It’s important for patients and voters to know what’s going on behind the scenes in healthcare.
On the national stage and in front of the curtain, we only hear from politicians, pundits and special interests. What these folks say is typically questionable at best; truthfulness in politics doesn’t seem to count for much these days. The airways are dominated by buzzwords that are intended to influence rather than inform. How many times have you heard a talking head mention “quality”, “affordability” and “access to care”? Hundreds, right? When was the last time you heard them define any of those terms? Probably never.
The sad fact is that political speeches, television commercials and media pronouncements don’t contribute much when it comes to the real you and your real health. Politicians, pundits, political parties and special interests aren’t the ones who care for you when you’re sick, and the odds are that they have no idea what it’s like to be seriously ill, worried about insurance or unable to find a physician who will accept them into their practice. In spite of all of those “personal” stories they tell, (you know, the ones about the worried mother they met on that campaign swing through Everytown, USA – the one who asked them to rigorously pursue their political agenda “for the children”), the vast majority of our political leaders and pundits haven’t a clue about the healthcare system or what they’ve done to it. Heck, they don’t even bother to read the healthcare legislation they pass, as Senator Max Baucus recently admitted to a constituent:
Whew! It only took three weeks longer than expected to complete the copy edits for my upcoming book, get permissions to use quoted text, figures and tables, revise or remove the figures, tables and text for which permission couldn’t be obtained (or cost more than budgets would allow), and document everything in tracking spreadsheets and file folders. In light of this experience it’s easy to understand why it’s easier to most politicians and pundits just make things up when they decide to weigh in on a topic.
Speaking of making things up, the most interesting piece of healthcare news I’ve seen recently is here: a leaked presentation of “research findings” that is meant to guide Democratic candidates on how to sell their newly passed healthcare reform law to voters. The answer seems to be by backing away from it and claiming that it can “be improved”.
Doesn’t that imply that you created something that wasn’t very good in the first place?
Lord knows, Americans can be forgiven for thinking that they were supposed to be getting a sweet deal when the “Patient Protection Act” healthcare reform bill was passed earlier this year. After all, this is the legislation that Vice-President Biden excitedly characterized as “A big f***ing deal”. President Obama recently assured us that "reform has actually added at least a dozen years to the solvency of Medicare — the single longest extension in history — while helping to preserve Medicare for generations to come." And a spokesman for House Speaker Nancy Pelosi recently claimed that the new healthcare law “could create 250,000 to 400,000 jobs a year”. Presumably in the same way that hurricanes create lots of jobs in the clean-up and construction industries.
But it seems as if reality is finally catching up to the rhetoric that was originally used to sell this legislative lemon. I’m one of the most non-partisan people you’ll find, being equally discouraged and disgusted by a lack of common sense and honesty on the part of both Democrats and Republicans. But the assertions used by President Obama and the Democratic leadership in selling this 2,400+ page monstrosity have gone above and beyond the call of duty. These folks had their minds made up, and didn’t wish to be confused, restrained or even influenced by facts.
The all-encompassing nature of the deception was well documented a couple of weeks ago by Mary Katharine Ham of the Weekly Standard and Townhall political editor Guy Benson. Together they researched and wrote an extensively researched and linked article entitled “ObamaCare: The sum of all fears”. It’s well worth reading. In it they document the fallacy of eight of the most prominent promises made by the President and others who had a hand in creating this law. These include:
If you are satisfied with your existing health care arrangement, you can keep it.
That this reform will lower America’s health care spending.
That this reform will lower Americans’ health care premiums.
Obamacare will not lead to a doctor shortage, or escalate the primary-care physician shortfall.
There will be no government rationing of medical care.
“The firm pledge” – Ninety-five percent of Americans will not see any form of tax increase because of Obamacare (or anything else).
Health care reform won’t add “a single dime” to the deficit—and will actually cut it.
Health care reform will help businesses—employers and employees, alike.
My particular favorite piece of contradiction is the video here of the President arguing vigorously that a mandate to buy health insurance was not a tax,
only to have his own Justice Department argue a few months later that – not only is it a tax, but that makes it immune from lawsuits that have been filed based upon the individual mandate portion of the law. To quote the New York Times story on this:
“When Congress required most Americans to obtain health insurance or pay a penalty, Democrats denied that they were creating a new tax. But in court, the Obama administration and its allies now defend the requirement as an exercise of the government’s “power to lay and collect taxes.”
And that power, they say, is even more sweeping than the federal power to regulate interstate commerce.
