Tag Archives: Insurance

Stop Calling It Obamacare

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By Adrain Murray

When Mitt Romney went before the convention of the NAACP and said that as president he would repeal “Obamacare”, he was roundly and predictably booed.  In doing so, he stepped into a carefully laid trap.

Why is the Patient Protection and Affordable Care Act routinely referred to as “Obamacare”?  Surely no one seriously believes President Obama wrote the 2,700 page bill or, for that matter, even knows what is in it.  Yet the act is commonly labeled President Obama’s signature piece of legislation, the crowning achievement of his first term.

Even Nancy Pelosi would not take credit for authoring the bill, famously declaring we had to pass it in order to find out what’s in it.  So if the president didn’t write the Affordable Care Act and the Speaker of the House didn’t know what was in it, why is it called Obamacare?

One could make the argument that it’s just laziness on the part of the media, which revels in finding the lowest common denominator to explain complex issues.  One could argue that it is political posturing by Republicans who want to saddle the president with responsibility for what is undeniably an unpopular law.  One could argue it is the president himself, trying to take legislative credit for something he had nothing to do with, popular or not.  In fact Obama, a supporter of a single payer system, actively campaigned against many of the provisions that have ended up as cornerstones of the ACA law.

One could make a lot of arguments, but calling the Affordable Care Act “Obamacare” is a huge tactical error.  Why?  Because naming the law after Obama personalizes it and, as Romney learned from the NAACP audience, opposing Obamacare equals opposing Obama and the only reason anyone opposes Obama is, of course, because he is black.  To those inclined to think as such, opposing the complete government takeover of the healthcare system and changing the status of Americans from private citizens to property of the state is, quite simply, racist.  It also distracts from the true question that should be asked:

Who, precisely, wrote the Patient Protection and Affordable Care Act and why?

Our first clue comes from testimony given by Peter Orszag, then-Director of the Office of Management and Budget, before Congress in August of 2009.  “Ultimately,” he said, “without structure in place to help contain health care costs over the long term as the health market evolves, nothing else we do in fiscal policy will matter much, because eventually health care cost will overwhelm the federal budget.”

If Orszag had been addressing the board of directors of Wellpoint, the nation’s second largest managed health care company, such a statement might seem perfectly proper.  But, even accepting the wildly suspicious claim that 30 million Americans were uninsured, that’s still just 10% of the population.  If 90% of Americans in 2009 were covered by private insurance, why would health care costs overwhelm the federal budget?  It is more likely that rising health care costs would soon overwhelm the nation’s health insurance providers.

According to Kaiser Permanente, total health insurance costs in 1980 were $286 billion.  By 2010, they had increased nearly tenfold to $2.3 trillion.  As the population ages, that number is expected to soar.  According to federal estimates, health care costs will double in the next decade and are likely to double again by 2030, when 70 million Americans – fully 20% of the population – will be over the age of 65.  Could such dire estimates have provided the health insurance industry with a powerful $10 trillion incentive to move this looming liability off their balance sheets and onto the backs of the American taxpayer?

In May 2010, after final passage of the current health care law, Senator Max Baucus, from whose Finance Committee the legislation emerged, stood before the Senate and members of the press to publicly thank the person he credited with making it all happen:

“I wish to single out one person, and that one person is sitting next to me. Her name is Liz Fowler. Liz Fowler is my chief health counsel. Liz Fowler has put my health care team together. Liz Fowler worked for me many years ago, left for the private sector, and then came back when she realized she could be there at the creation of health care reform because she wanted that to be, in a certain sense, her professional lifetime goal. She put together the White Paper last November–2008–the 87-page document which became the basis, the foundation, the blueprint from which almost all health care measures in all bills on both sides of the aisle came.”

So who is Liz Fowler?  Prior to joining Baucus’ staff as the senior advisor on health care, she was Vice President of Public Policy and External Affairs for none other than the aforementioned number two insurance company, Wellpoint.  Not to put too fine a point to it, but the chief lobbyist for AHIP (America’s Health Insurance Plans), a national trade organization of over 1,300 insurers, infiltrated the Senate Finance Committee and wrote a law to benefit not the American people, but the entire insurance industry.  As it turns out, the Patient Protection and Affordable Care Act is not intended to make health insurance more affordable for the American people.  It is designed to make the American people more affordable for the health insurance industry.

