240,000 doctors from 19 organizations have sent this letter to Senator Reid stating they "oppose the legislation as currently written." This is a letter that provides an appropriate answer and not the too-soft-to-be-effective approach of the AMA. Needless to say that the AMA does not represent me! And as far as I know, the AMA does NOT represent the majority of physicians!
Here is a copy of a letter by Dr. Palmisano to Senator Reid. I support the opinion expressed in this letter, it represents my feelings very accurately.
Start of letter of Dr. Palmisano:
Lots of different opinions exist and if one takes this collection of doctors plus the Coalition of State and Specialty Societies led by MAG plus the Coalition to Protect Patients' Rights, one has a large number of physicians opposing the current legislation as written. So when Washington, DC says trust the doctors and doctors favor the reform as written, remind them of the "rest of the story."
Imagine a simple bill of about 20 pages containing individual ownership of health insurance policies, tax credits to help those who buy their own insurance rather than being job-locked, proven medical liability reform, the right to privately contract for patients and physicians without penalty, convert current Medicaid to a voucher system and give those patients the same rights as senators and representatives, namely the right to pick insurance from an array of choices and periodically change the policy if needed. Encourage medical saving accounts rather than putting up barriers or trying to eliminate them. Address pre-existing conditions via purchasing exchanges. And yes, allow people to buy health insurance across state lines to ensure real competition.
Wow! That is a plan that will keep doctors in practice, give the patients control of their destiny, and not bankrupt America. If the plans in the House and Senate pass, the system will collapse and in the end the doctors will be blamed for the failure. Count on it.
Meanwhile, here is the letter that went to Senator Reid on behalf of 240,000 doctors.
December 1, 2009
The Honorable Harry Reid
Majority Leader
United States Senate
Washington, D.C. 20510
Dear Leader Reid:
On behalf of the over 240,000 surgeons and anesthesiologists we represent and the millions of surgical patients we treat each year, the undersigned 19 organizations strongly support the need for national health care reform and share the Senate’s commitment to make affordable quality health care more accessible to all Americans. As you know, we have been working diligently and in good faith with the Senate during the past year and have provided input at various stages in the process of drafting the Senate’s health care reform bill. To this end, we have reviewed the
Patient Protection and Affordable Care Act of 2009.
As you may recall, on November 4 our coalition sent you a letter outlining a number of serious concerns that needed to be addressed to ensure that any final health
care reform package would be built on a solid foundation in the best interest of our patients. Since those concerns have not been adequately addressed, as detailed below, we must oppose the legislation as currently written.
We oppose:
• Establishment and proposed implementation of an Independent Medicare Advisory Board whose recommendations could become law without congressional action;
• Mandatory participation in a seriously flawed Physician Quality Reporting Initiative (PQRI) program with penalties for non-participation;
• Budget-neutral bonus payments to primary care physicians and rural general surgeons;
• Creation of a budget-neutral value-based payment modifier which CMS does not have the capability to implement and places the provision on an unrealistic and unachievable timeline;
• Requirement that physicians pay an application fee to cover a background check for participation in Medicare despite already being obligated to meet considerable
requirements of training, licensure, and board certification;
• Relying solely on the limited recommendations of the United States Preventive Services Task Force (USPSTF) in determining a minimum coverage standard for
preventive services and associated cost-sharing protections;
• The so-called “non-discrimination in health care” provision that would create patient confusion over greatly differing levels of education, skills and training among health care professionals while inappropriately interjecting civil rights concepts into state scope of practice laws;
• The absence of a permanent fix to Medicare’s broken physician payment system and any meaningful proven medical liability reforms; and
• The last-minute addition of the excise tax on elective cosmetic medical procedures. This tax discriminates against women and the middle class. Experience at the state level has demonstrated that it is a failed policy which will not result in the projected revenue. Furthermore, this provision is arbitrary, difficult to administer, unfairly puts the physician in the role of tax collector, and raises
serious patient confidentiality issues.
This bill goes a long way towards realizing the goal of expanding health insurance coverage and takes important steps to improve quality and explore innovative systems for health care delivery. Despite serious concerns, there are several provisions in the Patient Protection and Affordable Care Act of 2009 that the surgical community supports, strongly believes are in the best interest of the surgical patients, and should be maintained in any final package. Specifically these include: health insurance market reforms, including the elimination of coverage denials based on preexisting medical conditions and guaranteed availability and renewability of health insurance coverage; strengthening patient access to emergency and trauma care by ensuring the survival of trauma centers, developing regionalized systems of care to optimize patient outcomes, and improving emergency care for children; welldesigned
clinical comparative effectiveness research, conducted through an independent institute and not used for determining medical necessity or making coverage and payment decisions or recommendations; and the exclusion of ultrasound from the increase in the utilization rate for calculating the payment for imaging services.
Further, while redistribution of unused residency positions to general surgery is a positive step in addressing the predicted shortage in the surgical workforce, we
believe that the Senate should look more broadly at the issue of limits on residency positions for all specialties that work in the surgical setting that are also facing severe workforce problems.
Finally, we are pleased that you have accepted our suggestion and removed language which would reduce payments to physicians who are found to have the highest
utilization of resources - without regard to the acuity of the patient’s physical condition or the complexity of the care being provided. We thank you for making this important change.
While we must oppose the Patient Protection and Affordable Care Act as currently written, the surgical coalition is committed to the passage of meaningful and comprehensive health care reform that is in the best interest of our patients. We are committed to working with you to make critical changes that are vital to ensuring that this legislation is based on sound policy, and that it will have a long-term positive impact on patient access to safe and effective high-quality
surgical care.
