that reimbursements to the hospital will not be disrupted.

The future of medicine is about choice

Patients and physicians need to make a decision whether to be a part of this system. As the foundation of our healthcare system, both need to determine whether they want to decide their value or will they have it decided for them. For physicians that may mean opting out not only of Medicare and Medicaid but commercial insurance altogether; and for patients that may mean deciding that they are worthy of receiving care from a physician who is their advocate and not an agent for the government.

Freedom of choice is the essence of quality healthcare. Its power emanates from the individual. Choosing to go to an independent physician who offers transparent pricing (in the form of direct pay, sliding scale fees or a membership model); choosing free standing urgent care facilities, instead of emergency rooms for routine care, choosing independent surgery centers  (The Surgery Center of Oklahoma) instead of the hospital; choosing medical cost-sharing (www.libertyoncall.org) as a way of paying for medical services instead of commercial medical insurance; and adding supplemental policies such as AFLAC or Mutual of Omaha to help cover routine and catastrophic healthcare needs will give the patient the ability to both take their power back, and have an affordable way to finally get what they actually pay for. Those physicians who choose to take their power back will empower an alternative system where they can stop being ‘providers’ and once again have the freedom to love being a doctor. Furthermore, patients who want to have the freedom to take personal responsibility will be rewarded with affordable high quality healthcare which is based on their well-being.

 

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Playing Politics Can Be Hazardous To Your Health

Proponents of the Affordable Care Act are getting exactly what they wanted. They have declared victory because of the decrease in health care costs. What they fail to mention is the reason there has been a decrease is because people can’t afford to use their insurance due to high out of pocket costs.

In this election season it is imperative to remember those who voted for this disaster without having read the bill; those who demonized people who raised valid questions about access to care, costs and rationing; and those who cried racism when valid points were raised about how the quality of care would necessarily drop because there was never enough money to subsidize a substantial number of the 30 million newly insured people. Those on Medicare need to remember that over 700 million dollars was taken from money that would have been used for their care to set up the unwieldy bureaucracy that is the underpinning of Obamacare.

Obamacare actually doubles down on what makes the US healthcare system so expensive. The only change is the creation of a bureaucratic infrastructure that allows the government to centrally control the delivery of healthcare via regulations and compliance covered in the cloak of  innocuous catch phrases like ‘meaningful use’, ‘accountable care organizations’ and ‘ a medical home’. Make no mistake what it all distills down to is control not health care. It is all about destruction of the doctor and the patient relationship and control of the healthcare choices that are allowed.

Now that the ACA is entering its second year it is clearly evident that promises have not been delivered. People have not been able to keep their doctor or the health insurance they like. The government has forced those with a moral objection to abortion to pay for it, and the promised savings of $2500 per family has morphed into average out of pocket costs of $6000  and premiums that have risen exponentially.

Over 220,000 doctors are currently not accepting Obamacare,  and that number is growing not because doctors don’t want to take care of patients, but because the reimbursements are so low they can’t keep their practices open. Furthermore, those who believe in the Hippocratic Oath have declined to accept Obamacare because of their refusal to work against the interest of their patientsThe decision to hide the true cost of health insurance until after the election is politics as usual – it wreaks of cynicism and hypocrisy, and it shows the contempt that proponents of the bill have for the American people. What they don’t want you to know is that it will only get worse after the election

  • Even if the insurance that people like has not been terminated, they will likely be priced out due to the further rise premiums and the out of pocket costs.
  • Those who have coverage through their employers will likely lose it because of the prohibitive cost to the employer.

This is all designed to fill up the healthcare exchanges ‎with people who have nowhere to go because the rug has been pulled out from beneath them. Voting for the status quo will only reward those who have put us on a path to single payer and encourage the irreversible destruction of the essence of our healthcare system which is based in both individualized patient care and on privacy and the sanctity of the doctor patient relationship. On November 4th, it is time to send a message that it stops NOW.

 

 

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The Immigration Problem: What Are The Health Risks?

There are some troubling facts about the wave of immigration through the southern border that are coming to light despite efforts by the government to keep Americans in the dark. Those that have questions have been silenced using the usual tactics of cries of racism, selfishness, and lack of compassion. However, questions need to be asked because the health of Americans is potentially at risk.

 This is what has been said:

 Proponents of immigration have said that the wave of immigration is no different from the past.

