Tag Archives: Medicare

What would a Biden economy look like, and what will healthcare go from here? Also, When Should We Get Vaccinated for the Flu?

As I listened to the Democratic convention, I was horrified by the hate against President Trump, and the in general. My wife doesn’t want me to say it, but the average citizen, especially the socially and history ignorant citizens are basically stupid and believes those of the liberal democrats. As an Independent I don’t believe. But I thought that I would skip the updates regarding the Corvid pandemic and consider the economy and healthcare with former Vice President Biden in control. Oh, Horror!

The Week Staff wrote that if you’re wondering what a Biden presidency would mean for the economy, look to Biden’s last financial crisis, said Jeffrey Taylor at Bloomberg. In 2009, as vice president, Biden approached the crisis from a middle-class, Rust Belt viewpoint, aggressively pushing for an auto bailout while championing tighter restrictions on banks and arguing against Wall Street in key debates. While today’s situation is obviously different from the Great Recession, Biden sees “common threads” that could help him pursue an agenda focused on addressing income inequality and promoting public works. His top priority is a massive $3.5 trillion infrastructure, manufacturing, and clean-energy program “that appears likely to grow substantially if he is elected.” He plans to pay for the program by raising the corporate tax rate from 21 percent to 28 percent and increasing taxes on wealthy real-estate investors. In the wake of the pandemic, Biden has “edged away from the moderate economic approach he advocated last year,” but he is still not likely to “embrace punitive demands from the Left.”

“There is nothing ‘moderate’ about Biden’s tax plan,” said Mark Bloomfield and Oscar Pollock at The Wall Street Journal. For taxpayers with income above $1 million, Biden wants to tax capital gains as ordinary income. Combined with an upper-income tax increase, that would make top capital gains tax surge from the current 20 percent to 43 percent, exceeding the rate in “every one of the 10 largest economies.” We are not going to compete with China by adopting “tax policies that discourage those who are best able to invest, take risks, and start companies.”

Certain industries are sure to be in Biden’s crosshairs, said Anne Sraders at Fortune​. “Trump’s fight to lower drug prices will likely be carried on,” meaning “potential headwinds for Big Pharma.” And energy and “environment-sensitive industries” such as oil and gas production could underperform under a Democratic administration. But the naming of Kamala Harris as his vice-presidential nominee “might actually be good for Big Tech” because of her ties to Silicon Valley. For the first time in a decade, Wall Street donors are actually giving more to Democrats than to Republicans, said Jim Zarroli at NPR. Trump “still has friends in finance,” but many investors have “soured on his management style,” which makes it hard for them to make long-term plans.

Whatever the outcome, investors are starting to worry about “stock-market mayhem” surrounding the November election, said Gunjan Banerji and Gregory Zuckerman at The Wall Street Journal. “Markets tend to be volatile ahead of elections,” but pessimism about what might unfold appears “even more intense this time around.” One adviser is urging clients to insure themselves against losses by buying options that will profit if the S&P 500 index plunges more than 25 percent through December; other firms are telling clients to bet on gold. The behind-the-scenes anxiety is unfolding even as markets hit a record high. “October and November tend to be the wildest months of the year” in any case, and market uncertainty could skyrocket if in the days after the election there is no clear winner.

Here’s Where Joe Biden Stands on Every Major Healthcare Issue

Lulu Chang reviewed Biden’s stand on healthcare. The stage is set, the players have been finalized, and the countdown has begun in earnest. In less than three months, voters across the United States will head to the polls (or mail in their ballots) to elect their president.

The Democrats recently finalized their ticket, making history with the inclusion of Kamala Harris as Joe Biden’s vice-presidential pick, making her the first African American and Asian woman to appear on a major party ticket. Over the course of the next several weeks, the Biden and Harris team will make clear their platforms and policy suggestions to win over voters. I’ll discuss Harris’s stand on health in the next section of this post. And of course, in the face of a global pandemic, high on the list of priorities for many Americans is the Democratic nominee’s position on healthcare.

We’ve put together a list of where Joe Biden stands on every major health issue to help you make a more informed decision as you mail in your ballot or head to the polls in a few short months.

Medicare

  • No Medicare for All
  • Lower age to 60 (currently 65)
  • Add a public option

Biden supports making Medicare, the federal health insurance program for folks older than 65 and certain younger Americans with disabilities, more readily accessible to a greater swath of the population. He does not, however, support Medicare for All, which would offer complete health care to all Americans regardless of age without out-of-pocket expenses. Instead, Biden advocates for lowering the eligibility age for Medicare to 60, which would certainly expand the program’s reach.

In addition, Biden wants to add a public option to American healthcare, which was discussed during the writing of the Affordable Care Act, but ultimately passed over. A public option would allow folks to select into government-run insurance—like Medicare—instead of a private insurance plan. This too would allow a greater proportion of the population to access government-run healthcare options. As Biden explains on his campaign website, “If your insurance company isn’t doing right by you, you should have another, better choice…The Biden Plan will give you the choice to purchase a public health insurance option like Medicare. As in Medicare, the Biden public option will reduce costs for patients by negotiating lower prices from hospitals and other health care providers.”

Undocumented Immigrants

  • Allow undocumented immigrants to buy into a public option

The Biden Plan emphasizes the importance of providing affordable healthcare to all Americans, “regardless of gender, race, income, sexual orientation, or zip code.” But it is not only Americans who Biden seeks to cover under his policies—rather, his plan would allow undocumented immigrants to purchase the public option, though it would not be subsidized.