Administration officials say the tax argument is a linchpin of their legal case in defense of the health care overhaul and its individual mandate, now being challenged in court by more than 20 states and several private organizations.”
Why on Earth do we Americans allow our politicians – of any party – to get away with this sort of dishonesty? It is unrestrained doublespeak like this that has helped turn healthcare into hellthcare over the past twenty years.
But back to the new “modern”, post-PPACA “talking”, er, “ducking points”. What are they and why are they designed this way?
The presentation is based upon polling and focus-group research conducted by Herndon Alliance Research between April and August of 2010. It points to a “challenging environment” for supporters of the PPACA legislation. What makes it challenging?
“Straightforward ‘policy’ defense fails to be moving voters’ opinions about the law.
Public is disappointed, anxious and depressed by current direction of the country – not trusting.
Voters are concerned about rising health care costs and believe costs will continue to rise.
Women in particular are concerned that health law will mean less provider availability – scarcity an issue.
Many don’t believe health reform will help the economy.”
Why, voters don’t seem to trust their political leaders anymore! How strange that this should be the case after the passage of a healthcare proposal that does none of the things that its proponents said that it would do.
The recommended course of action as result of this mess? To focus on the goodies and ignore any potential costs or consequences. Simple, folksy, “personal” stories that ignore the big picture are the tool of choice. Here’s the example provided by the consultants:
“My name is Lindsay. I’m 23 years old and I have a 6 year old son named Jacob who has asthma. We got our health insurance from my husband’s employer, but he lost his job recently. He found a new job that pays OK, but his new health insurance company will not give Jacob coverage because he has a pre-existing condition. I wait tables too, but we just can’t afford to pay medical expenses out of pocket. I know that new health insurance law isn’t perfect, but starting in September, it will be illegal for insurance companies to deny children with pre-existing conditions healthcare coverage. I can’t tell you what a relief it is to me that Jacob will get the care that he needs. I really hope this new law does not get repealed.”
This is a touching story, and it should be possible to obtain health coverage without regard to pre-existing conditions. But how much is Lindsay going to have to pay for Jacob’s insurance given the way this law was structured? Does she know that having Congress remove any sort of cap on benefits will mean that she and her husband could be stuck with helping to pay for someone else’s $10 million hospitalization? Was she told that all of the new government departments, rules and regulations would increase the cost of care for everyone, while further alienating Jacob’s doctors? Of course, that’s if she can find a doctor for Jacob at all. The Association of American Medical Colleges is now projecting a shortage of about 150,000 primary care physicians over the next ten years. With tens of millions of new patients being added to the Medicaid program by 2014, many patients will have trouble finding a doctor much, much sooner.
Details, details.
The consultants are also careful to provide of list of things that shouldn’t be said:
Don’t:
assume the public knows the health reform law passed or if they know it passed understand how it will affect them. [Ed. note: I can pretty much guarantee that no one is going to truly understand all of the ways in which this law is going to affect them. Not even the people who wrote the law...];
list benefits outside of any personal context;
barrage voters with a long list of benefits [Ed. note: That would, of course, assume that one could actually come up with a long list of benefits.];
use complex language or insider jargon;
use heated political rhetoric or congratulatory language;
say how the law will reduce costs and deficit.
This last point is perhaps the most important because, of course, the law really won’t reduce costs or the deficit. But Lindsay doesn’t need to know about that either. After all, it’s Jacob who will be footing the bill.
The hellth of it is that it didn’t have to be this way. In passing this legislation and signing it into law, our elected Leaders made a conscious decision to push a healthcare reform plan that was designed for bureaucrats, by bureaucrats. The bill’s framers either didn’t know, or didn’t care about what’s really wrong with the current healthcare system or why. It’s doubtful that they asked a single practicing physician – or people who work with practicing physicians – for input along the way. Instead, the emphasis was continuously focused on buying votes and imposing more bureaucratic controls on an industry that has been more shaped and damaged by thoughtless bureaucracy than any other.
They did this because they could, and because it matched the way they believe medicine should work, rather than the way in which it really does. They did it without regard to whether it was sound medical or economic policy. And they voted like sheep, right along party lines; regardless of the best interests of the people they ostensibly represent.
The least they can do now is take full, complete and unadulterated credit for it.
"You don't mind if I add one more thing to your to-do list, do you?"
Greetings dear readers!