  • Historically immigrants that have come to America (e.g., Ellis Island) went through a structured process which allowed them to be checked for communicable diseases. In some cases they were quarantined until they no longer proposed a health threat and in other cases they were sent back to their country.
  • Border patrol agents have confirmed that the immigrants flooding in are not checked for diseases because of the sheer volume and lack of manpower.

This is what has been said:

The children from Central America have the same immunization rate as American children and therefore are not a health risk to Americans.

This is what we know:

  • The immigrants coming in have been documented as having communicable diseases such as tuberculosis and swine flu. Because there is limited use of the vaccine for the former and limited effectiveness of the vaccine for the latter (studies vary on the effectiveness of the swine flu vaccine estimates range from 42-96%),  individuals that come in contact with people with these diseases are at risk of becoming infected. Those who are the most vulnerable are first responders such as border patrol agents, children, seniors, and those with a compromised immune system.
  • Immigrant children in California have been hospitalized with bacterial pneumonia and border patrol agents have been stricken with bacterial pneumonia in Texas.
  • Other documented diseases and conditions include meningitis, scabies and lice.
  • Potentially it isn’t the diseases that we have been vaccinated against that are the most concerning, but ones like TB which have developed multiple drug resistance, or tropical diseases such as Dengue fever that doctors may have difficulty diagnosing and there is no treatment for them.
  • The American population has already been put at risk with people being dropped off at bus stations and being put on commercial airlines. It could potentially escalate this fall if these sick children are placed in schools exposing classmates, teachers and their families.

The government is seeking over 3 billion dollars for legal representation and for dispersing people to various states into communities without notification of governors under the guise of protecting the privacy of these immigrants; however, there is no attention being paid to the health of these people.

Why aren’t questions being raised about whether it is humane to place people in unoccupied prisons, overcrowded holding pens, and now FEMA centers without adequate health screening or separation of those who are sick from the general population?  Is it compassionate to dump people bus stations with the clothes on their back with nowhere to go, no job and no money? Is it moral to encourage people to travel over a thousand miles forcing them to run a gauntlet that puts them at risk of abuse, rape and potential human trafficking on top of the health risks? Is winning at all costs and staying in power so important that it trumps safety for both the immigrants and the American people?

The answer is clear. The immigration problem is not about compassion it is about politics.

 

 

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Obamacare’s Health Inequality

Whether we like it or not, Obamacare is the law of the land. Moreover, no one can argue that it has fundamentally changed the American healthcare system. We have been distracted by the disastrous roll out. Unfortunately, while we were distracted by constant bickering, the government has inserted itself between the doctor and the patient and taken control of the system – from a doctor’s treatment options to a patient’s choice from cradle to grave, and everything in between.

The debate on whether to repeal, amend or let the process continue to its conclusion has devolved into a heated argument where it is all about winning at any cost. But while pundits and politicians are preoccupied with winning, people are dying, people are losing their financial underpinning, and there is both a transfer of health and a transfer of wealth. In short, the healthcare system is breaking into a two-tiered system – those who are relegated to Obamacare will be trapped in a system which locks them out of  the very best healthcare that our country has to offer while those who can afford to will simply opt-out.

The current belief that everything will be rosy if everyone has health insurance is fundamentally flawed because having health insurance does NOT equal having access to affordable quality healthcare. The players involved with crafting Obamacare such as the pharmaceutical industry, the medical insurance industry, and the hospitals helped to craft a law that doubles down on the worst aspects of the health insurance problem. This explains why 30 million people will remain uninsured even if Obamcare is ever fully implemented.

The mantra of ever increasing healthcare costs caused by unscrupulous doctors has been dinned into our collective consciousness without regard to facts. The truth is care given by an independent private physician is the most cost effective type of healthcare received. If the independent private physician and the patient had been given a seat at the table, they would both have provided a powerful voice to distill the problems and provide solutions. After all who knows better about what is broken in a system than those on the front line who have to advocate for their patient while doing what it takes to make payroll, and those who want to find the best and most cost effective health care respectively.

Academic solutions to health care such as buying health insurance across state lines and keeping children on their parents health insurance until age 26 are great talking points, Unfortunately, they ignore the reality that there is still no cap on what an insurance company can charge the patient in out of pocket expenses; they can still deny coverage after a medical service is rendered; and they can still deny needed medical care on the basis of what they decide is medically necessary or what care will be allowed because they consider it experimental without regard to what the physician finds is medically indicated.