Affordable Care Act

  • Strengthen the ACA
  • Increase subsidies
  • Bring back the individual mandate

The Affordable Care Act was passed under the Obama administration, so it comes as little surprise that Biden wants to bring back many of the provisions from the bill that were dismantled under the Trump administration. As he notes in his official platform, Biden seeks to “stop [the] reversal of the progress made by Obamacare…[and will] build on the Affordable Care Act with a plan to insure more than an estimated 97% of Americans.”

This would involve increasing tax credits in order to reduce premiums and offer coverage to a greater swath of Americans. In particular, Biden wants to do away with the 400% income cap on tax credit eligibility, and lower the limit on cost of coverage from today’s 9.86% to 8.5%. In effect, that means that no one purchasing insurance would have to spend any more than 8.5% of their income on health insurance.

Biden would also bring back the individual mandate, which is a penalty for not having health insurance. Trump eliminated this element of the Affordable Care Act in 2017, but Biden claims that the mandate would be popular “compared to what’s being offered.”

Are you kidding? Remember the burden on our healthy young newly employed or new business owners!

Prescriptions

  • Lower prescription drug pricing

The prices of prescription drugs have skyrocketed in recent years, making big pharma companies a common target among presidential candidates. Biden promises to “stand up to abuse of power by prescription drug corporations,” condemning “profiteering off of the pocketbooks of sick individuals.”

The Biden Plan includes a repeal of the exception that allows pharmaceutical companies to avoid negotiations with Medicare over drug prices. Today, nearly 20% of Medicare’s spending is allocated toward prescription drugs; lowering this proportion could save an estimated $14.4 billion in medication costs alone.

Furthermore, Biden would limit the prices of drugs that do not have competitors by implementing external reference pricing. This would involve the creation of an independent review board tasked with evaluating the value of a drug based on the average price in other countries. Biden would also limit drug price increases due to inflation, and allow Americans to buy imported medications from other countries (provided these medications are proven to be safe). Finally, Biden would eliminate drug companies’ advertising tax breaks in an attempt to further lower costs.

Abortion

  • Expand access to contraception
  • Protect a woman’s right to choose

Joe Biden has been infamously inconsistent in his position on abortion; decades ago, Biden supposed a constitutional amendment allowing states to reverse Roe v. Wade. As a senator, Biden voted to ban certain late-term abortions as recently as 2003. But his official position as the Democratic nominee is to protect a woman’s right to an abortion, and increase access to birth control across the spectrum.

Under the Biden Plan, the proposed public option would “cover contraception and a woman’s constitutional right to choose.” Biden would seek to “codify Roe v. Wade” and put an end to state laws that hamper access to abortion procedures, including parental notification requirements, mandatory waiting periods, and ultrasound requirements.

Biden would also restore federal funding for Planned Parenthood, reissuing “guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers that refer for abortions or provide related information.”

Surprise Billing

  • Stop surprise billing

Surprise billing, as the name suggests, allows healthcare providers to send patients unexpected out-of-network bills, often in large sums. Biden’s plan would prevent this practice in scenarios where a patient cannot decide what provider he or she uses (as is often the case in emergency situations or ambulance transport). While ending surprise billing could save Americans some $40 billion annually, it is not entirely clear how Biden would end surprise billing.

The plan suggests that Biden would address “market concentration across our health care system” by “aggressively” using the government’s antitrust authority. By promoting competition, Biden hopes to reduce prices for consumers, and more importantly, improve health outcomes. Next is Kamala’s stand on healthcare.

Kamala Harris’ Stance on Healthcare Is Pretty Different from Biden’s

Katherine Igoe noted that healthcare is also an issue that sees a lot of variety across Democratic candidates, ranging from a single-payer healthcare system (meaning that all health insurance is covered through the government, and everyone is covered) to a more hybrid approach that doesn’t exclude private healthcare companies (half of the American population is currently enrolled in private plans).

At least according to her stance in the past, Harris favors the latter, hybrid approach—and it’s quite different from what Biden has proposed. What is her take, and how may her stance have shifted?

As a presidential candidate, Harris proposed Medicare for All.

The issue is personal for Harris. Citing her mother’s terminal cancer diagnosis, she’s said that her interest in improving coverage comes from that relationship: “She got sick before the Affordable Care Act became law, back when it was still legal for health insurance companies to deny coverage for pre-existing conditions. I remember thanking God she had Medicare…As I continue the battle for a better health care system, I do so in her name.”

The details can vary, but the basics of Medicare for All would be to vastly expand the government’s role to include everyone’s healthcare needs. By making Medicare more robust, the program would work to reduce costs for the insured, increase coverage to include those who were previously excluded, and expand upon existing plans in an effort to allow people to keep their existing doctors. But unlike other, more extreme proposals, Harris’ plan would subsequently allow private insurers to participate—in a similar way to the current framework of Medicare Advantage. “Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services,” she explained.

The candidates’ stances have had to incorporate what governmental influence would do to the private market, and Harris didn’t favor a plan that would abolish private insurance. She had initially expressed support for something along that lines, but then changed that stance; her perspective on the subject has evolved. She’s also proposed a decade-long “phase-in” period for this new Medicare plan to be put in place.

When they were both presidential candidates, Biden and Harris clashed over healthcare—she said his plan would leave Americans without coverage, he dismissed her plan as nonsensical.

Biden’s take on healthcare is vastly different.