By now tens of thousands of you, (or at least a short conga line's worth), will have noticed that I've been missing for a week or two. Alas, like this donkey I've been temporarily overwhelmed. The good news is that the the rush to complete the final edits on my book is almost complete. Actual production process is slated to begin shortly at Prentice Hall.
(In the process the title has now been changed to "Stop the Bleeding:How to Save Trillions by Overhauling America's Healthcare Machine". Oh those wily marketing people!)
Regardless of what it's called, the basis of the book - that American healthcare is being overwhelmed by thoughtless, expensive and quality-sucking bureaucratic complexity - is truer than ever. The passage of the 2,400+ page Obamacare legislation has only accelerated the process. We have a short window of opportunity to fix things before the medical, social and financial consequences of poor planning and administrative mis-management come crashing down upon us. The irony is that the solutions are so much easier and cheaper than what we're doing now!
It brings to mind the adage about hitting oneself repeatedly with a hammer because it feels so good when you stop. The big question is whether we can muster the common sense and political will to quit hurting ourselves and future generations?
At any rate, I should be back blogging about the Road to Hellth just after August 7th or so. There will be tons to catch up on.
"For 2011, provide aggregate numerator and denominator through attestation as discussed in section II(A)(3) of the final rule For 2012, electronically submit the measures as discussed in section II(A)(3) of the final rule"
In a classic Ten Commandments moment, the Department of Health and Human Services released its final version of the rules regarding the "Meaningful Use" of healthcare information technology (HIT). Meaningful use entered our vocabulary in early 2009 as part of a $20+ billion gift from doctors, hospitals and the taxpayers to the needy folks at Cerner, GE, Siemens, Allscripts, Epic and other purveyors of complex, expensive and difficult-to-use and potentially even dangerous medical software products. Dr. Scot Silverstein has written some excellent posts here, here and hereabout the problems increasingly caused by the HHS/HIT-Industrial Complex, and anyone interested in the greater good of economic efficiency and patient care should spend some time reviewing his articles and websites.
As our non-medical readers may or may not know, in 2009 President Obama and the Democratic Party majority in Congress passed "economic stimulus" legislation that called for doctors and hospitals to suddenly rapidly massive numbers of complex and expensive electronic medical records and computerized ordering systems. The law created a "play-or-be-punished" program. Doctors and hospitals who handed their own money over to Cerner, GE, Allscripts, Epic and a few other large vendors early on (i.e., before 2014), would be eligible to receive federal rebates. (These rebates consist of money that our Federal government has presumably borrowed from China for this purpose.) On the other hand, if these same providers persisted in not handing their money over to the HIT industry after 2015, Medicare would cut their payments for delivering actual patient care by 1% each year (1% in the first year, 2% in the second year, and so on), until they did.
This may not seem like much as financial penalties go, but that's how it's supposed to look to the average person. As explained here in a previous post, these sorts of reductions in gross income turn out to be twice as big in terms of their reduction in net provider income. In other words, a 5% reduction in gross Medicare payments actually traslates into a 10% reduction in take-home pay.
Yes, your doctor could be providing top quality care, making diagnoses everyone else has missed, be saving millions in healthcare costs and finding the cure for cancer. But if she is not using a governement-sactioned piece of software in a certain sort of way, then *thwack!*, off with her mortgage payments!
Dr. James Gault's Retired Doc's Thoughts blog has an excellent post today about the abrupt recess appointment of Dr. Don Berwick as the head of The Center for Medicare Services. The post points out that Dr. Berwick appears to express contradictory views about society's need to ration and the individual's desire to have whatever the heck they want in the way of medical care, whenever the heck they want it.
It should be a grave disappointment to all of us that Dr. Berwick, (possibly the first pediatrician ever to be placed in charge of healthcare for the elderly), was never asked or allowed to explain his perspectives and approach to managing Medicare and Medicaid to the American public prior to his appointment. For all practical purposes the appointment was made "in the dead of night", and in a way specifically designed to hide Dr. Berwick and his views from public scrutiny.
As detailed here, President Obama's comments about making the recess appointment as a way to circumvent Republican delays are disingenuous at best.
Of course, recess appointments have been made before by Presidents of both parties. But this has almost always been done after hearings and after the opposing party has actually engaged in some sort of obstruction or delaying tactics. A pre-emptive recess appointment by a President whose party deliberately shielded the candidate from public scrutiny is a different animal altogether. It should be nothing less than disgraceful from a political leader who pledged on the record that:
"My Administration is committed to creating an unprecedented level of openness in Government. We will work together to ensure the public trust and establish a system of transparency, public participation, and collaboration. Openness will strengthen our democracy and promote efficiency and effectiveness in Government."
