Obama Health Care. Finally? Part II

Anyone watching the presidential address this evening has no doubt that Obama will be known as one of the “great communicators” among American presidents.  His speech was forceful, uplifting, emotional, and at times, tearful. One topic of interest to me was related to the process of health care reform.  Previously, the promise was for universal health care. Now the promise is for health care reform. The post election Obama/Biden plan is now posted on the White House website here.  The WH website rehashes what Obama/Biden were promoting during the election. The concept was touched upon during the speech this evening, but with much less detail. One aspect Obama did touch upon was the development of electronic health records as a way to reduce costs and medical errors. Is that really the best we can do?

I have spoken to many physicians whose hospitals have all electronic data entry including progress notes, laboratory reports, nursing notes, radiology and pathology reports and the like. What they tell me is that because of the “templates” used (pre-formatted outlines for ease of entry) it is much easier to document a patient’s information but it is also easier to make mistakes. Let me explain to you how that works.  During a patient’s stay a progress note is completed each day.  The template automatically imports vitals signs from the nursing notes, lab data from the laboratory, etc. What it also does is pull up your previous days note in it’s completed form for you to review and modify for the current day.  If you’re in a hurry, you can simply leave it the way it is and submit it for that day’s note with no changes, even if there may have been changes that should have been addressed and recorded.  This can be done day after day, with no change in the note but with significant changes in the patient’s condition.  So, did the expensive electronic medical record save money, provide better quality of care or increase efficiency?

Some of the concepts of the Obama plan are sound, should save money and extend health care to more people. Importation of safe drugs, more stringent scrutiny of the insurance companies, increased competition among them will all help to control, and even decrease, costs.  But unless the government looks within to trim waste and corruption, they will never be able to eliminate it elsewhere.  By making the waste inherent in any government endeavor the first and most public target, Obama will provide much needed credibility to further his efforts out into the private sector. Everyone respects a person who admits and overcomes their faults and shortcomings. If they can conquer their own, maybe they can help me with mine? Absolutely.  Just as Obama stated there would be open accounting of the cost of the war in Iraq, he should offer an open accountability of the waste in Medicare and Medicaid. Let all of us see just how our tax dollars are being spent by the very people who are asking us to trust them with even more of our money.

Mr. President, put our money where your mouth is!

Doc B.

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Advice is worth exactly what you pay for it.

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Obama Health Care. Finally? Part I

Things related to health care have been quiet lately, mostly because of the current economic crisis.  President Obama inherited a huge mess from George Bush, and it will take nothing short of a miracle, or just good old fashioned time, to make it better.  During his first month in office, Obama has overseen the most expensive piece of legislation aimed at defibrillating a dead economy back to life.  What has taken a backseat was health care.  That is until the number of unemployed began to increase to some of their highest monthly levels in years.  These displaced workers became some of the very “uninsured” that the candidates were drawing to their respective bosoms in an attempt to get their vote at election time.  Now that the number of uninsured have swelled because of increasing unemployment, the government again will have to step in to provide coverage, or they will be an even greater drain on an already strained health care system.  Obama’s first move was to extend CHIP to cover more children. Some of these are children of the recently unemployed or children who did not qualify for coverage previously.  And most people think that by extending that coverage fixes a problem.  But it really does not.  What it does is drive a self-paying patient into the health care system where the reimbursement for that patient is LESS than the cost to see them, process their claim and pay for the overhead costs associated with their visit.  Many physicians would rather NOT process the claim and just see them for free.  The feeling is that it is cheaper!

In my state of Ohio, Medicaid pays about 45% of the usual and customary fee that Medicare pays for the identical service.  Once that reduced payment goes through one of the managed Medicaid programs like Molina Healthcare, Amerigroup or Buckeye, the amount of reimbursement is much less, if you get paid at all.  No wonder they are so successful!  Just don’t pay.  Great concept.

As a result, many physician groups have refused to see these patients, limiting their choice for true quality health care.  If you look back to my previous post of 1/26/08, I looked at the cost of health care in the US using the same data that the candidates quoted last election to whip everyone into a frenzy.  Looking at the data again, you’ll see that by expanding CHIP, the government just increased funding for one of the most expensive health care programs in the country.  At nearly three times the cost of the private sector, it covers far fewer people for the same dollar.  And this is the type of fiscal responsibility that is pushing a 787 Billion dollar stimulus package through Congress.  What if the stimulus package has as much waste as the CHIP program the government thinks is so wonderful?

Sounds like politics as usual.

Doc B.

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Advice is worth exactly what you pay for it.