Sincerely,
American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Otolaryngology-Head and Neck Surgery
American Association of Neurological Surgeons
American Association of Orthopaedic Surgeons
American College of Obstetricians and Gynecologists
American College of Osteopathic Surgeons
American College of Surgeons
American Osteopathic Academy of Orthopedics
American Society of Anesthesiologists
American Society of Breast Surgeons
American Society of Cataract and Refractive Surgery
American Society of Colon and Rectal Surgeons
American Society for Metabolic & Bariatric Surgery
American Society of Plastic Surgeons
American Urological Association
Congress of Neurological Surgeons
Society for Vascular Surgery
Society of American Gastrointestinal and Endoscopic Surgeons
Society of Gynecologic Oncologists
cc: United States Senate
Stay well,
Donald
Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
312-560-0180 cell
DJP@intrepidresources.com
www.intrepidresources.com
www.onleadership.us
This DJP Update goes to 2156 leaders in Medicine representing all of
the State Medical Associations and over 100 Specialty Societies plus
some other friends.
You can share it with your friends and colleagues and it has the potential to reach
800,000 physicians.
Sunday, December 6, 2009
Tuesday, September 8, 2009
The AMA does not represent physicians
We physicians should declare that the AMA does NOT speak for us – and that they have the spine of a jellyfish....
The AMA recently had a historic chance of opening their mouths very wide and getting their intentions known. They had the attention of the president and the media and the pundits – and for a brief moment everybody on the health care reform stage was waiting to see what "the doctors" think about Obama’s important reform project. If you negotiate with someone like the US president, you do not open the conversation by saying "We basically agree with you". In that instant, you have lost, you are dead, you are in his pocket and only a side note in the health care debate.
And the AMA blew it, they blew it so magnificently and so terribly that I cannot find words for it. It was horrible....
Here is what they should have said:
”Dear Mr President:
before we even begin to talk about reform,
WE WANT
1. MALPRACTICE REFORM – and we want it our way, for example with health courts or with “Patient’s comp”, an institution analog to Workman’s comp. This will be much more fair than the present lottery system. It will encourage systems reform, it will curb defensive medicine. And that will save the country and the health care system a bold 100-200 billion a year - just what you want.
2. we want GUARANTEED BALANCE BILLING – for all patients, anywhere, all the time. Just like the dentists. Because that is the only way to ensure our financial survival. Then your government can decide to pay peanuts for our work, and we will still be able to find a way to survive.
3. and then, still before we take a look at your bill, we demand COLLECTIVE
BARGAINING for physicians. This seems to run in counter of the previous demand, but it is for all those physicians that agree to accept whatever an insurance company or government decides to pay us for our work. It is the only way they can hold up against the massive pressure of these usually very large and very powerful entities that have been lowering payments to us consistently over the past 20 years.
WE WANT THIS, because WE ARE health care. We are the people who do the work, we are the people who have the knowledge, the skills and the experience. Nobody else has.
When you have allowed us to write the above three points into the bill, we will consider the rest of the bill. And don’t even try to insinuate that we do not have the best interest of patients in mind, that would be despicable rhetoric – we have work for them all day long, it is our dedication, our choice, our profession to have their best interest in mind!
And if you and your party do not agree to this we will say louder than you can imagine that we are opposed to your plans, and we will not cooperate, in no way. We will continue to trumpet this into the world, no matter what happens. And we are not only the heart and core of health care, we talk to patients, to everybody, every day, all day long”
Now, that would have been a message! Not a meek rearranging of priorities of the points in Obama’s reform list.
I am not blind enough to think that these demands will go through. But you have to bring them up, you have to shout them out, you have to stand up for your concerns and your needs! Only then can you pester the other side with "well, you did not agree to 1 nor to 2 nor to 3 etc....so now you have to....."
The AMA does not even know the 101 of negotiating. What the AMA did was to lower their heads and demurely convey "oh, our demands will not go anywhere anyway, we may just throw the towel right away". Predictably the president filed the AMA away as “done deal, they are on my side”. Check.
We should be- and we are - selfless and always place patients first when in the office. But in politics we also have a few needs of our own. Representing those needs requires more than the AMA can see, can muster, can wrap their minds and their inner strength around and definitely more than what they can do.
The AMA missed, again, a historic opportunity to represent the interests of physicians. If they represent anything at all, it is certainly not physicians…..
AMA, if you have NO GUTS - and NO STREET SMARTS - then you should at least have the decency not to pretend to "represent" physicians.
Go home, AMA! You are not representing me!
The AMA recently had a historic chance of opening their mouths very wide and getting their intentions known. They had the attention of the president and the media and the pundits – and for a brief moment everybody on the health care reform stage was waiting to see what "the doctors" think about Obama’s important reform project. If you negotiate with someone like the US president, you do not open the conversation by saying "We basically agree with you". In that instant, you have lost, you are dead, you are in his pocket and only a side note in the health care debate.
And the AMA blew it, they blew it so magnificently and so terribly that I cannot find words for it. It was horrible....
Here is what they should have said:
”Dear Mr President:
before we even begin to talk about reform,
WE WANT
1. MALPRACTICE REFORM – and we want it our way, for example with health courts or with “Patient’s comp”, an institution analog to Workman’s comp. This will be much more fair than the present lottery system. It will encourage systems reform, it will curb defensive medicine. And that will save the country and the health care system a bold 100-200 billion a year - just what you want.
2. we want GUARANTEED BALANCE BILLING – for all patients, anywhere, all the time. Just like the dentists. Because that is the only way to ensure our financial survival. Then your government can decide to pay peanuts for our work, and we will still be able to find a way to survive.
3. and then, still before we take a look at your bill, we demand COLLECTIVE
BARGAINING for physicians. This seems to run in counter of the previous demand, but it is for all those physicians that agree to accept whatever an insurance company or government decides to pay us for our work. It is the only way they can hold up against the massive pressure of these usually very large and very powerful entities that have been lowering payments to us consistently over the past 20 years.
WE WANT THIS, because WE ARE health care. We are the people who do the work, we are the people who have the knowledge, the skills and the experience. Nobody else has.
When you have allowed us to write the above three points into the bill, we will consider the rest of the bill. And don’t even try to insinuate that we do not have the best interest of patients in mind, that would be despicable rhetoric – we have work for them all day long, it is our dedication, our choice, our profession to have their best interest in mind!
