The fatal flaw, or poison pill, of our entire healthcare system, is that we’ve tried in vane to make it a system.
We set aside everything we knew about human behavior and motivation and behavioral economics and pretended it didn’t exist. We based interventional policy on myths such Roemer’s Law. We tied it to employment by using the tax code. We handicapped markets with McCarran-Ferguson. We handicapped Physicians and other providers with HIPAA. We perverted insurance with all manner of mandate such that it violated every principle of what insurance is supposed to do. This has created Health insulation rather than health insurance.
Then the geniuses thought they can fix it with HMO and then PPOs and now ACOs and all the rest of the alphabet soup that they serve up. All of this has one thing in common and that is price opacity. We have not had a market failure we’ve had one giant pricing failure. We put healthcare on an island and treated it differently and treated it weirdly and regulated it excessively.
Many have gotten wealthy but patients are suffering and doctors are demoralized.
“Snippets from the frontline” sent in from Gene Uzawa Dorio, M.D.
You’ve been told surgery required to repair a herniated disc has been denied; a mammogram to evaluate a new lump won’t be allowed; or you must be discharged from the hospital because an insurance company doctor you have never met will not approve further hospitalization.
As my patient’s advocate, I frequently must discuss their care with insurance doctors in peer-to-peer phone conversations. This is what I do starting this conversation: I get the doctor’s name; in what state they are licensed; their specialty; and tell them their name will be placed on the patient’s record as being a participant in medical decision-making.
With that, they must weigh their medical versus financial judgement, and know they might be subject to the same accountability I face. Does this make a difference? Sometimes.
Medical decision-making has been removed from your doctor and given to distant paper pushers of the insurance industry. Urge your physician in their peer-to-peer conversations to make insurance doctors responsible too.
Open letter to patients, physicians and lawmakers from Sharon S. Jellinek M.D.,
This is the first letter I have ever written to a political figure and I pray that someone on your staff will bring this letter to your attention.
I have been a physician for close to 30 years. I am a second-generation pediatrician struggling to keep an independent solo practice alive. Not one politician has addressed what I feel is the major threat to health care…the physician-patient relationship. Without this, there is no quality of care no matter what you do. Physician patient relationships require time with the patient. Most of my diagnosis is derived from my patient-parent interview and a “hands on exam” of the child. You cannot possibly read a cookbook of medical questions and treatments and have the same result. The current insurance treadmill model of primary care makes this impossible. There is a hemorrhaging exodus of well-trained physicians unwilling to jeopardize this patient relationship. Continue reading →
After spending the last 7 years treading water naively and optimistically waiting for things to be repealed and fixed and after countless trips to DC and across the country trying to cry from the wilderness of the practice of medicine from the trenches with many of you and our organizations, I am convinced this is beyond repair and will never be repealed by those in power.
The Philosophy of the architects of the current system we are floundering in is the antithesis of Hippocratic medicine and in fact works to undermine and dismantle it. Just take innovation- look at Ezekiel Emanuel’s own words on this- he believes innovation is too expensive and the taxes in Obamacare reflect this opinion. He also is an ethicist whose roots stem from his area of expertise which is dying with dignity and systems of rationing like the complete lives system. Continue reading →
Please vote NO on HR-2, the current SGR “doc fix” bill. Repeal is necessary; but not this version.
Here is what the bill really does: “…shifting Medicare reimbursement from fee-for-service to pay- for-performance.” This is Orwellian double-speak for P4P “value” pay; the PPACA cost control stratagem, which only reproduces decades of the failed HMO capitation experiment.
Why is this not good?
1) The bill is a death knell for professional integrity—a serious danger to patients. Doctors at the bedside are literally paid (“bonus rewards”) for restricting use of “payer” money (government/corporate) for patient care under the guise of “stewardship”, “value pay”, “choosing wisely”, or whatever slogans can sell this bedside gatekeeper rationing bill. Continue reading →
The addiction to middlemen and conscription to the Fourth Branch of Govt and regulatory bodies probably began ~ 1929 when the first insurance company, covering Dallas/Ft Worth teachers was formed.
50 cents every other paycheck, only for catastrophic care, a simpler time.
-1944- With salaries and other benefits frozen during WWII, businesses start offering HC ins to retain/recruit employees.
-1965- Medicare/Medicaid/Govt begins to insert itself as you describe. HC costs, at that time 3-4% of GNP begin to soar. Approaching 20% today, and as E Bowles says- ‘The vapor that is driving our economy into the abyss.’ Continue reading →