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Universal Health Care: A New Concept That Can Work

If you’ve read any of my previous posts, you’ll know that I am not a firm believer that any of the proposed solutions to the current health care crisis will work. Universal health care is a lofty goal but if there is any hope that it will work, it has to involve every American as an invested individual, equally and fairly.

In a conversation I was having with a few colleagues, an idea came to me that seems so simple it just has to work.  Let us assume that some form of universal health care will be enacted.  We must also assume that in order for the insurance companies to survive, only the largest and most efficient, able to take advantage of economies of scale, will be likely to survive.  Participation in any form of universal health care will be mandatory, whether it is sponsored or offered by an employer or the government. You will have little or no choice. When there are only a few suppliers or producers, you have an oligopoly.  An oligopoly is defined as “A market dominated by a small number of participants who are able to collectively exert control over supply and market prices”.  Does insurance fit his definition? Yes it will.

If we do have a situation where a few large suppliers or producers dominate a market, we as consumers, need regulation and protection from them just like we do in the utilities markets. You may not be aware of their presence, but the public utilities commissions of your individual states make sure that the suppliers of your water, electric, natural gas, railways and telephone services are treating you, the public, fairly. They are also responsible for the oversight of those industries, review requests for rate increases and monitor the industry’s return on equity and investment to their respective shareholders.  Can this model be applied to health insurance? Absolutely.

Anthem BC/BS was a mutual insurance company until it changed it’s status and was later acquired by Wellpoint, Inc.  A mutual company is defined as ” A company whose profits are distributed in proportion to the amount of business each participant does with the company”.  Sounds like a perfect structure for universal health care.  Since there will likely be mandatory participation, all payments to the insurance companies will come from the government in the form of direct or indirect payments. If each household is given a “share” in their insurance provider for each covered life, that household has a direct invested interest in seeing that their insurance company is as successful and profitable as possible.  They would be encouraged to utilize their health care resources only when necessary.  Decreased utilization by the individual covered lives means lower insurance company expenses , greater profits and additional distributions (dividends) per covered life.  Since every person covered receives a share when they sign up for insurance, you receive a direct financial dividend when your insurance provider earns a profit.  The most efficient insurance companies that are also providing the best health care benefit will naturally attract more participants, increasing their efficiencies through economies of scale.  In an effort to increase “shareholder” satisfaction, these companies, like their utility company counterparts, will seek to be more efficient, maximize value, return on investment and equity, and take the greatest advantage of financial leverage.  Rather refreshing for an insurance company to be operating on your behalf, as a shareholder, instead of only a hostage or paying customer.

It makes much more sense to combine the benefits of a regulated industry where each covered life is treated like a shareholder with a voice, in conjunction with what will be mandatory participation.  Under this scenario, you are as important to the insurer as a consumer as you are as shareholder.  The shareholder’s voice of displeasure can effect who runs the insurance company depending on how they vote at the annual shareholder’s meeting.  You also have a voice on how well you feel your insurance provider cares for you as a consumer.  If they do a good job, you’ll tell others, attracting more members/shareholders.  If you don’t like how you are being treated, you’ll change insurance carriers and tell all your friends and co-workers.

I don’t have a lot of confidence in the government to fix the problems with health care and I have less confidence that the insurance industry will do anything in the individual’s best interest unless they are made to do so.  But, if I am in a position to benefit directly from their quality and efficient care to patients (me and mine), I would feel much better about universal health care, government regulation and the insurance companies continuing as ongoing concerns.

Doc B.

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Advice is worth exactly what you pay for it.

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Bedbugs; Recurrence of an Age Old Scourge

When I was a child my parents would tuck me into bed and say “Sleep tight and don’t let the bedbugs bite”. It was horrifying to hear, especially as a child, but mostly because I had no idea what the hell they were talking about. I really had no idea they were even a real “bug” until the last few years. Bedbugs have made a roaring comeback. I believe the word “epidemic” is being used to describe their resurgence as one of the most difficult pests to eradicate. If you haven’t been infested with them, you probably know someone who has.

Most people assume that if you have bugs you must be dirty. Not the case with bedbugs. They are a true non discriminating, equal opportunity offender. They do not care about your income level, age, sex, level of education or your fine pedigree. You are a warm blooded human being. They love you for who you are. You can provide a blood meal. You are perfect. Thank God they don’t spread disease. At most they are a nuisance and may cause some itching or red spots, but they won’t really do you any harm. Still, I just don’t like the thought of the little buggers coming out of hiding at night to feast on my wonderfulness, while I’m sleeping.

A great website describing the life cycle of bedbugs, their preferred habitats, treatment options and some photographs can be found here. From what I can gather from news reports, articles and the website, we have a problem that we are not going to be able to control. Our most effective pesticide for combating bedbugs, DDT, was banned several years ago and that is when their numbers began to increase. Major metro areas are having problems that even their Departments of Health cannot afford to tackle.