And if you and your party do not agree to this we will say louder than you can imagine that we are opposed to your plans, and we will not cooperate, in no way. We will continue to trumpet this into the world, no matter what happens. And we are not only the heart and core of health care, we talk to patients, to everybody, every day, all day long”
Now, that would have been a message! Not a meek rearranging of priorities of the points in Obama’s reform list.
I am not blind enough to think that these demands will go through. But you have to bring them up, you have to shout them out, you have to stand up for your concerns and your needs! Only then can you pester the other side with "well, you did not agree to 1 nor to 2 nor to 3 etc....so now you have to....."
The AMA does not even know the 101 of negotiating. What the AMA did was to lower their heads and demurely convey "oh, our demands will not go anywhere anyway, we may just throw the towel right away". Predictably the president filed the AMA away as “done deal, they are on my side”. Check.
We should be- and we are - selfless and always place patients first when in the office. But in politics we also have a few needs of our own. Representing those needs requires more than the AMA can see, can muster, can wrap their minds and their inner strength around and definitely more than what they can do.
The AMA missed, again, a historic opportunity to represent the interests of physicians. If they represent anything at all, it is certainly not physicians…..
AMA, if you have NO GUTS - and NO STREET SMARTS - then you should at least have the decency not to pretend to "represent" physicians.
Go home, AMA! You are not representing me!
Tuesday, September 1, 2009
The Physician' s Appeal
The Physicians' Appeal, written by the The Sermo Team - of Sermo.com
To the American People,
We, the physicians of this country want to reform health care and improve the quality and access to care for our patients while reducing costs. True health care reform will only succeed if:
1. Unnecessary tests and procedures are reduced through tort and malpractice reform
2. Doctors are allowed to spend more time with their patients and less time on paperwork by streamlining billing and making pricing more transparent (create an alternative to CPT codes)
3. Medical decisions are made by physicians and their patients, not insurance company administrators
4. Adequate supply of qualified physicians is assured by revising the methods used to calculate reimbursements.
We invite policy makers to work directly with the men and women who are on the frontlines of health care each and every day caring for the citizens of this country.
We pledge to be partners in true health care reform, improving the health care delivery system in this country while honoring the Hippocratic oath that we all have taken.
Respectfully Yours,
America's Physicians.
To the American People,
We, the physicians of this country want to reform health care and improve the quality and access to care for our patients while reducing costs. True health care reform will only succeed if:
1. Unnecessary tests and procedures are reduced through tort and malpractice reform
2. Doctors are allowed to spend more time with their patients and less time on paperwork by streamlining billing and making pricing more transparent (create an alternative to CPT codes)
3. Medical decisions are made by physicians and their patients, not insurance company administrators
4. Adequate supply of qualified physicians is assured by revising the methods used to calculate reimbursements.
We invite policy makers to work directly with the men and women who are on the frontlines of health care each and every day caring for the citizens of this country.
We pledge to be partners in true health care reform, improving the health care delivery system in this country while honoring the Hippocratic oath that we all have taken.
Respectfully Yours,
America's Physicians.
A Few Words to Our Patients
This is a letter that I recently received from Dr. Cameron Schaeffer, pediatric urologist in Lexington, Kentucky. It stands out due to its clarity and creativity. I very much agree with him!
Begin quote:
We, the undersigned physicians of this community, are concerned that expansion of the role of the Government in our nation’s health care system will significantly harm our nation, our profession, and our ability to care for you. We fear that we are on a path well-traveled by other nations and with a destination so predictable that the journey need not be repeated. Despite its faults, America still has the best health care system in the world as evidence by the hundreds of thousands of people who flock to this country every year for training and care; for critics to claim otherwise for political gain and without scrutiny is unconscionable.
We adhere to the following:
Privacy: Third party involvement in the doctor patient relationship is a fundamental violation of patient privacy and our Hippocratic Oath. Personal health information of the most sensitive nature already resides in the vast databases of insurance companies and governmental agencies. A centerpiece of proposed Government health care reform is the expansion of these databases, which are NEVER secure. We do not want your most personal secrets to leave our offices without your explicit permission.
Freedom: This Nation and its economy were founded on the right of independent parties to contract freely for goods and services in a competitive market, and this includes doctors and patients. Free markets lower costs and improve services. Goods and services are exchanged based on price, and prices for health-related services should be negotiated in advance of illness by insurance companies on behalf of their clients or by patients contracting directly with doctors and hospitals. Government price schedules have no market basis and often do not adequately cover physician costs, which is why many doctors do not accept Medicare and Medicaid. For markets to function properly, people must understand what they are exchanging. Our health care system woefully lacks transparency in price, cost, reimbursement, and quality of the services provided at every level. Reforms should empower all parties in the health care economy to contract freely, intelligently, transparently, and in good faith. Your freedom to determine what happens to your body must not be abridged.
Cost: The costs of Medicare and Medicaid are already staggering and unsustainable, and the Congressional Budget Office has stated that additional programs will incur more debt. Our debts, mostly carried by foreign countries, must be paid by our children or by devaluing the dollar. This course threatens our economy and our future as a Nation. Our health care system is based on, and our tax laws promote, third party payment schemes which are inherently inflationary because the patient and his doctor are incentivized to consume. Until we are incentivized to shop wisely as individual consumers caring for our own bodies, the problem will continue. As long as third parties, i.e. the Government an insurance companies, are paying the bills, they are incentivized to limit and to ration care.
Insurance Reform: We need fundamental insurance reform in this country. We can start by making health insurance about insuring risk of serious injury or illness, not a prepayment scheme for every sniffle. We have auto insurance for accidents, not oil changes. New private risk pools for individuals and not-for-profit insurance companies would enhance competition, i.e. improve services and lower costs. If insurance companies are required to accept all applicants, including those with preexisting conditions, they will create larger risk pools to manage the risk. The Government should not be allowed to “compete” because it is impossible to compete against an entity that prints money, does not have to collect premiums, does not have wellness programs, and does not pay taxes. Patients should be allowed to purchase health insurance across state lines like everything else that is sold in this country, and it should be tax-deductible. They should buy it as individuals for life, like life insurance, which makes it guaranteed, portable, and not subject to preexisting conditions. Freed of the need to provide health insurance for employees, employers will pay higher wages to stay competitive in the labor marketplace. Insurance companies need to improve transparency in physician contracts and quit playing reimbursement games with doctors.