Biden worked with President Obama on the Affordable Care Act (ACA), and thus his plans for healthcare would be to expand upon and further develop the ACA, while protecting it from current attacks. People could choose a public plan (i.e., they wouldn’t be mandated to join Medicare) and the government would provide tax benefits. “It would also cap every American’s health-care premiums at 8.5 percent of their income and effectively lower deductibles and co-payments. Biden recently said he also wants to lower the Medicare enrollment age by five years, to 60.”

The plan would separately take on exorbitant pharmaceutical pricing, which is another hot-button issue that hasn’t had any resolution. Multiple bills have been debated in Congress but the House’s recently passed bill is heavily opposed by Republicans.

Harris wasn’t the only one to criticize Biden on his plan, which may still exclude many from coverage. But now that the two are running mates, they may need to come up with a cohesive strategy that incorporates both of their stances (or, Harris may have to adopt a more moderate approach).

Harris has proposed several healthcare solutions for COVID-19.

Harris has been active in proposing economic relief towards individuals, families, and businesses during the pandemic, and healthcare is no exception. She’s proposed the COVID-19 Racial and Ethnic Disparities Task Force Act, which (among other things) would be designed to address barriers to equitable health care and medical coverage. This is one of the area’s in which she’s pledged to act towards racial justice—and it may be another area in which her stance impacts the Biden-Harris platform.

It’s crucial to get a flu shot this year amid the coronavirus pandemic, doctors say

I just received my yearly flu vaccination this past Wednesday and I have been advising all my patients to get their flu shots now! Adrianna Rodriquez that the message to vaccinate is not lost on Americans calling their doctors and pharmacists to schedule a flu shot appointment before the start of the 2020-2021 season. 

Experts said it’s crucial to get vaccinated this year because the coronavirus pandemic has overwhelmed hospitals in parts of the country and taken the lives of more than 176,000 people in the USA, according to Johns Hopkins data.

It’s hard to know how COVID-19 will mix with flu season: Will mask wearing and social distancing contain flu transmission as it’s meant to do with SARS-CoV-2? Or will both viruses ransack the nation as some schools reopen for in-person learning? 

“This fall, nothing can be more important than to try to increase the American public’s decision to embrace the flu vaccine with confidence,” Centers for Disease Control and Prevention Director Robert Redfield told the editor of JAMA on Thursday. “This is a critical year for us to try to take flu as much off the table as we can.”

Here’s what doctors say you should know about the flu vaccine as we approach this year’s season: 

Who should get the vaccine?

The CDC recommends everyone 6 months and older get a flu vaccine every year. State officials announced Wednesday the flu vaccine is required for all Massachusetts students enrolled in child care, preschool, K-12 and post-secondary institutions.

“It is more important now than ever to get a flu vaccine because flu symptoms are very similar to those of COVID-19, and preventing the flu will save lives and preserve health care resources,” said Dr. Lawrence Madoff, medical director of the Bureau of Infectious Disease and Laboratory Sciences at the Massachusetts Department of Public Health.

When should I get my flu shot? 

Dr. Susan Rehm, vice chair at the Cleveland Clinic’s Department of Infectious Diseases, said patients should get the influenza vaccine as soon as possible.

CVS stores have the flu vaccine in stock, and it became available Monday at Walgreens.

“I plan to get my flu shot as soon as the vaccines are available,” Rehm said. “My understanding is that they should be available in late August, early September nationwide.”

Other doctors recommend that patients get their flu shot in late September or early October, so protection can last throughout the flu season, which typically ends around March or April. The vaccine lasts about six months.

The CDC recommends people get a flu vaccine no later than the end of October – because it takes a few weeks for the vaccine to become fully protective – but encourages people to get vaccinated later rather than not at all.

Healthy people can get their flu vaccine as soon as it’s available, but experts recommend older people and those who are immunocompromised wait until mid-fall to get their shots, so they last throughout the flu season.

What is the high-dose flu shot for seniors? 

People over 65 should get Fluzone High-Dose, or FLUAD, because it provides better protection against flu viruses.

Fluzone High-Dose contains four times the antigen that’s in a standard dose, effectively making it a stronger version of the regular flu shot. FLUAD pairs the regular vaccine with an adjuvant, an immune stimulant, to cause the immune system to have a higher response to the vaccine. 

Research indicates that such high-dose flu vaccines have improved a patient’s protection against the flu. A peer-reviewed study published in The New England Journal of Medicine and sponsored by Sanofi, the company behind Fluzone High-Dose, found the high-dose vaccine is about 24% more effective than the standard shot in preventing the flu.

An observational study in 2013 found FLUAD is 51% effective in preventing flu-related hospitalizations for patients 65 and older. There are no studies that do a comparative analysis between the two vaccines.

Is the flu vaccine safe?

According to the CDC, hundreds of millions of Americans have safely received flu vaccine over the past 50 years. Common side effects for the vaccine include soreness at the injection spot, headache, fever, nausea and muscle aches.

Dr. William Schaffner, professor of infectious diseases at the Vanderbilt Medical Center in Nashville, Tennessee, emphasized that these symptoms are not the flu because the vaccine cannot cause influenza.

“That’s just your body working on the vaccine and your immune response responding to the vaccine,” he said. “That’s a small price to pay to keep you out of the emergency room. Believe me.”

Some studies have found a small association of the flu vaccine with Guillain-Barré syndrome (GBS), but Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said there’s a one in a million chance of that happening.

Not only is the flu vaccine safe, but the pharmacies, doctors offices and hospitals administering it are also safe.