Bedbugs can be spread during travel, from hotel rooms, hospitals, spring break, college dormitories and visiting the mansion down the street. They are everywhere and we have been helping them travel, by using us as their means of transportation. Once we drop our bedbug load, they make a home and start reproducing.

May be time to think about the development of new pesticides or at least take another look at DDT. If not, the time will come when everyone we know and everyplace we go will have them. I don’t want to be an insects nightly snack. Do you?

Doc B

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Advice is worth exactly what you pay for it.

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Back to Health Care Related Issues

Now that the election is over and a Democrat will be taking office, maybe we can get back to where we were when Clinton was in office. During the Clinton years, stem cell research advanced by leaps and bounds. Researchers were on the verge of developing stem cell lines for the treatment of diabetes, parkinson’s and advances in spinal cord injury. During the Bush administration’s hysterical ban on embryonic stem cells, beginning in 2001 and at least until Barack Obama takes office, the development of new stem cell lines was essentially illegal.

What Bush did do inadvertently was to push stem cell research in new areas. Much of the research was done overseas in collaboration with their American counterparts. Researchers in the US were forced to develop methods to encourage their existing stem cells to become pluripotential again for differentiation into different cells. They also were able to find and exploit adult stem cells from the tissues and blood of adults. After a very slow start, the stem cell community is ripe for the development of multiple lines that have the potential to treat and/or cure many diseases. All they need is the support that Obama will have the authority to give.

Interestingly enough, both McCain and Obama support stem cell research. During the last 3 years they both supported the same four pieces of legislation regarding stem cell research, including embryonic stem cells. Their main area of disagreement was in the use of embryos created for use in fertility clinics. The excess embryos are typically destroyed. Obama supports their use while McCain did not. Both supported the ban on the use of embryos created for the sole purpose of research. Now that Obama is president, hopefully he can get legislation passed that allows the use of those excess embryos from fertility clinics for stem cell research.

I have a particularly strong personal interest in this area. Type 1 diabetes runs in my family. My father died of complications related to his diabetes after suffering a heart attack and an amputation of his lower leg due to poor circulation. He had diabetes for more than 50 years. When you think about, he actually did quite well considering the fact that most of the advances and understanding of diabetes occurred in the last twenty years. Unfortunately, diabetes is genetic. My daughter and I are also type 1 diabetics. My hope is that even if there is no “cure” during my lifetime, there will be for my daughter.

While it may seem initially that my motivation is selfish (and I admit that I am looking at this from a personal perspective also), the statistics are overwhelming and crying for a cure. The current estimates(2008) state that there are currently 21 million Americans with diabetes and 54 million with pre-diabetes. Deaths due to diabetes and it’s complications are 224,000 per year. If the current trend continues, a person born in the year 2000 has a one in three chance of developing diabetes in their lifetime. For minorities, that lifetime chance of developing diabetes is a staggering one out of two!

The economic costs related to diabetes should place it on everyone’s radar for control and cure. A paper published by the American Diabetes Association entitled Economic Costs of Diabetes in The U.S in 2007, estimates that in 2007 there were 17.5 million diagnosed diabetics and another 6.6 million who were undiagnosed. Combined, that represents 8% of the total US population. For the diagnosed diabetics, the ADA calculates the “economic burden of diabetes caused by increased health resource use” to be $174 Billion per year. The increasing prevalence of diabetes means increasing expenditures for years to come.

From a purely fiscal point of view, it would make sense to prevent or cure a disease that has such a high cost to society. This can be accomplished in many ways. Stem cell research can, and will, find a cure for Type 1 diabetes eventually. But Type 1 diabetes represents only a small percentage of the total diabetic population. The epidemic of obesity, a major contributor to the development of Type 11 diabetes, has to be controlled as well.

As our new president takes office during the worst economic crisis since the Great Depression, the promise of universal healthcare will still be on many Americans minds as they are laid off, look for work or try to keep their current employment, even though it may offer no healthcare benefits. The enormous cost of implementing universal healthcare begs for cost containment, more efficient use of tax payer dollars, and focusing on disease prevention as a way to decrease our expenditures for chronic diseases. What a perfect opportunity for a progressive president to spend a few billion dollars in support of embryonic stem cell research that will yield an economic benefit worth many times it’s cost.

For a president who will make history just by having been elected, imagine the footnote that can be added to his already monumental achievement by stating that he was responsible for the first true cure of a costly chronic disease simply by his support of embryonic stem cell research. With the legislation currently in place, sure seems like a short step in the right direction.

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.

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