As it further turns out, Baucus’ staff was infested with Wellpoint hirelings.  Prior to Fowler arriving on scene, the chief advisor on Senator Baucus’ team was Michelle Easton.  Upon passing the baton to Ms. Fowler, Easton went to work as a lobbyist for Wellpoint at Tarplin, Downs and Young, a DC-based lobbying firm founded in 2006 “specializing in strategic consulting and policy development with a particular focus on health care”.

Keep turning the wheel, though, and we come to Stephen Northrup.  Northrup was the chief health advisor to Wyoming Senator Mike Enzi when Enzi pushed similar health care legislation in 2006.  Prior to joining Enzi’s staff, Northrup was the executive director of the Long Term Pharmacy Alliance, an organization that played a lead role in drafting the mother of all giveaways to Big Pharma, Medicare Part D.  Not surprisingly, the revolving door and interchangeable roles of advisors/staff/lobbyists eventually lead Northrup in 2007 to Wellpoint, where he served as Vice President of Federal Affairs.

The insurance lobby, tired of decades of failed attempts to influence Congress to create a national health care plan which would immunize them from the looming trillions of dollars in liabilities they faced as the boomer generation aged, simply decided they would infiltrate Congress instead and write the legislation themselves.  Time, after all, was running out.

But simply enacting the legislation was not enough.  Big Insurance also demanded a seat at the table when it came time to actually drafting the regulations and implementing the law, since incompetent government bureaucrats could not be trusted to enact regulations and procedures that would fully indemnify the insurance lobby to its complete satisfaction.  Which brings us to the return of Liz Fowler, the author of the Affordable Care Act who is now the Deputy Director of Consumer Information and Oversight at the U.S. Department of Human Services, sort of an industry cop on watch to be sure government employees do what they are told.

Despite Big Insurance’s success in pulling off one of the most intricate swindles in the history of mankind by transferring tens of trillions of dollars of liabilities from their balance sheets to that of the Treasury Department, all to be paid for by massive tax increases on the American people (or fees, if you’re still arguing about the Commerce Clause in the increasingly irrelevant Constitution), the whole transaction would certainly deserve a special place in the pantheon  of lawlessness were it not for the decidedly unhappy outcome it will have for the true victims of this crime – the American citizens, who are now merely the property of an insurance industry that has a vested interest in keeping them healthy while they are still useful.  Those 22 year-olds who are today gleeful that they can stay on Mommy and Daddy’s insurance for a few more years won’t be quite as cheerful in 2030 when they are called before a panel Liz Fowler will undoubtedly have had a role in creating to explain why their cholesterol level has increased or are informed that certain substances detected in their last blood test indicated they are surpassing the monthly limit on pepperoni pizzas.  After being sent home with a hefty fine and orders to adhere to a strict diet of carrot sticks and mineral water, along with the latest behavioral modification drug developed by the recent merger of Pfizer and Merck, they may well wish they had been paying attention back in 2012, when there was still a chance to put a stop to it all.

In the meanwhile, it would be nice if certain political figures would put a stop to feigning political courage by mockingly referring to this legislation as Obamacare.  Obama didn’t write it or read it and there is nothing caring about it.  Call it what it is:

The Health Insurance Industry Protection Act.

You could also call it the end of freedom.

 

This post was authored by Adrian Murray is a business man in Fort Worth, Texas (President and CEO of Painless Performance Products) and an ardent Conservative thought leader in the North Texas community. It is with his expressed permission that this incredible piece is offered here. Thank You Adrian for your patriotism.

Renewing the SPIRIT of Healthcare

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Over the last few years much has been written and said about the problems facing physicians within the American Healthcare System. The purpose of this particular post is not simply to further define those problems, but to offer a logical solution. The title of this writing is also the “Mission Statement” of my own practice, and the action being suggested is one I have personally employed.

Throughout the western world, universal healthcare has become a touchstone for the progressive, socialist movement. It is after all, relatively easy to argue that everyone deserves access to medical care when they are sick or injured; it is simply the humane thing for a society to provide. But, once the state defines healthcare as a basic human right, they are then faced with the challenge of allocating adequate resources to ensure that everyone has access.

Proponents of “universal health coverage” argue that there are only two viable choices, either mandate that everyone purchase insurance, as called for under the Patient Protection and Affordable Care Act of 2010, or have a government run single payer system where healthcare is paid for through taxation of the population. But a “one size fits all” healthcare system has proven to be unworkable. Even in mature socialized system such as the National Health Service in Great Britain, a significant private healthcare system has emerged. This is analogous to the rise of private schools in America, despite the fact that public education is available and essentially free to everyone. This is obviously a natural phenomenon based on individual expectations and the will to control one’s own destiny.