Caring for the Uninsured: The Government cannot make uninsured patients disappear by passing laws. They are a societal problem. To ask providers to shoulder most of the cost of caring for the uninsured is unfair. The Government should allow providers to deduct the cost of caring for the uninsured from their taxes, like any other act of charity. Rather than create new programs for the uninsured, the Government should create a mechanism to allow immediate enrollment of the uninsured in Medicaid at the point of service. The insurance status and personal financial liability of these patients can be evaluated retroactively by Medicaid.
Malpractice Reform: The cost of medical liability insurance for physicians is high, and the cost of defensive medicine is real and enormous. Ultimately, these costs are paid by all of us. The utter absence of any discussion of malpractice reform in Washington is a disgrace and fundamentally dishonest. We believe that patients should be compensated for economic damages caused by medical malpractice, but we also believe that our legal system is a circus of blackmail and jackpots, disconnected from true medical malpractice and true damages. Furthermore, and cruelly, it takes years for deserving patients to receive compensation, long after they most need it.
Regulatory Burden: Our regulatory burden is onerous both in time and money, and it frequently contributes nothing of material value to you, our patients. We need relief from this burden to better care for you. Any proposed reforms should diminish, not expand, this regulatory burden.
Personal Responsibility: We all have a civic duty to buy health insurance, and those who cannot afford it should be subsidized, perhaps through taxes on unhealthy foods and non-essential purchases. Some people, particularly the young and healthy, choose not to buy health insurance, even when they can afford it. These individuals must be incentivized to buy health insurance to spread the risk.
Wellness: Under our current system, patients have almost no financial incentive to lead healthy lifestyles. Mechanisms to incentivize wellness could be created, and patients who take care of themselves should be rewarded with lower health insurance premiums.
Professionalism: We are professionals, not commodities. Our training required years of dedication, and it came at a great cost, personally and financially. The assets of the businessman reside in his building and its contents; ours reside in our heads and in our hands. They belong to us, not the insurance companies and not the Government. These assets have real value, and we passionately want to use them to heal you when you are sick, on mutually agreeable terms. Any attempt to force us to work for the Government, without our individual consent, is a form of theft, a corruption of our relationship with you, and an assault on our professionalism.
Stand with Us: Send this advertisement to your representatives and tell them that free market principles can work in health care, just as they do in other service industries. Demand that they fix Medicare, Medicaid, and every VA Hospital BEFORE creating any additional programs. Demand removal of distortions in the tax code that promote third party payment and thus health care inflation. Demand the expansion of tax-free medical savings accounts which empower you, the patient, to find good care at a good price. Demand policies that incentivize providers to discuss their results and disclose their pricing. Remind them that “health care” starts with individuals and that all Americans must be incentivized to stay healthy. Tell them that jackpot justice has no place in the compensation of patients who have been injured while receiving medical care, irrespective of the cause of injury. Stand for freedom, dignity, and respect for the individual citizen, and oppose any reforms that might imperil your right to determine what happens to your body.
Signatures:
Contact information for Kentucky Congressmen:
Email: www.webslingers.com/jhoffman/congress-email.html
Jim Bunning 316 Hart Senate OB Washington, DC 20510
Phone: 202/224-4343 Fax: 202/228-1373
Mitch McConnell 361-A Russell Senate OB Washington, DC 20510
Phone: 202/224-2541 Fax: 202/224-2499
Ed Whitfield 2411 Rayburn HOB Washington, DC 20515
Phone: 202/225-3115 Fax: 202/225-3547
Brett Guthrie 510 Cannon HOB Washington, DC 20515
Phone: 202/225-3501 Fax: 202/226-2019
John Yarmuth 435 Cannon HOB Washington, Dc 20515
Phone: 202/225-5401 Fax: 202/225-5776
Geoff Davis 1108 Longworth NOB Washington, DC 20515
Phone: 202/225-3465 Fax: 202/225-0003
Hal Rogers 2406 Rayburn HOB Washington, DC 20515
Phone: 202/225-4601 Fax: 202/225-0940
Ben Chandler 1504 Longworth HOB Washington, Dc 20515
Phone: 202/225-4706 Fax: 202/225-2122
This advertisement was wholly purchased by the physicians listed above, unconnected with any political party or interest group
Begin quote:
We, the undersigned physicians of this community, are concerned that expansion of the role of the Government in our nation’s health care system will significantly harm our nation, our profession, and our ability to care for you. We fear that we are on a path well-traveled by other nations and with a destination so predictable that the journey need not be repeated. Despite its faults, America still has the best health care system in the world as evidence by the hundreds of thousands of people who flock to this country every year for training and care; for critics to claim otherwise for political gain and without scrutiny is unconscionable.
We adhere to the following:
Privacy: Third party involvement in the doctor patient relationship is a fundamental violation of patient privacy and our Hippocratic Oath. Personal health information of the most sensitive nature already resides in the vast databases of insurance companies and governmental agencies. A centerpiece of proposed Government health care reform is the expansion of these databases, which are NEVER secure. We do not want your most personal secrets to leave our offices without your explicit permission.
Freedom: This Nation and its economy were founded on the right of independent parties to contract freely for goods and services in a competitive market, and this includes doctors and patients. Free markets lower costs and improve services. Goods and services are exchanged based on price, and prices for health-related services should be negotiated in advance of illness by insurance companies on behalf of their clients or by patients contracting directly with doctors and hospitals. Government price schedules have no market basis and often do not adequately cover physician costs, which is why many doctors do not accept Medicare and Medicaid. For markets to function properly, people must understand what they are exchanging. Our health care system woefully lacks transparency in price, cost, reimbursement, and quality of the services provided at every level. Reforms should empower all parties in the health care economy to contract freely, intelligently, transparently, and in good faith. Your freedom to determine what happens to your body must not be abridged.
