Health Care Reform Becomes Insurance Mandate

After all the hullabaloo about public options, socialized medicine, death panels, and employer mandates, yada yada, it all comes down to this, judging by the bill the U.S. Senate is poised to pass:

You must buy health insurance or go to jail. Or pay a fine. Or get a government subsidy. Or thumb your nose and see what happens (probably nothing).

WINNERS: Insurance companies.

LOSERS: Just about everyone, as this will no doubt raise premiums sky high even as services are reduced to cover new, unserviceable demand.

PREDICTION: If Obama and the Democrats survive in power after 2012, look for the public option to come back in full force as they once again demonize the insurance companies, when in truth it's Medicare and Medicaid that are driving the system bankrupt and unaffordable.

What Are the Odds of This Law's Surviving?

The Senate Finance Committee, in the legislative equivalent of a show trial, has voted unanimously to force Members of Congress and their staffs to choose their health insurance from the proposed insurance exchanges beginning in 2013.

The exchanges, under health care legislation being currently considered, would be the one-and-only-stop shop for health insurance for the public, and it would look unseemly for politicians to exempt themselves in favor of the VIP health plans they currently enjoy.

Of course, it's easy to vote for something that makes you look like one of the public when the vote doesn't mean anything. By the time this provision gets to the full Senate floor, however, it'll be invisibly swept under the rug and forgotten forever.

It would be sheer delusion on our part to think that the politicians who enact our laws ever have any intention of following them themselves. They routinely exempt Congress from the laws they themselves pass, including sexual harassment and other acts they routinely engage (read: revel) in.

Currently, Congress and federal employees get to choose from a generous array of health plans administered by the Federal Employees Health Benefits Program (FEHBP), which candidate Obama promised he'd extend to all Americans but which President Obama has conveniently forgotten in favor of "Medicare for all" and rationing for the elderly.

There's no way the Congressional elite is going to give up its exclusive, VIP health packages. While the rest of us will be forced onto a health care dole, our politicians will continue to have gold-plated private care that knows no boundaries.

What the Public Option Will Mean to Your Wallet

If the Democrats succeed in creating their "robust public option" of health insurance for those who currently don't have any insurance, there will be blood. Well, maybe not actual blood, but the color of blood--red--all over the budgets of people and entities from coast to coast.

Consider this:

A study by the actuarial firm Milliman calculated that public programs, such as Medicare and Medicaid, currently shift $88.8 billion in costs onto private payers per year, increasing the typical American family's annual private health insurance premium by $1,512. Can you imagine the cost shift if 103.4 million more Americans were on a government plan?

Pretty frightening, huh? And since the "public option" will be just as underfunded as Medicare/Medicaid, you can chalk up another $37 trillion in unfunded liabilities over the next 50 years or so.

But the Democrats will forever be able to charge at election time that "the Republicans will take away your health care" and thus presumably win votes.

However, since they'll also have to ration and deny health care just to be able to pay 80 percent of what private insurers do (in order to make the public option "affordable"), taking away one's health care won't amount to a whole lot. You won't be able to get any medical services anyway, so what will there be to take away?

Painting 'The Doctor' Far From Today's Reality

Sir Luke Fildes lost his eldest son Phillip on Christmas Eve 1877 while a doctor spent a compassionate vigil at the child's side. In commemoration, Sir Fildes painted "The Doctor" (above) in 1891 to depict "the physician in our time."

This same painting was used by the American Medical Association (AMA) in 1949 to stop President Harry Truman in his attempt to nationalize health care. The message was "Keep Politics Out of This Picture."

The AMA can't use this picture or tactic this time around. Things have changed too much.

Some of us who've lived long enough can actually recall how doctors once did make house calls and could even be reached on weekends and evenings for emergencies. (Today, you get a voice recording commanding you to "Dial 911.")

To say the least, we've come a long way in our medical care, and in one sense Obama is correct--the system is broken if you're looking for compassion and home visitations.

But it's not really broken, just adapted to a new reality. We're now a nation of 300 million people with nowhere nearly enough doctors to even treat all of us, let alone make house calls (though some still do and swear by it).