Horovitz and Schaffner said hospitals take all the necessary precautions to make sure patients are protected against COVID-19. Some hospitals send staff out to patients’ cars for inoculation while others allow them to bypass the waiting room. Doctors offices require masks and social distancing, and they are routinely disinfected.

“Call your health care provider to make sure you can get in and out quickly,” Schaffner advised. “It’s safe to get the flu vaccine and very important.”

Will it help prevent COVID-19?

Experts speculate any vaccine could hypothetically provide some protection against a virus, but there’s little data that suggests the flu vaccine can protect against the coronavirus, SARS-CoV-2, which causes COVID-19.

“We don’t want to confuse people of that … because there’s simply no data,” Schaffner said. “Flu vaccine prevents flu; we’re working on a coronavirus vaccine. They’re separate.”

A study in 2018 found that the flu vaccine reduces the risk of being admitted to an ICU with flu by 82%, according to the CDC.

“People perhaps forget that influenza is something that we see every year,” Rehm said. “Tens of thousands of people die of influenza ever year, including people who are very healthy, and hundreds of thousands of people are hospitalized every year.”

Doctors said it will be even more hectic this year because some flu and COVID-19 symptoms overlap, delaying diagnosis and possibly care.

What can we expect from this year’s flu season and vaccine?

“Even before COVID, what we say about the flu is that it’s predictably unpredictable,” Rehm said. “There are some years that it’s a light year and some years that it’s horrible.”

Flu experts said they sometimes look at Australia’s flu season to get a sense of the strain and how it spreads, because winter in the Southern Hemisphere started a few months ago. 

According to the country’s Department of Health surveillance report, influenza has virtually disappeared: only 85 cases in the last two weeks of June, compared with more than 20,000 confirmed cases that time last year.

“Australia has had a modest season, but they were very good at implementing COVID containment measures, and of course, we’re not,” Schaffner said. “So we’re anticipating that we’re going to have a flu season that’s substantial.”

The CDC said two types of vaccines are available for the 2020-2021 season: the trivalent and quadrivalent. Trivalents contain two flu A strains and one flu B strain and are available only as high-dose vaccines. Quadrivalents contain those three strains plus an additional flu B strain, and they can be high- or standard-dose vaccines. I made sure that I received the quadrivalent vaccine.

Though some doctors may have both vaccines, others may have only one, depending on their supply chain. Natasha Bhuyan, a practicing family physician in Phoenix, said people should get whatever vaccine is available.

“Vaccines are a selfless act. They’re protecting yourself and your friends through herd immunity,” she said. “Any vaccine that you can get access to, you can get.”

Horovitz said vaccine production and distribution have been on schedule, despite international focus on coronavirus vaccine development. He has received his shipment to the hospital and plans to administer the vaccine with four strains closer to the start of the season.

“I don’t think anything suffered because something else was being developed,” he said. “(The flu vaccine) has been pretty well established for the last 20 to 30 years.”

Producers boosted supplies of the flu vaccine to meet what they expect will be higher demand. Vaccine maker Sanofi announced Monday that it will produce 15% more vaccine than in a normal year.

Redfield told JAMA the CDC arranged for an additional 9.3 million doses of low-cost flu vaccine for uninsured adults, up from 500,000. The agency expanded plans to reach out to minority communities.

What about the nasal spray instead of the shot? 

After the swine flu pandemic in 2009, several studies showed the nasal spray flu vaccine was less effective against H1N1 viruses, leading the CDC and the Advisory Committee on Immunization Practices to advise against it.

Since the 2017-2018 season, the advisory committee and the CDC voted to resume the recommendation for its use after the manufacturer used new H1N1 vaccine viruses in production.

Though agencies and advisory committees don’t recommend one vaccine over the other, some pediatricians argue the nasal spray is easier to administer to children than a shot.

Other doctors prefer the flu shot because some of the nasal spray side effects mimic respiratory symptoms, including wheezing, coughing and a runny nose, according to the CDC. Horovitz said anything that presents cold symptoms should probably be avoided, especially among children who are vectors of respiratory diseases.

“Giving them something that gives them cold (symptoms) for two or three days may expel more virus if they’re asymptomatic with COVID,” he said.

So, get vaccinated!!

Examples of Single Payer Health Care Systems

I guess I should have been horrified about the allegations that came to light these past two weeks in regard to the Veterans Administration Health Care problems. However, since I have worked in the VA system as well as see patients who have used the VA system and have needed my surgical care due to the inadequacies found within this health care system. So, I have included the latest article regarding the whistleblowers bringing to light more examples of revelations.

The allegations of wait times, delayed care for veterans and cooked books began in Phoenix, but new revelations by two more Veterans Affairs whistleblowers in two different states suggest the VA problems are endemic.

“What really bothered me was that this delay was a direct result of this extremely low sense of caring for the patient,” said Dr. Jose Mathews, the chief psychiatrist for the VA Medical Center in St. Louis starting in Nov 2012.

Mathews and another whistleblower in Texas detailed their concerns to Fox News.

According to Mathews, he noticed that the doctors he oversaw who were responsible for seeing veterans with post-traumatic stress and other acute mental health issues were working just a few hours a day. They were seeing about half the patients they could, Mathews alleged in a federal whistleblower complaint filed last year. Meanwhile, there were mounting suicides among veterans being treated at his facility — and officially, the St. Louis VA was reporting to its headquarters in Washington that its productivity was among the highest in the nation.

“They all got bonuses — that’s the sad part. Because in reality we were not really doing a good job, but it shows up on paper as if we are,” Mathews told Fox News.