Cost: The costs of Medicare and Medicaid are already staggering and unsustainable, and the Congressional Budget Office has stated that additional programs will incur more debt. Our debts, mostly carried by foreign countries, must be paid by our children or by devaluing the dollar. This course threatens our economy and our future as a Nation. Our health care system is based on, and our tax laws promote, third party payment schemes which are inherently inflationary because the patient and his doctor are incentivized to consume. Until we are incentivized to shop wisely as individual consumers caring for our own bodies, the problem will continue. As long as third parties, i.e. the Government an insurance companies, are paying the bills, they are incentivized to limit and to ration care.
Insurance Reform: We need fundamental insurance reform in this country. We can start by making health insurance about insuring risk of serious injury or illness, not a prepayment scheme for every sniffle. We have auto insurance for accidents, not oil changes. New private risk pools for individuals and not-for-profit insurance companies would enhance competition, i.e. improve services and lower costs. If insurance companies are required to accept all applicants, including those with preexisting conditions, they will create larger risk pools to manage the risk. The Government should not be allowed to “compete” because it is impossible to compete against an entity that prints money, does not have to collect premiums, does not have wellness programs, and does not pay taxes. Patients should be allowed to purchase health insurance across state lines like everything else that is sold in this country, and it should be tax-deductible. They should buy it as individuals for life, like life insurance, which makes it guaranteed, portable, and not subject to preexisting conditions. Freed of the need to provide health insurance for employees, employers will pay higher wages to stay competitive in the labor marketplace. Insurance companies need to improve transparency in physician contracts and quit playing reimbursement games with doctors.
Caring for the Uninsured: The Government cannot make uninsured patients disappear by passing laws. They are a societal problem. To ask providers to shoulder most of the cost of caring for the uninsured is unfair. The Government should allow providers to deduct the cost of caring for the uninsured from their taxes, like any other act of charity. Rather than create new programs for the uninsured, the Government should create a mechanism to allow immediate enrollment of the uninsured in Medicaid at the point of service. The insurance status and personal financial liability of these patients can be evaluated retroactively by Medicaid.
Malpractice Reform: The cost of medical liability insurance for physicians is high, and the cost of defensive medicine is real and enormous. Ultimately, these costs are paid by all of us. The utter absence of any discussion of malpractice reform in Washington is a disgrace and fundamentally dishonest. We believe that patients should be compensated for economic damages caused by medical malpractice, but we also believe that our legal system is a circus of blackmail and jackpots, disconnected from true medical malpractice and true damages. Furthermore, and cruelly, it takes years for deserving patients to receive compensation, long after they most need it.
Regulatory Burden: Our regulatory burden is onerous both in time and money, and it frequently contributes nothing of material value to you, our patients. We need relief from this burden to better care for you. Any proposed reforms should diminish, not expand, this regulatory burden.
Personal Responsibility: We all have a civic duty to buy health insurance, and those who cannot afford it should be subsidized, perhaps through taxes on unhealthy foods and non-essential purchases. Some people, particularly the young and healthy, choose not to buy health insurance, even when they can afford it. These individuals must be incentivized to buy health insurance to spread the risk.
Wellness: Under our current system, patients have almost no financial incentive to lead healthy lifestyles. Mechanisms to incentivize wellness could be created, and patients who take care of themselves should be rewarded with lower health insurance premiums.
Professionalism: We are professionals, not commodities. Our training required years of dedication, and it came at a great cost, personally and financially. The assets of the businessman reside in his building and its contents; ours reside in our heads and in our hands. They belong to us, not the insurance companies and not the Government. These assets have real value, and we passionately want to use them to heal you when you are sick, on mutually agreeable terms. Any attempt to force us to work for the Government, without our individual consent, is a form of theft, a corruption of our relationship with you, and an assault on our professionalism.
Stand with Us: Send this advertisement to your representatives and tell them that free market principles can work in health care, just as they do in other service industries. Demand that they fix Medicare, Medicaid, and every VA Hospital BEFORE creating any additional programs. Demand removal of distortions in the tax code that promote third party payment and thus health care inflation. Demand the expansion of tax-free medical savings accounts which empower you, the patient, to find good care at a good price. Demand policies that incentivize providers to discuss their results and disclose their pricing. Remind them that “health care” starts with individuals and that all Americans must be incentivized to stay healthy. Tell them that jackpot justice has no place in the compensation of patients who have been injured while receiving medical care, irrespective of the cause of injury. Stand for freedom, dignity, and respect for the individual citizen, and oppose any reforms that might imperil your right to determine what happens to your body.
Signatures:
Contact information for Kentucky Congressmen:
Email: www.webslingers.com/jhoffman/congress-email.html
Jim Bunning 316 Hart Senate OB Washington, DC 20510
Phone: 202/224-4343 Fax: 202/228-1373
Mitch McConnell 361-A Russell Senate OB Washington, DC 20510
Phone: 202/224-2541 Fax: 202/224-2499
Ed Whitfield 2411 Rayburn HOB Washington, DC 20515
Phone: 202/225-3115 Fax: 202/225-3547
Brett Guthrie 510 Cannon HOB Washington, DC 20515
Phone: 202/225-3501 Fax: 202/226-2019
John Yarmuth 435 Cannon HOB Washington, Dc 20515
Phone: 202/225-5401 Fax: 202/225-5776
Geoff Davis 1108 Longworth NOB Washington, DC 20515
Phone: 202/225-3465 Fax: 202/225-0003
Hal Rogers 2406 Rayburn HOB Washington, DC 20515
Phone: 202/225-4601 Fax: 202/225-0940
Ben Chandler 1504 Longworth HOB Washington, Dc 20515
Phone: 202/225-4706 Fax: 202/225-2122
This advertisement was wholly purchased by the physicians listed above, unconnected with any political party or interest group
Friday, May 8, 2009
"Right to Healthcare"
You have RIGHT to health care, you say?