Medical care is now like visiting an auto mechanic. "Doc, it hurts here." "Let me take a look." A few small probes and examinations later, and the doctor is ready. "Fortunately, nothing is broken. I'll prescribe you some painkillers. You should be fine in a few days."

Okay, so I've simplified things here a bit (I left out the two sets of x-rays and follow-up MRIs), but the general picture of "sick care" in America is just that. It's like taking your car into the shop, except it's your body--and your life.

Paucity of time and doctors can account for our new reality, but the biggest contributing factor to what Obama calls our "broken" health care system is Medicare and Medicaid.

Since most doctors won't accept the payment structure of Medicaid, leaving that to emergency rooms, your family doctor is modelling his or her practice on the Medicare payment structure--the more procedures he or she can perform, the more the office can bill for your visit. ("I also notice your car's belts are getting worn. We'd better replace those for $125 before you get stuck on the freeway." Get the analogy?)

So, the next time you hear politicians' bemoaning our "broken" health care system, remember it's only broken because Medicare made it into an assembly-line industry, with each nut, bolt, worker, and procedure along the line being billed for and paid separately.

This is the typical pattern with government: First break it, then blame it on others and come rushing to the rescue to garner votes for the next election, reality be damned.

Politicians just created the housing and credit crises by pushing banks to create "affordable housing." Now they're blaming the bankers and everyone one else in the Fannie Mae/Freddie Mac food chain and claiming to have the solution with "more regulation."

If they really wanted to "fix" health care, all they have to do is fully fund Medicare and come up with a payment structure that rewards healthful results rather than procedures. That'll stop the cost-shifting to private insurers and build some efficiencies into the system.

Instead, they'll give us more regulation (read "rationing") and expand Medicare, the very cause of the crisis in the first place.

R&D, and It Ain't Research and Development

Rather, it's the two words the Democrats crafting so-called health care reform won't mention, and if they're uttered around them, will instantly dismiss as fanatical right-wing hallucinations--rationing (R) and denial (D) of medical service or medicines.

Just this week, Obama vowed to cut $300 billion over ten years from the Medicare budget by streamlining administrative procedures and rooting out waste and corruption.

Two more words, "Yeah, right."

The only way he'll save a penny, other than cutting payments further, is to do what every other respectable left-wing government does with its health care--ration it (long lines and waiting periods) and deny it ("you're too old for a hip replacement, so live with it").

I hate to disillusion all you "free health care" daydreamers out there, but this is change we can live without. Let's hope no one really believes in all the ridiculous promises being made.

(N.B.: Even the liberal New Republic has come out and demanded that the "reformers" level with the public about what's going on. Read "The Public Remains in the Dark.")

Peering Through the DoubleSpeak to Clarity

Here's a piece on Senator Jay Rockefeller (D-W.Va.) and his "principles" on health care reform:

Rockefeller's principles. On April 21, 2009, Sen. Jay Rockefeller (D-W.Va.), chairman of the Senate Finance Subcommittee on Health Care, outlined his principles for a 21st century health care delivery system as the Finance Committee unveiled a series of roundtables leading up to health care reform legislation. Sen. Rockefeller’s principles for reforming the health care delivery system are: (1) create a National Director for Health Care Quality; (2) strengthen the Medicare Payment Advisory Commission (MedPAC) and provide expedited implementation of its recommendations; (3) provide the Agency for Healthcare Research and Quality with greater authority to coordinate public and private quality improvement; and (4) require health information technology as a “condition of participation” in Medicare by 2015.

Translation: We're gonna ration it, baby. You'll have access to health care (for an unspecified yearly and per-visit price), but you'll get nothing in return if it's too expensive. However, those of us in government--and our cronies--will have taxpayer-funded, gold plate, everything-is-available-and-free health care. These are my principles, sucka.

Why Not Smart Cards Instead of EHRs?

As the gathering storm of health care reform threatens individual privacy in the form of electronic health records (EHRs) that can be accessed nationwide--and no doubt cleverly hacked into just as everything else is hacked into--a simple solution is to leave the data-keeping to individual patients.