Deliberately avoinding hearings through back-door appointments does nothing to earn the public's trust. In fact, it should have the affect of making us all very, very wary.
Thinking is hard work. This is why so few people bother. At least voluntarily. So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare “reform” and guidelines of care.
This comes up as a result of a conversation that I had with a patient the other day. A pleasant, obese gentleman. He had been struggling with his weight and Type II diabetes for some time, and there were now some early indications of some potentially serious long-term complications. He mentioned to me that he was working hard to prepare for gastric bypass surgery. I asked him how he was doing that.
“Why, by eating!” he replied. Huh? By eating?
“Oh yes”, he explained. “You see, I’m getting these complications from my weight and diabetes and all of my doctors think that I’m an excellent candidate for weight loss surgery. Based on my previous weights, if I can just get lose about 40 or 50 pounds, I should have much better blood sugars and need far less insulin. God, that stuff is expensive when you’re using hundreds of units per day!”
That sounded perfectly reasonable. This gentleman is a walking advertisement for the virtues of slimming down. And for gastric bypass, in fact. So why is he holding that venti whole milk mocha with 508 calories and 27 grams of fat?
If you kidnap someone and no one notices, is it really a hostage-taking?
This is the dilemma currently facing House Speaker Nancy Pelosi. You have to be sympathetic to her plight. As we described in our last post, Ms. Pelosi “saw no reason” for the House of Representatives to vote on a Senate measure that would have prevented Medicare doctors from having the net income that they receive from Medicare and TRICARE cut by 43%. (TRICARE takes care of the families of our military servicemen and women, and bases its own rates on Medicare. However it pays even less than Medicare in most cases.)
Her clearly stated rationale was that, by threatening to bankrupt doctors taking care of the elderly, she could force the Senate to vote for additional unfunded billions of dollars in unemployment benefits:
"The inadequate legislation on physicians' fees that Senate Republicans allowed to pass today is a great disappointment. The House has approved long-term reform that ensures that Medicare patients will have access to quality physicians' services.
"The bill Senate Republicans allowed to pass is not only inadequate with respect to physician fees, but it ignores urgent sections of the House bill to provide jobs. The House has repeatedly sent jobs-creating bills to the Senate since December -- Build America Bonds, small business hiring incentives, and importantly, summer jobs -- and yet Republicans continue to block approval of jobs legislation.
“What is it that Republicans in the Senate and House don't understand about the need for jobs in America?
"I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate. House Democrats are saying to Republicans in the Senate: Show us the jobs!"
A stop-action photo of Medicare physicians being used as a political football by Congress. Note that patients are left up in the air...at least temporarily.
If there were any lingering doubts that the our elected officials are too irresponsible, petty and incompetent to be allowed to run something as important as healthcare, they’re now a thing of the past. If you’ve not been following the saga of the “doc fix” in Congress recently, then you should be – even if you’re not elderly or a healthcare provider. Why? Because it’s the best available indicator of how our political Leaders are going to be managing the rest of the healthcare market under the law popularly known as Obamacare.
The story goes like this:
In 1997, Congress passed a law that says that the rate of growth in Medicare spending can grow no faster than the gross domestic product, even though there is absolutely no reason why the two should have anything to do with one another. If it does, doctors will be arbitrarily penalized by cutting the fees they get for providing healthcare services to Medicare patients.
Every year for the past 13 years, the rate of growth in Medicare spending exceeds the rate of growth in GDP. And nearly every year, Congress has said “Gosh, that was a terrible law we passed. We don’t really want doctors to have their payments cut and force them to stop seeing Medicare patients.” But rather than eliminating the law, Congress has passed a short-term band-aid that restores physician payments for a year or so. Meanwhile, the cuts became cumulative. As of this year they add up to 21.5% reduction in physician payments.
Whew! It only took three weeks longer than expected to complete the copy edits for my upcoming book, get permissions to use quoted text, figures and tables, revise or remove the figures, tables and text for which permission couldn’t be obtained (or cost more than budgets would allow), and document everything in tracking spreadsheets and file folders. In light of this experience it’s easy to understand why it’s easier to most politicians and pundits just make things up when they decide to weigh in on a topic.
Thinking is hard work. This is why so few people bother. At least voluntarily. So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare “reform” and guidelines of care.