When Mathews complained, he was removed from his job, assigned to an isolated office to oversee pensions and compensation. He was told not to contact the other doctors or patients.

“I think they have some form of moral blindness or something. They’re not able to see that this is not right, what they’re doing is not right,” said Mathews, a soft-spoken psychiatrist who says the veterans would have to wait a month or more for mental health treatment.

Spokesman Paul Sherbo, of the St. Louis VAMC, said in a written statement: “The St. Louis VA Medical Center leadership is aware of and is addressing the alleged issues. VA is committed to providing the best quality of care that all our nation’s Veterans need and deserve.”

A second whistleblower — from Harlingen, Texas – Dr. Richard Krugman accused the VA facility he oversaw in southeast Texas of delaying life-saving colonoscopies in order to cut costs. He provided a memo from his boss from 2011 outlining the shift in policy. He, too, was fired.

“I was treated like an animal. I was treated like a leper. I was treated like, how dare you attack me, or how dare you say what you’re saying,” said Krugman, a former associate chief of staff at the Veterans Affairs health care system.

He argued that his boss told them to require three successive fecal occult blood tests before sending the patient for a colonoscopy, a delay that could cause potential colon cancer to go from a treatable stage 1 to a deadly stage 4, if unaddressed.

His boss — now a VA director in Texas — pushed back, issuing the following response:

“Allegations such as the [VA] stopped sending patients for colonoscopies because the agency could not afford non-VA care and instead utilized a fecal occult blood test instead of colonoscopies was not substantiated” by the independent Office of Special Counsel that investigated Krugman’s charges and closed the case last November, according to the statement provided by Jeff Milligan, former director of VA Texas Valley health network. Krugman disputed the claim.

The Office of Special Counsel found none of Krugman’s claims to be substantiated. But when it closed the case, it admitted in a report and letter written to President Obama last November that it was forced to rely on an internal investigation carried out by the VA itself. It did not have the ability to independently investigate Krugman’s claims. The investigative panel assigned to get to the bottom of Krugman’s allegations was appointed by VA Under Secretary of Health Robert Petzel, who resigned Friday.

As first reported by Fox News last September, Petzel told congressional oversight committee members he had “no regrets” about awarding $63,000 in bonuses to hospital administrators in Pittsburgh after more than five veterans died of preventable Legionnaire’s disease contracted at a VA facility. 

“What I really got upset about was, over the last couple of weeks, everybody is now saying, ‘Oh, I never knew that. Oh, I didn’t see that,” Krugman said in an interview with Fox News. “The reports have been there since 2010, 2011, and each article, or each new material that I received, I purposely sent to those different gentlemen, with a backup copy, just so that they can’t say, ‘Oh, I never knew this, or I never knew that because every time that they say, ‘I don’t know this or I don’t know that,’ somebody else dies.”

Veterans’ groups met in Washington this week to call for secure hotlines so that more whistleblowers feel they can come forward and not face retaliation.

Jennifer Griffin currently serves as a national security correspondent for FOX News Channel . She joined FNC in October 1999 as a Jerusalem-based correspondent. 

I was approached by one of my patients who posed the question-If Kaiser Permanente can run a health care system effectively and efficiently, why can’t the government? This is an interesting question, which brings up a few points.

When I was training I found the VA system inadequate in health care delivery, but very cost effective for the patients, the veterans. However, the treating nurses and physicians were inadequate, either in their training, their qualifications or their dedications and concern regarding their patients. Very often, as a resident in training, I would stay after my rotation to care for the patients to make sure that they received their wound care or received their proper medications, etc.

Shift to my present experience where my practice consists of many cancer patients.

How do I experience the VA system and its inadequacies now? A number of my patients, who are veterans, proceed to the VA clinic or hospital when asked by their primary care doctors where they wanted to go for evaluation and treatment. Often they are referred to my office due to the waiting times to gain access to the system or due to inadequate treatment. Now I am faced with more advanced cancers to treat, challenging my surgical skills. Sometimes the malignancies are so advanced that radiation or chemotherapy are necessary, or even the patients showing up being now deemed untreatable.

This system, like the Medicaare system is a government health care run system. Unlike the Medicare program, the VA system is a true system consisting of delivery of health care through clinics, hospitals, employed delivery personnel such as physicians and nurses and finally the payment part of the equation.

I worry; looking at the government managed health care examples such as the VA system, Medicare and Medicaid programs, that the Affordable Care Act and all that it consists of will suffer the same poor quality and financial stresses leading to limitations or care delivery.

Let’s look at Kaiser’s history and examine their successes, failures, strategies, and organization. We should also compare it to other medical health care systems like Massachusetts and the European countries have worked out. Have they all been successes and what determines success? How are they financed and what limitations are “required” to make their systems sustainable?

Kaiser Permanente evolved from industrial health care programs for construction, shipyard, and steel mill workers for the Kaiser industrial companies during the late 1930s and 1940s. It was opened to public enrollment in October 1945.

The organization that is now Kaiser Permanente began at the height of the Great Depression with a single inventive young surgeon and a 12-bed hospital in the middle of the Mojave Desert. When Sidney Garfield, MD, looked at the thousands of men involved in building the Colorado River Aqueduct Project, he saw an opportunity. He borrowed money to build Contractors General Hospital; six miles from a tiny town called Desert Center, and began treating sick and injured workers. But financing was difficult, and Dr. Garfield was having trouble getting the insurance companies to pay his bills in a timely fashion. To compound matters, not all of the men had insurance. Dr. Garfield refused to turn away any sick or injured worker, so he often was left with no payment at all for his services. In no time, the hospital’s expenses were far exceeding its income.