Another major challenge to various attempts to manage individual healthcare from the top down is the independent behavior of those who actually provide the care. Government bureaucrats and insurance executives have assumed “providers” can be controlled through financial incentives, corporate directives, or government mandates. What they failed to consider is that physicians will consistently attempt to resist doing or not doing things that are contrary to their training and their professional ethics.

Physicians are by nature inclined to put the interest of individual patients ahead of their own, or those of the payer; a concept that is vital to the establishment and maintenance of a meaningful patient-physician relationship. But in recent years, economic motivations and not so subtle pressures from elements of the “third party payment system” have gradually drawn many physicians away from their most basic obligation, like sailors to a sirens song. Such conflicts have created a loss of practice satisfaction, anger and frustration, and a practice environment where many physicians have opted for an early exit from the profession they spent a lifetime pursuing.

Perhaps the best evidence of this changing paradigm is observed simply by calling a physician’s office to arrange an appointment. The first question you will likely be asked is “What kind of insurance do you have?” Healthcare has become all about payment, yet patients rarely even ask what it costs. The system has insulated patients from the payment process, while at the same time doctors who participate in Medicare and Medicaid, or who work under insurance contracts, have virtually nothing to say about how they are compensated.

So what’s the answer? The only logical solution is for physicians to take the lead by returning to their professional roots. This means independently treating their patients according to their knowledge and training, and then looking to the patient for appropriate payment for those services. The ability to truly serve as the patient’s advocate can only come when the contractual bondage to outside payers is broken. As long as physicians continue to sign contracts with entities other than their patients, their true allegiance will be questioned.

The solution is therefore not an AMA solution, or a legislative solution, or a specialty society solution. It is an individual physician solution, which requires a personal introspective analysis. Such self-examination is certainly difficult and the issues are obviously complex. In the end, each physician must decide for himself or herself whether or not a divided allegiance is being used to “manage” the care they provide.

I’m not so naive as to believe that America’s physicians will suddenly receive a collective epiphany, leading to a mass exodus from the insurance roles. The fact is that most physicians are in one or more business relationships that may prevent them from taking such action. Others will not be willing to risk the loss of their financial security, based on “guaranteed” insurance payment. Thus, for a variety of reasons, truly independent physicians are likely to remain a relatively small minority well into the future. But over time they will differentiate themselves by appealing to those patients who recognize the value and wisdom of controlling their own healthcare decisions.

Some will argue that by opting-out of insurance contracts physicians are actually promoting a two tiered healthcare system. Perhaps that is true, but like it or not some consumers want the opportunity to choose from a group of independent physicians rather than being compelled to accept whomever happens to be “on duty” at the local clinic. Certainly the majority of Americans will continue to accept whatever providers are available through their insurance carrier’s network or government program. But, these two options are indeed complementary in an overarching system which seeks to provide healthcare to everyone according to their own choice.

To meet the expectations of a growing consumer-driven, private healthcare system, independent practitioners must work to re-establish a level of trust that has been undermined in recent years. It is time for a new and more modern independent physician’s pledge; one that considers both the rights of patients and the rights and obligations of physicians. To be relevant, this pledge must address the specific challenges of today’s complex world, while at the same time reaffirm the traditional ethics that made the practice of medicine an honored profession over the centuries.

The Independent Physicians’ Rights and Obligations Pledge outlines a new covenant between physicians and their patients based on “mutual trust, mutual respect and mutual responsibility”. Any physician who is considering breaking the bonds of third party contracts should embrace this pledge as a new contract, entered into directly with each patient whom they are privileged to serve. Each physician should also consider this pledge as their personal commitment to the renewal of their own SPIRIT as they continue to pursue professional excellence.

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The Independent Physician’s Rights and Obligations Pledge

 

As an independent practicing physician I hereby acknowledge my role is central to ensuring quality care for all patients. I further recognize the potentially disruptive nature of outside influences on the patient-physician relationship, including various methods of payment. Through this pledge I hereby reaffirm my unconditional commitment to my patients, my colleagues and my profession, and to maintaining my SPIRIT as a physician.

I pledge, to provide personal healthcare to all those who I am privileged to treat, in accordance with my training and experience with a spirit of Service.

I pledge, to uphold, defend and perpetuate the time-honored ethics of the medical Profession.

I pledge, to conduct my practice with openness, honesty, fairness and personal Integrity.

I pledge, to keep the time-honored patient-physician relationship based on mutual trust, mutual respect and mutual Responsibility.

