Patient-based Health Reform or “Fannie Med?”

Rick_scottSet against the backdrop of the $787 billion stimulus bill and deficit spending that dwarfs the federal outlays of FDR’s New Deal and LBJ’s “Great Society,” the idea of spending hundreds of billions – or even trillions of tax dollars – to buy universal health care coverage for all Americans isn’t much of a stretch anymore.

Faced with $30 to $80 trillion in unfunded healthcare liabilities ($110,000 to $300,000  per American under the age of 65) “health care reform” discussions are  underway between President Obama and members of Congress in the 111th Congress to spend even more on health care, and Americans are  beginning to hear more and more about “patients’ rights” and similar jargon.

The problem is that “universal health care” and “patients’ rights,” while sounding harmonious, are in direct conflict.  The path to effective health care reform must be approached from the perspective of individual patients and their relationship with their doctors, and not from a top-down, big government perspective.  Anything that interferes with an individual’s freedom to consult their doctor of choice to make health care decisions defeats the purpose of meaningful health care reform.

True health care reform centers on four “pillars” of Patient’s Rights:

Choice – Any health reform proposal must guarantee a patient’s right to choose their own doctor, and must protect a consumer’s right to choose the health insurance that best fits their needs and budget.  Reform efforts should expand the choices without dictating or distorting them..

Competition – In addition to increasing patient choice, eliminating state regulations on health insurance would allow for broader competition and lower prices for consumers.  Patients also benefit when doctors are free to run their practices like any other business, competing on the basis of results and price.  Requiring health care providers to publicly post their pricing and results so consumers can shop and compare will make our health care system more efficient at delivering quality care at an affordable price.  Effective reform must rely on market dynamics, not government controls.

Accountability – Health reform efforts must reward individuals who are accountable for themselves.  Those who pay for their own health insurance should get the same tax breaks employers get.  Creating one standard reimbursement form, regardless of insurance company, will reduce costs and shift accountability where it belongs – to the individual whose life is most affected by the decisions that need to be made. Rare is the politician who would argue that an insurance executive or a bureaucrat in Washington D.C.is in a better position to make critical health care decisions than individual Americans and their doctors.

Responsibility – Successful health care reform must place responsibility squarely where it belongs: on the shoulders of the patient.  Encourage individuals to take responsibility for their personal health by allowing insurance companies to charge lower rates for people who make healthy lifestyle choices.  Infusing personal responsibility into health care reform allows us all to maintain our cherished freedom to live our lives without government intrusion.  This principle works now: a 40 year-old who has been smoking since he was 16 knows his life insurance policy is going to cost more than that of a non-smoker. A driver with a heavy foot knows his car insurance rates reflect his need for speed.

Any serious discussion of health care reform that does not include choice, competition, accountability and responsibility – the four “pillars” of patients’ rights – will result in our government truly becoming a “nanny-state,” making decisions based on what is best for society and government rather than individuals deciding what is best for each of us..

Because of budget constraints, regulators in the United Kingdom dropped pap smears for women under 25.  The result – young women are dying of cancer that could have been treated if the cancer was discovered in its early stages.    Many Canadians have to wait months for diagnostic tests to determine whether their tumors are malignant, giving cancerous tumors time to worsen, spread and progress to an irreversible stage.

Some of the ideas being advanced by our leaders in Washington fail to consider patients’ rights , focusing instead on “government oversight boards,” “negotiations” with drug companies, and other bureaucratic solutions that refuse to put the patient-doctor relationship first.

Worse, the danger of Washington’s recent willingness to spend inordinate sums of money on anything deemed to be a problem, is that we are conditioning ourselves to believe that our government has unlimited resources – and that any problem can be solved by simply spending vast amounts of cash.  What politician wants to be in office when it comes time to admit we can no longer spend for services we have come to expect?

Fannie Mae’s and Freddie Mac’s failed experiment to improve home ownership for “low and middle income families” should be a wake-up call to those who believe more government involvement in American healthcare will help “low and middle income families”. These two initiatives resulted in politicians being accused of receiving favored treatment, low and middle income families being forced out of their homes and a federal bailout that could cost taxpayers as much as $2.5 trillion.  We never envisioned politicians receiving favored treatment, the housing meltdown caused by the expansion of these programs, nor the unbelievable number of low and middle income families being evicted from their homes with their life savings depleted.  It’s not difficult to imagine similar results under a national health care system.

Given the evidence, now is the time for an investment of political willpower to institute a dramatic shift away from the influence of government, and toward a patient-centric system with the principles of choice, competition, accountability and responsibility powering a revolution in American health care.  The shakiness and uncertainty that permeate our economy, some of which is caused by our lack of competitiveness because of healthcare costs, argue vocally for patients’ rights as opposed to government control.