Founded in 1945, Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving approximately 9.3 million members, with headquarters in Oakland, Calif. It comprises:

            Kaiser Foundation Hospitals and their subsidiaries

            Kaiser Foundation Health Plan, Inc.

            The Permanente Medical Groups.

At Kaiser Permanente, physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible.

Kaiser Permanente’s creation resulted from the challenge of providing Americans medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Among the innovations it has brought to U.S. health care are:

            1. Prepaid health plans, which spread the cost to make it more affordable

            2. Physician group practice to maximize their abilities to care for patients

            a focus on preventing illness as much as on caring for the sick

            3. An organized delivery system, putting as many services as possible under one roof.

 

As of January, 2014, Kaiser consists of 38 Hospitals, 618 medical offices and other outpatient facilities.16, 942 physicians (all specialties), 48,701 nurses and 174,259 employees, which represented technical, administrative and clerical employees. In 2013 they had operating revenue of $53.1 billion. It has since become the largest organization of its kind an HMO. In its modern form, the HMO combines a large group practice, contracts with employers to care for a group of workers, and a prepayment plan for both hospitals and group practices.

So, how can Kaiser be so successful delivering healthcare efficiently as basically a single payer system, which is sustainable, and the VA and Medicare reek with so many problems? The difference government control and management or better, mismanagement.

Consider the latest error of judgment by our President. He choses former White House Aide Kristie Caneegallo as the next person to oversee the health care law. What are her credentials and should she be in charge? Canegallo worked at the U.S. Embassy in Afghanistan in 2007 and served in Iraq in 2008 as a governance and budget adviser to Anbar provincial government.

When is this administration going to learn that we need someone experienced in health care to oversee the ACA?

The VA and Medicare will continue to have their problems in delivering health care, and so will our new Affordable Care Act.

Wake up America!

Medicare patients –Another set of losers in Obamacare

I decided to change my blog plan and discuss the changes in Medicare as the ACA goes into full action. Consider the following letter from a Medicare patient and if you are a senior citizen tremble with fear!

 

Letter from a senior gentleman in Mesa, Arizona:

 

  Dear Family, Friends, Neighbors and former Classmates,

 

I just found myself in the middle of a medical situation that made it very clear that  “the affordable care act” is neither affordable, nor do they care.

 

  I’ll go back about seven years ago to a fairly radical prostate surgery that I underwent. The Urologist (a personal friend) who performed the surgery was very concerned that it was cancer, though I wasn’t told this until the lab report revealed it was benign.  Since that procedure, I have experienced numerous urinary tract infections, UTI’s. Since I had never had a “UTI” prior to the prostate surgery, I assume that it is one of the side effects from surgery, an assumption since confirmed by my Family Doctor.

 

  The weekend of March 8-9, I was experiencing all the symptoms of another bout of UTI. By Monday afternoon the infection had hit with full force. Knowing that all I needed was an antibiotic, I went to an Urgent Care Center in Mesa, AZ., to provide a specimen, a requirement for getting the prescription. After waiting 45 min. to see the Doctor, I started getting very nauseous and lightheaded.

 

  I went to the Receptionist to ask where the bathroom was as I felt that I was going to throw up. I was told that I would have to wait for the Doctor because I would need to leave a specimen and they didn’t want me in the bathroom without first seeing him.

 

  That was when the lights went out, my next awareness was that of finding myself on the floor (in the waiting room) having violent dry heaves, and very confused. At this point, I tried to stand up but couldn’t make it, and they made it very clear they weren’t going to let me get up until the ambulance got there. By the way, when you’re waiting to see the Doctor and you pass out, you get very prompt attention.

 

Now, “the rest of the story”, and the reason for sending this to so many of  you.

 

  I was taken to the nearest hospital, to emergency. Once there, I was transported to an emergency examination room. Once I had removed my clothes and donned one of those lovely hospital gowns, I finally got to see a Doctor. I asked  “what is going on” I’m just having a UTI, just get me the proper medication and let me go home. He told me that my symptoms presented the possibility of sepsis, a potentially deadly migration of toxins, and that they needed to run several tests to determine how far the infection had migrated.

 

  For the next 3 hours I was subjected to several tests, blood draws, EKG’s, and demands for specimens. At about 7:30 the nurse came back to my room to inform me that one of the tests takes 1- 2 days to complete, I asked if they (the results) could be emailed, at which point she informed me that I wouldn’t need them emailed because I wasn’t going anywhere. I started arguing with her but was told, “if you don’t start behaving, I’ll start taking your temperature rectally, at which point I became a perfect gentleman. I did tell her I wanted to see the doctor because I had no intention of staying overnight.

 

  Now, this is what I want each of you to understand, please read these next sentences carefully. The doctor finally came in to inform me that he was going to admit me. I said,  “are you admitting me for treatment or for observation?” He told me that I would be admitted for observation. I said Doctor, correct me if I’m wrong, but if you admit me for observation my Medicare will not pay anything, this due to the affordable care act , he said that’s right, it won’t. I then grabbed for my bag of clothing and said, then I’m going home. He said you’re really too sick to be going home, but I understand your position, this health program is going to hit seniors especially hard.

