Yesterday, the U.S. House of Representatives passed legislation, on a 355 to 59 vote, to postpone a July 1st 10.6% cut in payments to physicians treating Medicare patients. They instead recommended trimming the government’s funding of the wasteful Medicare Advantage programs, a proposition that the White House has threatened to veto.
The Medicare cuts can seriously threaten the viability of many medical practices and may force doctors to stop seeing Medicare patients. The current postponement under the House legislation is only for 18 months and the ball has moved to the Senate’s court. Powerful health insurance companies are aggressively opposing the House’s decision since it recommends reducing the scope of Medicare Advantage programs. Humana has the most to loose since Medicare Advantage accounts for 48% of its revenues. Patients and doctors, on the other hand, have a lot to gain if the government eliminates these programs.
There is nothing wrong with making money unless it’s at the expense of retarding innovation, competition, and delivery of apporpriate services, as it’s the case with our health insurance system which is operating according to principles set forth by the mafia and third world dictatorships (I’ll write more about this befitting analogy later).
So here’s the latest news from California: “HMOs spent $6 billion on administrative costs, which include hefty CEO salaries, according to a report by the California Medical Association, which said the money could have gone toward driving down premiums or better protecting the insured.”
It seems like people are going bankrupt because of “rising insurance premiums and having their benefits gutted simultaneously.” Insurance companies are even going as far as “taking steps to persuade physicians and patients to switch from effective medicines to different medicines based primarily on cost to the insurer, without appropriate regard for each patient’s best treatment option,” according to an op-ed piece by Marcy Zwelling-Aamot, an internist and critical care physician in Los Alamitos.
I wonder when all this nonsense and criminal-like behavior on part of some insurance comapnies is going to stop.
I’m in Canada again for a business meeting and this was on the front page of Yahoo: “Canadians continue to suffer from a doctor shortage, according to a new report that found 1 in 5 people have not been able to find a physician to treat them regularly.”
There is a serious problem with access to care in Canada, proving that universal coverage does not equal universal access to care. It seems like no one in the country wants to go to medical school anymore, despite the fact that it’s almost free. The draconian healthcare system in Canada is turning a lot of smart people away from pursuing a career in medicine, a trend that is also happening in the U.S., although for different reasons.
The health insurance industry in the United States is the primary reason behind rising healthcare costs and the increasing disenchantment of physicians and patients with the status quo. By inserting themselves between doctors and patients, health insurance companies restrict access to care and divert massive amounts of healthcare dollars into corporate profits. The above graph tells a great story and doesn’t need a lot of explanation. It compares the profits of the top 5 health insurance companies to the top 5 companies in the oil and gas equipment sector who have a very bad reputation in the public eye. Health insurance companies have much better profit margins. It’s important to note that the graph depicts pure profits. Total revenues are much higher. For example, in 2006 UnitedHealth Group had a revenue of $71,542 million and “the evil” Halliburton had a revenue of $22,576 million. This is the money health insurance companies are taking from patients and withholding from doctors, getting in the way of delivering proper care in the process. It’s no surprise that the technical term used by insurers for payments given to doctors is medical loss.
The American Medical Association (AMA), which has been lately criticized by many physicians for no longer genuinely representing their interests, may be finally showing signs of change. In an attempt to “reduce the substantial administrative burden of ensuring accurate insurance payments for physician services” and to counteract health insurers’ biased practice of rating physicians, the AMA has announced the Cure for Claims Campaign, releasing its first health insurance report card. The country’s most profitable health insurance company, UnitedHealth Group, had the lowest rating in the AMA report, paying only 62% of the claims at the contracted rate (i.e., the negotiated rate promised to physicians).
Stating that physicians spend about 14% of their total income to obtain accurate payment for their services, the AMA says that “if physicians and payers use electronic transactions instead of manual ones for the estimated 3 billion claims submitted annually, the health care system can save over $90 billion each year.” This may be true but wouldn’t it better to just take the greedy hands of third parties completely out of our routine healthcare transactions?
The Open Letter Campaign is entering a new phase with top health policy experts and notable figures expressing their support for the movement. One of the latest supporters of the Open Letter is the world-renowned surgeon Dr. Edward R. Annis whose impressive accomplishments include serving concurrently as President of the American Medical Association and the World Medical Association from 1963-1964.
The following is Dr. Annis’s statement about the Open Letter:
I started medical practice in 1938 and for the first twenty years after that patients were free to choose their doctors, to agree with their doctors on what was best indicated to take care of any medical problems that required treatment, and to agree to fair and sensible payment for services rendered. For those with low income or no income, realistic adjustments were common practices so that proper treatment could always be provided.
I consider the Open Letter to be a superb document containing easily substantiated facts as to why people have been separated from their doctors and why todays medical costs are so abusive and unjustified.
The answers are in the first paragraph of the Open Letter which summarizes how patients have been separated from their doctors by politics, profits and special interests.
I consider the Open Letter to be an excellent document containing clear and understandable messages that need no additions and I hope that it gets Nationwide distribution to alert the American people.
Ed
Click here to read the Open Letter from America’s Physicians.
The current healthcare system is burdened by needless administrative costs that consume over 30% of our healthcare dollars. This is no small change and amounts to billions of dollars of wasted money and resources. Advocates of a single payer healthcare system claim that consolidating the fragmentation of third party requirements into a single payer system is the only way to recapture this wasted money. These people remind me of corporate managers who believe that the only way to improve their prospects is through mergers and acquisitions. Unfortunately, evidence and history have shown us that most mergers and acquisitions fail and, as James Surowiecki in a recent New Yorker article puts it, “corporate marriages only rarely end in bliss.”