Some countries, notably Taiwan in this comparative study, issue each person a smart card, onto which physicians and other health care providers encode the patient's medical history, medicines being taken, and other pertinent information. Patients carry the cards with them and can present them at any doctor's or specialist's office, and the smart card functions not only as a data center but also as a credit card to bill the government.

Cost for a family of four is just $650 annually and co-pays are low, just $7 for doctors, $1.80 for dentists, and a maximum of $6.50 for prescriptions.

Problem is, like our Medicare, the system is going broke.

Just proves the old adage that you can't have your cake and eat it too.

Health Care Reform: Ending Hospital Readmissions

You have to really dig hard to find out what the government is doing to make health care "affordable," one of the goals everyone from Barack Obama on down cites in undertaking health care reform.

But I bet you didn't know that Medicare wants to end hospital readmissions, especially in the 30 days after the first hospitalization. CMS, the Centers for Medicare and Medicaid Services, is looking at various carrots and sticks to bring down the 18-percent average rate of readmissions in the first 30 days. Lowering readmissions by 75 percent would save $12 billion a year, CMS claims.

Carrots include paying bonuses to hospitals that cut their readmission rates, and sticks include reducing or denying payment for certain readmissions deemed to be the hospital's fault.

Now, all this gets scary if you read my posting from yesterday about how hospitals in Great Britain removed wheels from gurneys so they could call them hospital beds and avoid looking like their emergency rooms were clogged and inefficient.

I'm trying to think of clever ways hospitals here could bring down the readmissions rate. One doctor I read even suggested just keeping everyone in the hospital for 30 days.

Perhaps hospitals could create a readmissions clinic and call being there something other than an admission. I've got it--put patients in gurneys in the ER so you don't have to say they've been "admitted" or "readmitted" to the hospital! What was Britain's curse could be our hospitals' savior.

Anyway, on a more serious note, hospitals have had some success by assigning coaches to each patient leaving the hospital. Coaches keep in touch with the patients--and even visit them at home--to make sure they take their medications properly and follow all parts of the regimen assigned them, including diet, rest and exercise.

With my cynical mind, however, I can still see hospitals coming up with some way around the rule, just like their cohorts in Great Britain did.

Massachusetts Plan Fails; Ready for Obamacare?

Massachusetts' health initiative, called Commonwealth Care, has so far failed on all fronts, and now Obama and company have legislation in the works (see Baucus, Max, and Kennedy, Ted) that virtually mirrors the abysmal failure of Mitt Romney's plan (which Romney now repudiates, but probably for presidential aspiration purposes only).

Writing for Boston.com, Suzanne L. King, a physician who practices medicine in Massachusetts, grades Commonwealth Care against the five standards established by the Institute of Medicine; to wit, coverage should be universal, not tied to a job, affordable for individuals and families, affordable for society, and accessible by all.

On number one, Massachusetts' plan is not universal, still missing a few hundred thousand residents. On number two, it retains its reliance on employer-funded insurance while incorporating an individual mandate (see Baucus, Max, and Kennedy, Ted, and soon Obama, Barack). On three, Dr. King writes, "For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments." Also, co-pays are so high that many can't afford to see a doctor. On four, state costs have soared from $630 million a year to $1.3 billion are are still rising (a lot of the money goes to subsidizing people who can't afford to buy health insurance). And on five, accessibility, the answer segues from four--not only are co-pays expensive, but deductibles are too high in many cases.

Dr. King's solution, and here many might disagree, is just to get rid of private insurance and extend Medicare to everyone. My thought is that Medicare is the 800-pound gorilla already shifting costs from subsidized patients to paying patients, from Medicare to private insurers. Since Medicare doesn't pay all that it costs for the services and procedures it covers, those under private insurance make up the different in higher doctor and hospital fees.

Anyway, be prepared for some form of the failed Massachusetts plan to become the law of the land--and for your health care (unless you're poor and subsidized) to become both costlier and less affordable.

Maybe the key to surviving in our new day and age is just to become poor and a ward of the state. I sure hope not.