I pledge, to establish just and appropriate fees for the services I provide, treating all patients fairly and with compassion, free from any third party attempts to influence my professional judgment or Independence.

I pledge to work within the community of physicians to ensure the medical profession remains self-regulating and self-governing with respect to education, training, quality assurance and peer review, according to our time-honored Tradition.

Now, before all who are my witness, I accept and embrace these fundamental rights and obligations freely and without reservation, and declare my willingness to abide by them to the best of my ability.

The Lost Art of Personal Service

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Do you remember your first paying job? Mine was as a gas station attendant in Kansas City, Missouri. Back in those days they called them “service” stations. Cars would drive in off the street and that familiar “double ding” would announce their arrival. I’d run out to greet the driver and ask the standard questions: “Fill ‘er up sir?” “Regular or Ethyl?” (Ethyl was what we called premium back in the day.) “Can I check under the hood?” “Do you want me to check your tire pressures?” I’d then pump the gas and do whatever else the customer asked, and the job wasn’t complete until all the windows were washed. By the way, gasoline was 19 cents a gallon and motor oil was 50 cents a quart.

In the late ‘60s customer service was not extra, it was expected. At $1.15 an hour it was simply part of the job, even in the rather seedy part of town where I was working. Inside the station we had a couple of vending machines where customers would occasionally come in and buy a candy bar for a nickel or a coke for a dime. But the big sellers were cigarettes because back then it seemed almost everybody smoked.

Today it is pretty hard to find a “service station.” I can’t remember the last time someone actually came out to my car to pump the gas or check the oil. Obviously there’s no money in personal service at the pump. Instead, the gas station has actually become a front for the more lucrative convenience store. I’m sure most storeowners wish they’d never offered the “pay at the pump” option. They’d much rather you would come inside to pay so you’d also buy a lottery ticket and a three-dollar energy drink. Times have certainly changed, but not just in the retail business.

The other day I was reflecting on just how much change there has been in the practice of medicine over the 32 years since I first hung up my shingle. I was talking with one of the emergency physicians at our hospital about the fact that more and more of our colleagues have become shift-workers. This started with the specialty of emergency medicine, but it has grown to encompass nearly all areas of medical practice. Today nearly every hospital employs what are referred to as hospitalists. These docs typically work 12-hour shifts entirely in the hospital, caring for patients with whom they have no prior relationship. Likewise they are not likely to have any further contact with the patient once they leave the hospital.

One of the chief responsibilities of hospitalists is to admit and provide inpatient care for patients who come in through the emergency department. Notice I didn’t say emergency “room.” That area of the hospital has become the major portal of entry and hardly qualifies as a “room” any more. Most hospitals also employ various specialists to provide additional services such as radiology, pathology and anesthesia on a contracted basis. Recently, even surgical specialists have been lured into being employees of hospitals rather than maintaining independent practices. As a surgeon myself I find that pill a little hard to swallow.

The idea of performing major surgery on someone and never seeing them again is completely foreign to me. However, that seems to be a growing trend, as personal service gives way to an ever-increasing “drive through” culture. The unfortunate net effect is the gradual erosion of compassion and care. In fact I think it is safe to say that health “care” has morphed into what can only be referred to as health “acts.” I would say health “services” but that would imply that the patient is actually being treated as a customer. Unfortunately, the one paying the bill, and therefore deserving of the label “customer,” is the third party payer. Insurance companies and the Federal government appear to be detached from the actual delivery of health “acts” but, since they are writing the checks, they make most of the rules. Over the years the impact of third party payer rules on the practice of medicine has been enormous. To the point where many of those who entered the medical profession as a calling have become so frustrated with the over regulated environment they have chosen to pursue alternate careers. Others have decided just to go along to get along and the result is the development of a shift-worker mentality.

The tragedy of these changes is not measured in early physician retirements or even a loss of practice satisfaction. Rather, it is the loss of personal care, the basic hallmark of the healing arts. Care is a verb defined as: to be concerned or interested; to provide needed assistance or watchful supervision. These are not the actions of a corporate or governmental entity. Only individual human beings are capable of truly caring for another human being. This is the essence of the Hippocratic Oath, which is clearly under attack by a variety of faceless entities that endeavor to benefit from health “acts” without regard to the basic welfare of those who are in need of health care. It is that very oath that traditionally separates being a physician from virtually every other occupation. But once that personal pledge is not kept the practice of medicine goes from being an honored profession to just another job where service has become a lost art.

 

Visit my website at www.robertsewellmd.com