Most corporate takeovers are motivated by maximization of efficiency and management utility reasons, rather than by the maximization of shareholders wealth (Mallikarjunappa). I’m afraid that even if we achieved better efficiency in a single payer system (highly unlikely), we won’t be able to maximize our shareholders wealth, i.e. the health of our patients. The health of the public can best be served by new innovations and value creation driven by competition among providers. We need to shift the balance of power from insurers to providers, whose objectives are best aligned with patients’ needs. Single payer systems, just like corporate mergers, are anti-competition. They are more concerned with size and control than value and quality. As Surowiecki observes “while acquisitions, almost by definition, boost a company’s growth rate, they too often make it bigger without making it better.” In reconfiguring our fragmented healthcare system we have to try our best to make it better, not bigger.
I’m in Canada right now for a business trip and just saw a very funny comedy show on TV called This Hour has 22 Minutes. One of the clips was a parody of the FOX TV series House. It seems like Canadians are very aware of the deficits of their healthcare system. Luckily I was able to find the clip on YouTube. Watch it to see what I mean.
HDL has long been praised as the “good cholesterol,” as opposed to its evil twin LDL, aka the “bad cholesterol.” Low levels of HDL and high levels of LDL are associated with increased risk of heart disease. High levels of HDL are thought to be protective against heart disease and can offset some of the risk associated with having high LDL levels, or so we think. A recent study published in JAMA by Ruth Frikke-Schmidt and colleagues is challenging the notion that having low HDL levels is harmful. This study, which looked at patients with genetically low levels of HDL due to mutations in a gene called ABCA1, found no increased risk of heart disease after 30 years of follow up.
The results of this study can weaken the arguments about the protective effects of HDL and raise doubts about the success of designing drugs that increase HDL levels. You may remember what happened to Pfizer’s torcetrapib, a drug that was talked up to be the next big thing for the company. Despite significantly increasing HDL levels, torcetrapid actually ended up increasing the risk of death and heart attacks, leading Pfizer to halt its entire program. Some experts noted that the adverse effects of torcetrapib may have been due to the fact that it raised the patients’ blood pressure. Merck currently has a drug like torcetrapib called anacetrapib under development, which reportedly increases HDL levels without raising blood pressure.
With Pfizer’s disappointing experience with torcetrapib and Frikke-Schmidt’s new study, Merck may be on the wrong track. I wonder if we should spend more resources in promoting better-proven ways of reducing the risk of heart disease, such as eating healthy and exercising. Easy to say, I know. I too sometimes wish for a magic pill.
Everyone should have access to affordable care but universal health coverage does not equal universal access to care. Just look at countries like the UK and Canada where almost everyone is insured but you have to wait for months to see a doctor. On a recent trip to Canada, I spoke to a psychiatrist who told me about seeing a psychotic patient after he was on a waiting list for over 6 months. This patient was suffering from vivid hallucinations and was deemed to be a danger to himself and others after he was thoroughly evaluated.
We all know that a lot of Canadians get their care in the US and are starting to have private options available to them in their own country. A 2005 ruling of the Supreme Court of Canada stating that the Quebec government cannot prevent people from paying for private insurance for healthcare procedures and services covered under the national plan was an important event in acknowledging the deficits of the Canadian system. In making this ruling, the Supreme Court of Canada recognized that “delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.”This speaks volumes about the inadequacy of universal healthcare systems to provide equal access to all beneficiaries. In fact our own VA system, which provides universal heathcare coverage for all veterans, is tainted with health disparities and unequal access to care. A recent study of health disparities in the VA system found that:
… disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient–provider communication, shared decision making, and patient participation.
So having a strong doctor-patient relationship and patient participation, or accountability, are crucial factors in determining health outcomes. Just because someone has health coverage doesn’t mean that they have guaranteed access to quality care. In today’s over-regulated and abrasive healthcare system, there is no true relationship between doctors and patients. Furthermore, patients are not empowered to take better care of themselves and expect their physicians to do everything for them. These issues are among the primary determinants of health outcomes.
A recent review by Leonard E. Egede and Hayden Bosworth recommends the following strategies for reduction of health disparities:
Evidence-based health systems interventions to improve the process of care
Culturally tailored patient-level interventions to enhance self-management, self-efficacy, patient activation and patient empowerment
Interventions to improve patient–provider communication, build trust, and enhance shared decision-making
Telemedicine-based interventions to improve health care access and participation for people who reside in rural areas
The above recommendations are commonsensical and can best be accomplished by a concerted effort on behalf of the medical establishment to embrace novel technologies that streamline processes and strengthen the doctor-patient relationship by creating new channels of communication. We need to be progressive and realistic, as opposed to judgmental and paternalistic, when it comes to solving existing disparities in health outcomes and access to care.
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Everyone should have access to affordable care but universal health coverage does not equal universal access to care. Just look at countries like the UK and Canada where almost everyone is insured but you have to wait for months to see a doctor. On a recent trip to Canada, I spoke to a psychiatrist who told me about seeing a psychotic patient after he was on a waiting list for over 6 months. This patient was suffering from vivid hallucinations and was deemed to be a danger to himself and others after he was thoroughly evaluated.