Instead of starting with the doctor patient relationship as the core of what it takes to provide efficient, excellent individualized cost effective healthcare, the middleman has been empowered driving bureaucratic layers with regulations and committees that inevitably increase cost. That cost is borne by the patient in longer waiting time, rationed care, and replacement of their trusted physician with less experienced extender providers such as physician assistants and nurse practitioners. There has even been a movement towards expanding the scope of practice by allowing pharmacists to write prescriptions and nurse practitioners and physician assistants to perform certain surgical procedures in the name of providing access and cutting costs. However, there is no way to calculate the cost that a patient may pay with a missed diagnosis or a botched procedure in the one size fits all conveyor belt driven medical system that is being set up.

The two tier system that is being created under the auspices of Obamacare can be broken by following the alternate path of free market medicine which is alive and well and thriving. By removing the insurance company and government middlemen, a patient will find that their costs will drop precipitously. They will once again have their choice of doctor, have the procedures they want, have a quality relationship with their doctor who will be able to spend time with them, and know what their costs are up front. The options are myriad and include:

  • Urgent care centers staffed by board certified ER physicians that charge a flat fee for visits that include x-rays, blood work in addition to the consultation (eg., North Atlanta Urgent Care http://www.atlantaurgentcare.com/)
  •  Surgery centers who list their prices such as the Surgery Center of Oklahoma (http://www.surgerycenterok.com/pricing/)
  • Websites where you can bid for medical services (www.medibid.com)
  •  Doctors who barter and have a sliding fee scale (www.aapsonline.org)
  • Medical Cost sharing organizations (www.libertyoncall.org) which are allowed under Obamacare guidelines. For example, Liberty health share will pay for 100% of health care costs (no eye or dental) after a $500 dollar deductible are met, for $199 dollars per month for an individual with a maximum coverage of 1 million dollar per occurrence per year. Unlike an insurance plan which has in network panels, resources are pooled and costs are shared so members can see any doctor or go to any hospital they want since the company pays for the medical services for a self pay negotiated rate.
  • Supplemental plans offered by as AFLAC actually pay patients after they have medical services such as surgical procedures or treatment for cancer.
  • A website which is a one stop shop for information for those who want to explore the free market medical system (www.theselfpaypatient.com).

Each of these strategies provide an option that will give the patient true control of their health care dollar to spend in a system where there is true competition that is driven by innovation, customer service, collegiality and personal responsibility on the one hand  instead of cronyism, control and coercion on the other.

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A Physician’s Response To The State Of The Union Address

The power to choose your doctor, and for you in partnership with your doctor to decide your course of treatment is the foundation of excellent medical care. With The Affordable Care Act, the government has inserted itself to become the final arbiter of your care. It will ultimately decide who becomes the health winners and losers. Proponents of ObamaCare want people to believe that the system is so broken that it can only be fixed through fundamental change. The disastrous roll-out has certainly fed the push for single payer, but an argument can be made that the government bailout written into the bill has actually already ushered in single payer - since whoever controls the money controls the access and makes the rules.

As the ObamaCare train wreck continues to roll out, it will become painfully obvious to patients that although they have health insurance with no pre-existing conditions, free birth control and preventative care, they still may not be able to afford to access medical care when they need it because either the out of pocket costs from their co-insurance and deductibles are so high, or they will find that because they qualified for a subsidy, they will have that money clawed back the following year if their financial situation improves, or if they took the Medicaid option they will be unable to leave any of their wealth to loved ones because the government will take it to recoup payments made for their healthcare. Physicians will ultimately find that they will have no control of their talents. They will be considered to be providers of services that are a right that must be given for whatever value the government deems to be fair.  They will become interchangeable with the healthcare team and with that innovation, individualized healthcare and the art of medicine will be gone forever….but the antidote to what is ailing the American healthcare system is NOT more government intervention, it is more choice via free market medicine.

 

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Disenfranchised and Duped by Obamacare

It is no longer about the content of one’s character. It is all about winning at all costs. How else can the blind and dogged devotion of Progressives to Obamacare be explained. The architects have admitted that the law is inherently unfair. It creates a two tiered system that benefits the wealthy and privileged friends and relegates the poor, the middle class and the disenfranchised to an inferior healthcare system devoid of quality doctors in which the ‘unlucky’ ones who can’t afford it will be locked out of medical centers of excellence like Sloan-Kettering Cancer Center and MD Anderson, stuck paying higher costs for medication, and paying more as if it is a privilege.