 

  The doctor then left the room and I started getting dressed, I was just getting ready to put my shoes on when another doctor (the closer) came into the room, he saw me dressed and said, “where do you think you are going?” I simply said,  “I’m going home, to which he replied, quite vociferously, no you aren’t. I said, “Doc, you and I both know that under the “affordable care act” anyone on Medicare who is admitted to a hospital for observation will be responsible for the bill, Medicare won’t pay a cent”.  At which point he nodded in affirmation. I said, “You will either admit me for a specific treatment or you won’t admit me.” Realizing he wasn’t going to win this one, he said he would prepare my release papers.

 

  A few minutes later the discharge nurse came to my room to have me sign the necessary papers, relieving them from any responsibility. I told her I wasn’t trying to be obstinate, but I wasn’t going to be burdened with the full (financial) responsibility for my hospital stay.

 

  After making sure the door was closed, she said, “I don’t blame you at all, I would do the same thing.”  She went on to say, “You wouldn’t believe the people who elect to leave for the same reasons, people who are deathly sick, people who have to be wheeled out on a gurney.” She further said, “The ‘Affordable Care Act’ is going to be a disaster for seniors.  Yet, if you are in this country illegally, and have no coverage, you will be covered in full.”

 

  This is not internet hype folks, this is real, I just experienced it personally.  Moving right along, this gets worse.

 

  Today I went to a (required) follow up appointment with my Arizona Family Practitioner. Since my white count was pretty high, the follow up was important. During the visit I shared the experience at emergency, and that I had refused to be admitted. His response was “I don’t blame you at all, I would have done the same thing”.  He went on to say that the colonoscopy and other procedures are probably going to be dropped from coverage for those over 70.

 

  I told him that I had heard that the affordable care act would no longer pay for cancer treatment for those 76 and older, is that true? His understanding is that it is true.

 

  The more I hear, and experience the Affordable Care Act, the more I’m beginning to see that we seniors are nothing more than an inconvenience, and the sooner they can get rid of us the better off they’ll be.

 

  November is coming folks; we can have an impact on this debacle by letting everyone in Congress know that their responsibility is to the constituents, not the president and not the lobbyists. We need to let them ALL know that they are in office to serve and to look after the BEST INTERESTS of “we the people”, their employers, and not to become self-serving bureaucrats who serve only out of greed. And if they don’t seem to understand this simple logic, we’ll fire them.

 

  On the mend, (signed)

 

  REMEMBER:   Demand your hospital admission is for TREATMENT and NOT for OBSERVATION!

Letter from a senior gentleman in Mesa, Arizona:

So, is this a reality?

Consider the article written by Craig Joseph Dan, Medicare Patients are the First Casualty In Emerging Healthcare Revenue Battles. It turns out that how patients are technically admitted to a hospital, and how many “midnights” they stay, both play a critical role in what Medicare wi cover and what the out-of-pocket costs will be. Revenue battles are going to continue to heat up as the government decides how to pay for the care for the underinsured that will be covered by the ACA (Affordable Care Act).

The United States Department of Health and Human Services (DHHS) through the Medicare Modernization Act of 2003, created the Recovery Audit Contractor (RAC). The RAC identifies and recovers improper Medicare payments paid to healthcare providers under fee-for-service Medicare plans. The DHHS made the program permanent for all states by January 1, 2010 under section 302 of the Tax Relief and Health Care Act of 2006.

Dr. Bart Caponi wrote a summary of the RAC issue on te Hospital Leader blog site who offered his assessment. He stated that Medicare patients don’t really know that CMS uses private bounty hunters who are paid on contingency to audit and deny hospital claims. Therefore, hospitals provide the care and then either lose an audit or have to fight through a lengthy appeals process for reimbursement of services. This perceived risk or set of risks has changed the behavior of hospitals, which means, as we have seen in this letter, that patients can get blindsided with big out-of-pocket expenses.

Also, earlier this year, Maryland received a waiver from the Centers of Medicare and Medicaid Services (CMS) to institute a five-year demonstration program known as the all-payor model contract. This program attempts to reduce spending for hospital services by keeping the rate of revenue growth in hospitals from all sources- including private insurance, the government, and employers- to no more than growth in the overall state economy. The goal is to keep costs down by reducing the number of patients admitted the hospitals and encouraging hospitals to work with physicians to maintain their patient’s health. This program, implemented under H.B. 298 permits the Health Services Cost Review Commission to set rate levels and increases, which is the most comprehensive attempt by any state to control health care costs and includes all health care payors and most hospitals, as well as an enforcement mechanism. Interestingly, this commission is represented by a majority of the insurance industry. Lack of bias much???? Now who do you think is affected by these restrictions? Again consider the Medicare patients, especially in regions where the dominant people are the retired Medicare patients.

Beware senior citizens and those of you who will be covered by Medicare insurance in your future.

The ACA or Obamacare will force more consideration of costs and sustainability. Who will pay the cost of a flawed roll out and a flawed health care system?

Also, consider what the future of the ACA will be and what the future of health care will be?

Wake up America!

The Biggest Losers

I ended the last blog hinting about the losers in this new health care program and was encouraged to pursue this discussion while reviewing two articles.

But let me first set things straight, as a strategic planner, the reason we are where we are is due to the lack of real research and planning. As much as I am not a President Obama fan, I really believe he and years before, Hillary Clinton, really believed what they were proposing was a good thing for the American people. I only object to the method that was chosen and the politicization, the lack of real research and planning with people in the know.