Sounds good, doesn't it, feels good to demand it, doesn't it? Politicians demand it, "humanity" demands it, "compassion for your fellow citizens" demands it, health care is just...one of those "unalienable rights". Isn't it?
Well, you know, "Health Care" is not an abstract concept, and not just "something". Health care is what I personally do, an individual service from me for you. I requires preparation, a special setting and often help from other people. Health care is why I get up in the morning and why I go to work.
It took me quite a while to be able to give health care, by the way. 15 years of training, with countless sleepless night, plenty of sacrifices, low income for all those years, pressure and hard work.
And you state that you simply are entitled to this, that it is your right?
Did you do something for me? Did you help me get into medical school? Funny, I also did not see you paying for my medical school, and I did not see you paying for my residency training, nor I did not see you staying up at night with me, bringing coffee, holding my hand, nor helping me in any way at all. I passed all the exams quite well all by myself, and I do not remember you helping me to pass them. And now you claim a right to my success?
In short, you did not contribute to my 15 years of training, but now you say that day or night you have a right to my unique knowledge, my unique skills, my expertise, just because....?
Oh, because it is the "human" thing to do, the "compassionate" thing to do? Or is it because there was an "oath" that was written over 2500 years ago, at a time when we had no electricity, no technology, no paper money, an economic system of the most simple and underdeveloped form.....
Come on....
Ok, you say that you have a right to healthcare because it is really important to you and your really need it, you say it is a matter of life and death...
Well, well, don't we all have our needs..
Counting my needs, I would start with food, which is really, really important. Should food not be a right?
Well, go to your farmer, your supermarket or your grocery store and tell them that you have come to claim your right to food!
Let's continue with shelter, housing. Very basic. Just go to the construction company and tell them that you really, really need a house, and that you think housing is a right! Find out how well that goes over..
Next go to the Gap and tell them that you have a right to clothing! Listen carefully to their answer.
Money, well, that is really important. Money is handy, can be traded for a lot of other useful things. Please go to a bank and claim your "right " to money! Watch how pleased they are....
You might also want to call Warren Buffet and tell him you have a right to his expertise and his skills, after all, he is rich enough.....
Oh, I forgot....
Remind me, since you claim a right to MY work, do I actually have a right to YOUR work? NO? Why does this not surprise me?
To be frank, I think it is pretty nervy of you to demand that you have a right to my work!
To sum this up: I am a free individual and I can do with my life and my knowledge and my skills whatever I please. And no, you do not have any kind of "right" to my knowledge, my expertise and my skills. And, No, you do not have a right to my time, be it by day or by night, my past sacrifices, my blood, sweat and tears. No, you do not have a right to it.
Oh, so you don't really want to claim you right from me, you want to claim it from the government? You think "the government should provide health care"?
May I ask how this will happen? Do you expect the town clerk to provide care? The government as such cannot provide healthcare. Physicians provide health care. Should I assume that you want the government to lean on me, to force me to give you what is a "right"? Is that what you want?
You know, in the end it comes down to you, the patient, and me, the physician. Nobody else. That is health care. I do not see how the government matters in this.
And, no I will not give the government a discount. The government does not give me discounts either. And you remain exactly the same patient, regardless if you pay or if the government pays.
Just to be clear, I do not owe the government anything either. Neither does the government have a right to me, to my life, my skills, my expertise and my knowledge. To the government I am just the same as to you: an individual who is independent, to whose efforts and time neither you nor the government has any kind of "right".
We can trade though, at arm's length, and if we come to a mutually beneficial agreement I will be happy to give you my time and skills
Sounds good, doesn't it, feels good to demand it, doesn't it? Politicians demand it, "humanity" demands it, "compassion for your fellow citizens" demands it, health care is just...one of those "unalienable rights". Isn't it?
Well, you know, "Health Care" is not an abstract concept, and not just "something". Health care is what I personally do, an individual service from me for you. I requires preparation, a special setting and often help from other people. Health care is why I get up in the morning and why I go to work.
It took me quite a while to be able to give health care, by the way. 15 years of training, with countless sleepless night, plenty of sacrifices, low income for all those years, pressure and hard work.
And you state that you simply are entitled to this, that it is your right?
Did you do something for me? Did you help me get into medical school? Funny, I also did not see you paying for my medical school, and I did not see you paying for my residency training, nor I did not see you staying up at night with me, bringing coffee, holding my hand, nor helping me in any way at all. I passed all the exams quite well all by myself, and I do not remember you helping me to pass them. And now you claim a right to my success?
In short, you did not contribute to my 15 years of training, but now you say that day or night you have a right to my unique knowledge, my unique skills, my expertise, just because....?
Oh, because it is the "human" thing to do, the "compassionate" thing to do? Or is it because there was an "oath" that was written over 2500 years ago, at a time when we had no electricity, no technology, no paper money, an economic system of the most simple and underdeveloped form.....
Come on....
Ok, you say that you have a right to healthcare because it is really important to you and your really need it, you say it is a matter of life and death...
Well, well, don't we all have our needs..
Counting my needs, I would start with food, which is really, really important. Should food not be a right?
Well, go to your farmer, your supermarket or your grocery store and tell them that you have come to claim your right to food!
Let's continue with shelter, housing. Very basic. Just go to the construction company and tell them that you really, really need a house, and that you think housing is a right! Find out how well that goes over..
Next go to the Gap and tell them that you have a right to clothing! Listen carefully to their answer.
Money, well, that is really important. Money is handy, can be traded for a lot of other useful things. Please go to a bank and claim your "right " to money! Watch how pleased they are....
You might also want to call Warren Buffet and tell him you have a right to his expertise and his skills, after all, he is rich enough.....
Oh, I forgot....
Remind me, since you claim a right to MY work, do I actually have a right to YOUR work? NO? Why does this not surprise me?
To be frank, I think it is pretty nervy of you to demand that you have a right to my work!
To sum this up: I am a free individual and I can do with my life and my knowledge and my skills whatever I please. And no, you do not have any kind of "right" to my knowledge, my expertise and my skills. And, No, you do not have a right to my time, be it by day or by night, my past sacrifices, my blood, sweat and tears. No, you do not have a right to it.