 The cheerleaders of this ghoulish system think it is okay for people to die from a lack of access due to high costs or denial of medical services deemed to be either medically unnecessary, experimental or simply too expensive. The real human costs are distilled down to statistical talking points because it is more important to be on the winning team no matter the consequences. For those who believe in this system, it brings a whole new meaning to taking one for the team. It is immoral and unfair for those who created this system along with their friends to opt out while falsely crying racism to silence anyone who dares to question their hypocrisy.

It is past time to demand that we really live by Dr. Martin Luther King Jr’s call for people to be judged by the content of their character instead of being silenced by hypocritical race hustlers who want to control our destiny. The race card which has been overdrawn for too long must be declined, and those who want to create and perpetuate victims in order to remain relevant need to be exposed and rejected.

 

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A Practicing Physician’s Prescription For A Healthcare Fix

For all of the desperate attempts at distraction, demonization and outright lies about Obamacare the truth remains – having health insurance does not equal getting quality healthcare.

It is true that there are problems with the health insurance industry. If anyone had bothered to ask independent private physicians why they no longer take Medicare/Medicaid, or why many are opting out of insurance and moving towards a cash only practice in increasing numbers, they would tell you that they stopped because the game is rigged. It has become harder for doctors and by extension patients to access quality affordable healthcare. Obamacare expands and empowers the most expensive aspects of our healthcare system thereby dooming Americans to pay more money in the form of taxes and rationed care.

The proponents of Obamacare like Ezekiel Emanuel (the architect of  The complete Lives System ) and Paul Krugman are finally coming out and telling us the truth. Obamacare has always been about control of our healthcare system by centralizing the power in the government. The method to control costs will be driven by higher taxes and rationing (ie., death panels). Unfortunately, the 30 million people who did not have health insurance will be exchanged for those who did and were not dependent on government handouts. Obamacare is not only a transfer of wealth from the young and the middle class to the government and its corporate friends, but as an astute individual commented – it is actually a transfer of health. Americans stand to lose their freedom to choose their doctor, and their freedom to choose how they treat their illness. For example, under the current law people can no longer use their health savings account (HSA) to buy natural remedies such as vitamins and supplements only brand name prescription drugs. How long will it be before we will be mandated to take vaccines or be placed on psychiatric medication against our will? Under this collectivist system the costs to the system will override individual freedom. There will be no anonymity within the national electronic medical record database.

 These are some simple solutions:

  • Change the tax code to allow private physicians to write off bad debt. 

Allow physicians to write off delinquent patient bills as bad debt. This would alleviate the need to send the  patient to collections and  remove healthcare costs as a cause of bankruptcy. It would also encourage medical care that is gratis because physicians could afford to offer it.

  •  Tort reform

Make patients who bring frivolous lawsuits responsible for paying all court costs. Consider caps on damages. Encourage doctors to give free care by giving them a discount on their malpractice insurance or waiving it if they provide a certain amount of free care per year.

  •   Allow Medicare and Medicaid access to cheaper drugs from other countries

Allow importation of drugs from Canada to decrease costs to both Medicare/Medicaid patients and the government.    

  •  Reform EMTALA (The Emergency Medical Treatment and Active Labor Act

This is an unfunded congressional mandate passed in 1986, that required hospital emergency rooms to treat all patients regardless of their ability to pay. The unintended consequence of this bill has led to increased costs that get passed on to patients who are able to pay.

Instead: Require that patients who present to the emergency room be triaged and treated for real emergencies only, and not problems that are best treated in an outpatient office, clinic or urgent care setting. e.g., common cold or ear wax removal.

  • Require insurance companies to honor the pre-certification process

 Require that if an insurance company pre-certifies (approves) a procedure then they have to pay for it. They cannot deny it after the fact and leave the patient on the hook for paying the bill.

  • Separate the triumvirate of the pharmacies, the insurance companies and the pharmacy benefit management companies (PBMs)

They are colluding to keep prescription medication costs high, while limiting competition which would lead to cost control through honest competition.

  • Do not mandate the licensure of physicians be tied to taking Medicare/Medicaid  or Obamacare

This will guarantee an exodus of physicians further exacerbating the doctor shortage.

If the government really wanted to expand coverage for 30 million people all they would have had to do was expand Medicaid/Medicare. It would have been a lot cheaper than the cost of blowing up the private insurance market. Empowering independent doctors instead of the hospitals, the insurance companies and Big Pharma would have been a much cheaper fix.

 

 

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