I comments in this last paragraph were further strengthened when I read the comments by the Speaker of the House discussing the Republicans mistakes and the lack of ability to overturn the health care law and the need to modify it and make it work. It was interesting to read that House Speaker John Boehner inadvertently revealed that repealing Obamacare “isn’t the answer,” and that “Republicans also need to offer a replacement.”

I also object to Harry Reed and Nancy Pelosi being so arrogant and closed minded in not allowing a non partisan discussion and resolution of difficulties to result in a bill which can “get the job done” efficiently and effectively for all the American people.

This has become a political ping-pong ball and shows that our elected officials really don’t care about Middle America especially and also points to the necessity for term limits.

Jonathan Bernstein wrote that“ The challenge is that Obamacare is the law of the land. It is there and it has driven all types of changes on our health care delivery system. You can’t recreate an insurance market overnight…. So the biggest challenge we are going to have is—I do think at some point we’ll get there—is the transition of Obamacare back to a system that empowers patients and doctors to make choices that are good for their own health as opposed to doing what the government is dictating they should do.”

This is interesting to me due to one of my previous blogs and the strategy that needs to be embraced- getting over the repeal idea and instead find ways to make the law work.

Think about the question that I posed at the end of my last blog-Who are the Biggest Losers? Byron York in his latest Op-Ed piece notes that Obamacare losers are harder to discern. I think not! He finally noted that “The plans being offered through the exchanges in 2014 appear to have, in general, lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers’ use of health care than employment-based plans do.” The Congressional Budget Office (CBO) said “These features allow insurers that offer plans through the exchanges to charge lower premiums (although they also make plans somewhat less attractive to potential enrollees).”

The health care analyst, Bob Laszewski, questions who is harmed and points out that “when carriers converted their old policies to Obamacare-compliant policies, it was typical for the insurance company to increase costs about 35%” and “That increase could come in the form of higher premiums, more co-pays and deductibles and narrower networks.” This is what we are seeing in that enrollees are facing higher premiums and higher deductibles, which add up to a total higher cost, as well as a narrower choice of hospitals, doctors and prescription drugs than they had before. Therefore, what we are finding is that health care is becoming a more expensive and troublesome system.

Rick Newman in his article in The Exchange (April 25, 2014) points out that there are three subsets of people whose policies were canceled and then are the posers under the Affordable Care Act (ACA): people who are self-employed, those over 35, those who are white, or some combination of all of these three.

The biggest losers to ACA are the people who lost their insurance coverage but are unlikely to qualify for subsidies through one of the exchanges, which require an income of less than $47,000 for an individual or $95,000 for a family of four. Some of these people who lost insurance coverage report paying twice as much with deductibles of $4,500-$7,500 or more. It was interesting that Mr. Newman pointed out that it so happens that these groups so impacted negatively tend to be Obama’s political opponents.

Do the insurance companies lose? In a previous blog I pointed out that WellPoint was planning to increase their premiums and now I read that CEO of Aetna, Mark Bertolini, stated that their premium increases would range from low single digit to double digits, based on its first quarter earnings. So the insurance companies never lose. The have to make a profit and usually the profit is much larger than the proposed profit margins that the committees and government departments are demanding for health care facilities.

Ethan Rome (The Truth About Health Insurance Company Profits: They’re Excessive) reviewed health insurance company profits and went on to further review the American trade group American Health Insurance Plan’s (AHIP) focus on profit margins which he thought was misleading when they quoted 4.4%, and designed to protect their massive income by shifting attention away from their return on equity — a key measure of profits as a percentage of the amount invested. “That return is a phenomenal 16.1% as of today. By that measure, health insurers are ranked fourth highest of the 16 industries in the health care sector. They also deliver a higher return for investors than cellphone companies, beer companies, mortgage companies, life insurance companies, TV broadcasters, drug store companies or grocery stores.”

In May 2011, the New York Times reported “the health insurance industry is enjoying record earnings while millions of Americans get less medical care. Wall Street investors are delighted with the industry’s profits, and to health insurance executives, that’s all that counts. Insurance CEOs want investors to buy their stock and keep share prices marching higher, and that’s exactly what has happened. To achieve excessive profits, insurers are happy to gouge consumers and small businesses, do little to rein in medical costs and spend billions of our premium dollars on lobbying, secret political activities, bloated executive pay and stock buybacks.”

How about the greedy doctors? Are they losers? In the beginning and for quite a while they will lose as they have for years as their reimbursements (what they are paid by the insurance companies and the government, i.e. Medicare and Medicaid) are further discounted. But they will not be able to keep their offices open unless they become employees of the hospitals, universities or convert to boutique type practices. The boutique practices will charge patient fees to become practice members and or start to do procedures that they are not trained for and for which the complication rate will be high. But the added income will be necessary to maintain their overhead expenses.

Having insurance policies that include $5,000- $7,500 deductibles means that almost all health care needs, office visits, tests and surgery will be out of pocket expenses. How does the new plan then encourage good health care behavior and encourage preventative care?

Yes, the uninsured, if they fulfill the requirements for the government subsidies, will get coverage, but who will take care of these patients and cane you change their “bad” behavior? Will we have enough doctors to provide care and what type of care will be provided? I will discuss these topics further in future blogs.

Let us also consider who is in control of the ACA and what their history predicts. These are the same government systems that have control of the problematic Medicare, Medicaid and Veteran health systems. Remember what we have been hearing about concerning the Veteran Administration Health Care problems in the last few weeks. Long waiting times, poor care, lack of care, deaths, suicides, etc. What then can we expect for the future control and management of the ACA?