Oh, so you don't really want to claim you right from me, you want to claim it from the government? You think "the government should provide health care"?
May I ask how this will happen? Do you expect the town clerk to provide care? The government as such cannot provide healthcare. Physicians provide health care. Should I assume that you want the government to lean on me, to force me to give you what is a "right"? Is that what you want?
You know, in the end it comes down to you, the patient, and me, the physician. Nobody else. That is health care. I do not see how the government matters in this.
And, no I will not give the government a discount. The government does not give me discounts either. And you remain exactly the same patient, regardless if you pay or if the government pays.
Just to be clear, I do not owe the government anything either. Neither does the government have a right to me, to my life, my skills, my expertise and my knowledge. To the government I am just the same as to you: an individual who is independent, to whose efforts and time neither you nor the government has any kind of "right".
We can trade though, at arm's length, and if we come to a mutually beneficial agreement I will be happy to give you my time and skills
Saturday, July 5, 2008
Sabotaging health savings accounts
Herre is a copy from the AAPS website, worth repeating here:
start of quote
"Sabotaging health savings accounts
June 18th, 2008
Nothing probably shows the potential of health savings accounts (HSAs) better than their enemies’ attempts to wreck them. An attempt to load on costly administrative requirements passed the House of Representatives but not the Senate. President Bush had threatened to veto it. Expect it to come back.
H.R. 5719 would have required every HSA transaction to be reviewed and verified as a legitimate medical expense. Currently, such expenditures are subject to an IRS tax audit, and many are made with a debit card that is only useful at a facility providing medical supplies or services.
A Wall Street Journal editorial called it “Health Savings Sabotage,” with a key player being Rep. Pete Stark (D-CA), who views HSAs as a “weapon of mass destruction.” While Democrats, including Barack Obama and Hillary Clinton, decry the high cost of medical care, including insurance overhead, “Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money” (Wall St J 4/19/08).
Cheating is a nonproblem, the editorial stated: “In any case if people cheat on their HSAs, they are only cheating themselves.”
Lobbying for the provision was EvolutionBenefits, which makes software used for “substantiation” of expenses in employer-owned Flexible Spending Accounts. H.R. 5719 would have enabled EvolutionBenefits to charge twice as much for administering HSAs.
“This is a near perfect example of the corruption of Washington,” writes Greg Scandlen. “A powerful member of Congress using his authority to benefit a single company at the expense of millions of consumers and taxpayers” (Consumer Power Report #123, 4/23/08),
“The message is clear,” writes Dan Perrin of the HSA Coalition, “we (the Democrats) think you cannot make your own decisions, so we are going to force you to pay a company to review your decisions and then we will give you access to your own money but only after we decide whether you made the right choice in the first place.”
Since HSAs were created in December 2003, 3.2 million accounts have been opened, covering 4.5 million Americans, one-third of whom were previously uninsured and bought coverage on their own. Thirty-three percent of new users are small businesses that previously had not offered coverage to their employees.
Consulting firm Watson Wyatt found that average health-insurance costs in the last two years rose 3.6% for employers who offered high-deductible accounts, versus 7% for employers who did not (Wall St J 5/1/08).
According to the U.S. Government Accountability Office (GAO), the number of tax filers reporting an HSA tripled between 2004 and 2007 (GAO-08-474R).
“The take-up rate is the fastest of any benefits innovation of our lifetimes, states Greg Scandlen. “Faster than IRAs, 401(k)s, and far faster than HMOs. The only thing that rivals it may be the conversion of HMOs into PPOs in the mid to late 1990s.”
“Which is probably one of the main factors in pushing H.R. 5719,” writes Frank Timmins. “HSAs are a threat to the SP [single payer] crowd. They need to slowly poison this baby before it grows to maturity.”
end of quote
start of quote
"Sabotaging health savings accounts
June 18th, 2008
Nothing probably shows the potential of health savings accounts (HSAs) better than their enemies’ attempts to wreck them. An attempt to load on costly administrative requirements passed the House of Representatives but not the Senate. President Bush had threatened to veto it. Expect it to come back.
H.R. 5719 would have required every HSA transaction to be reviewed and verified as a legitimate medical expense. Currently, such expenditures are subject to an IRS tax audit, and many are made with a debit card that is only useful at a facility providing medical supplies or services.
A Wall Street Journal editorial called it “Health Savings Sabotage,” with a key player being Rep. Pete Stark (D-CA), who views HSAs as a “weapon of mass destruction.” While Democrats, including Barack Obama and Hillary Clinton, decry the high cost of medical care, including insurance overhead, “Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money” (Wall St J 4/19/08).
Cheating is a nonproblem, the editorial stated: “In any case if people cheat on their HSAs, they are only cheating themselves.”
Lobbying for the provision was EvolutionBenefits, which makes software used for “substantiation” of expenses in employer-owned Flexible Spending Accounts. H.R. 5719 would have enabled EvolutionBenefits to charge twice as much for administering HSAs.
“This is a near perfect example of the corruption of Washington,” writes Greg Scandlen. “A powerful member of Congress using his authority to benefit a single company at the expense of millions of consumers and taxpayers” (Consumer Power Report #123, 4/23/08),
“The message is clear,” writes Dan Perrin of the HSA Coalition, “we (the Democrats) think you cannot make your own decisions, so we are going to force you to pay a company to review your decisions and then we will give you access to your own money but only after we decide whether you made the right choice in the first place.”
Since HSAs were created in December 2003, 3.2 million accounts have been opened, covering 4.5 million Americans, one-third of whom were previously uninsured and bought coverage on their own. Thirty-three percent of new users are small businesses that previously had not offered coverage to their employees.
Consulting firm Watson Wyatt found that average health-insurance costs in the last two years rose 3.6% for employers who offered high-deductible accounts, versus 7% for employers who did not (Wall St J 5/1/08).
According to the U.S. Government Accountability Office (GAO), the number of tax filers reporting an HSA tripled between 2004 and 2007 (GAO-08-474R).
“The take-up rate is the fastest of any benefits innovation of our lifetimes, states Greg Scandlen. “Faster than IRAs, 401(k)s, and far faster than HMOs. The only thing that rivals it may be the conversion of HMOs into PPOs in the mid to late 1990s.”
“Which is probably one of the main factors in pushing H.R. 5719,” writes Frank Timmins. “HSAs are a threat to the SP [single payer] crowd. They need to slowly poison this baby before it grows to maturity.”
end of quote
Friday, July 4, 2008
The Car Care Crisis: A Metaphor
I owe this very good illustration and metaphor to a colleague on Sermo - DoctorCottle. Here is the copy of a recent post of his on my favorite website, sermo.
In the ten years since most automobile insurance companies were either bought out by health insurance carriers or reorganized along the lines of the "third party payer" health insurance model, it has become increasingly obvious that a crisis in car care is looming in the country. In the last twelve months alone, the average monthly cost of car insurance has increased by almost 200%.
"The cost to fill up my tank is outrageous," says New Jersey motorist Alan Duke. "A tank full of gas now costs me a $15 co-pay. Who can afford this?" Duke is not alone in his criticism of an automobile insurance system that costs drivers more and more, yet seems to deliver less and less. "I haven't had the oil changed in my car for almost 500 miles," complains Janice Taylor as she waits in a seemingly endless line at service station in her home town of Sacramento, California. Just a few short years ago, Taylor used to get oil changes two to three times a month, but like an increasing number of Americans, she has experienced repeated frustration with obtaining even basic automotive service.
Motorists are not the only ones affected by the failure of our car care system. "This will get rejected," sighs Eric Rasely, the owner and operator of a service station in Dayton, Ohio as he fills out the paperwork for a prior authorization for a wiper blade change. "It'll get rejected and then the customer will jump all over me because he has to pay out of pocket. And besides, he just had the blades changed last month. They're fine." Rasely has had to hire extra personnel over the last several months just to help him fill out and submit prior authorizations, billing claims, and other paperwork that he says takes up more man-hours than actually servicing cars.
Few would dispute that America's car care system is broken, but there is little agreement on how to fix it. Caraid, the federal automobile service assistance program for low-income motorists implemented five years ago by the President and Congress, has been plagued by skyrocketing costs and poor reimbursement for car service providers, prompting many mechanics and gas station attendants to "opt out" of the system. This has given political ammunition to Democrats whose proposed nationalized car service initiative, based on Canada's universal car care system, was rejected several years ago. While opinion polls show that an increasing number of Americans are receptive to the idea of so-called "socialized car care," concerns about waiting lists for brake jobs and rationing of gasoline, tires, spark plugs, and transmission fluid under the Canadian system have curtailed widespread acceptance of a universal car care system.
One radical solution that a small but growing number of drivers have chosen is returning to the old model of carrying catastrophic car insurance that covers only unlikely but serious and very expensive contingencies such as theft and accidents, paying for routine expenditures out of pocket. "To me it makes sense," says Ryan Smith, an economics major at the University of Alabama, as he pays at the pump with his debit card at one of Birmingham's "cash only" service stations. "Comprehensive car insurance premiums would cost me a lot more than I spend for routine stuff like gas and oil changes. I bet you'll see more and more people doing this sort of thing in the future. It just makes economic sense. Heck, I bet it would even work for healthcare."
In the ten years since most automobile insurance companies were either bought out by health insurance carriers or reorganized along the lines of the "third party payer" health insurance model, it has become increasingly obvious that a crisis in car care is looming in the country. In the last twelve months alone, the average monthly cost of car insurance has increased by almost 200%.
"The cost to fill up my tank is outrageous," says New Jersey motorist Alan Duke. "A tank full of gas now costs me a $15 co-pay. Who can afford this?" Duke is not alone in his criticism of an automobile insurance system that costs drivers more and more, yet seems to deliver less and less. "I haven't had the oil changed in my car for almost 500 miles," complains Janice Taylor as she waits in a seemingly endless line at service station in her home town of Sacramento, California. Just a few short years ago, Taylor used to get oil changes two to three times a month, but like an increasing number of Americans, she has experienced repeated frustration with obtaining even basic automotive service.
Motorists are not the only ones affected by the failure of our car care system. "This will get rejected," sighs Eric Rasely, the owner and operator of a service station in Dayton, Ohio as he fills out the paperwork for a prior authorization for a wiper blade change. "It'll get rejected and then the customer will jump all over me because he has to pay out of pocket. And besides, he just had the blades changed last month. They're fine." Rasely has had to hire extra personnel over the last several months just to help him fill out and submit prior authorizations, billing claims, and other paperwork that he says takes up more man-hours than actually servicing cars.
Few would dispute that America's car care system is broken, but there is little agreement on how to fix it. Caraid, the federal automobile service assistance program for low-income motorists implemented five years ago by the President and Congress, has been plagued by skyrocketing costs and poor reimbursement for car service providers, prompting many mechanics and gas station attendants to "opt out" of the system. This has given political ammunition to Democrats whose proposed nationalized car service initiative, based on Canada's universal car care system, was rejected several years ago. While opinion polls show that an increasing number of Americans are receptive to the idea of so-called "socialized car care," concerns about waiting lists for brake jobs and rationing of gasoline, tires, spark plugs, and transmission fluid under the Canadian system have curtailed widespread acceptance of a universal car care system.
One radical solution that a small but growing number of drivers have chosen is returning to the old model of carrying catastrophic car insurance that covers only unlikely but serious and very expensive contingencies such as theft and accidents, paying for routine expenditures out of pocket. "To me it makes sense," says Ryan Smith, an economics major at the University of Alabama, as he pays at the pump with his debit card at one of Birmingham's "cash only" service stations. "Comprehensive car insurance premiums would cost me a lot more than I spend for routine stuff like gas and oil changes. I bet you'll see more and more people doing this sort of thing in the future. It just makes economic sense. Heck, I bet it would even work for healthcare."
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