Ultimately, the decision will come down to who we believe will better allocate our limited healthcare dollars: the government or each of us. If we get this right, everyone wins.  If we get it wrong, the damage to our economy and our quality of life and the quality of life for our children and grandchildren may be irreversible.  The last thing America needs is for Fannie Mae to become “Fannie Med.”

Richard Scott is co-founder and chairman of Solantic Corporation, a Florida chain of 23 urgent care centers which posts prices on the internet and on a “Starbuck’s style” menu board. He’s best known for being the CEO of
Columbia/HCA which grew to quickly being the largest for-profit
hospital chain in the 1990s before he was forced out when the Federal
government investigated allegations of fraud. After Scott left, HCA settled the suits for
over $1.7 billion. More recently Scott has become a participant in the national debate over health reform. In 2009, He formed the Washington-based political action group “Conservatives for Patients Rights”, an organization dedicated to market-based reform of the healthcare system.

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  1. Conservative Healthcare Plan
    1. The United States Secretary of Health and Human Resources, aided by health care providers, will establish a basic health care coverage system, to provide BASIC health care to all employed persons.
    2. This will be a limited coverage plan.
    3. The AHC plan will be streamlined to provide the maximum amount of care for the lowest amount of cost. For example, experimental procedures will not be covered. Preventive care will be stressed. All procedures with a low percentage rate of success will not be covered. Conditions caused by preventable lifestyle choices such as diseases caused by alcohol or drug abuse, extreme obesity, or unsafe sex practices, will not be covered. If there is more than one method for treating the same condition, only the most cost effective will be covered. If more than one drug is available to treat the same condition, the least expensive drug will only be covered. Also, only generic drugs may be covered. There are no co pays and no deductibles.
    4. Persons enrolling in the program will have a very limited ability to sue for malpractice
    5. The AHC will be a voluntary program. It will be open to all employed people. Self employed people will be able to join. People receiving unemployment benefits will be able to keep coverage as long as they receive unemployment benefits.
    6. Everyone will pay the same premiums. Every person who works and who joins the AHC will pay the same amount, regardless of marital status. All children under the age of 19 will be covered under the parent’s coverage. If only one parent works, both parents and children are covered under the working parent’s coverage.
    7. The AHC program will be administered by a private insurance company based upon the bid procedure. The company who bids the lowest cost per person per month will receive the contract to administer the program. This is a winner take all provision, just as in the private sector.
    8. Digital medical records will be used to streamline costs. The bid process will be repeated every 4-10 years.
    9. The AHC will eliminate the cost of employer sponsored health insurance. Employers may opt to subsidize all or part of their employee’s premium costs. Or they may offer their own plans, or a combination of both.
    10. This plan will cost the federal government almost nothing. This plan will cost employers almost nothing. This plan will lower costs by being a limited coverage plan, using the winner take all bid system, and by using the large number of enrollees to spread the cost around.

  2. My, my, we do indeed live in the the United States of “Amnesia” if this ilk of executive can effectively recycle himself into both the corporate board room, and tragically, the national psyche as well.

  3. This is very encouraging in the depth of discussion! I totally agree with the comments that comparison with Europe and Canada are basically bullshit and lies. The principles of reform must encompass, Universality, transparency, Accountability, Affordability, Availability and Evidence based. To this end using the national provider number figures should be publically available for the cost per patient per doctor per year for all public ie. taxpayers expenditure payments. This would be very raw data as protested by the AMA but it would give the patients their fires opportunity to chose between going to the local Toyota dealer or Mercedes dealer medically wise. Someone or some agency would I’m sure help to compare various specialists, including those with financial interest in imaging centers or hospitals and primary care providers who may or may not have financial relationships with the specialist they refer to.
    How does one treat the patient who given choice does not choose cancer care as an extra expense on his health insurance menu and then six months later unexpectently comes down with cancer. How does the physician decide on appropriate care for the homeless, obese, diabetic, nicotine dependent, drug addicted, alcoholic with no family support no transportation when our whole social support system and public mental health system is collapsing?

  4. Right on post describing the problems with “universal healthcare” and the issues needing attention if true reform is to be seen in our lifetimes.

  5. I am watching a health care discussion on CSPAN (April 5th AM) chaired by Senator Baucus. In my opinion there is very little getting accomplished. The big elephant in the room that is being totally ignored is that the US pays double what other industrialized countries pay for health care and receives worse results!! The more sensible approach would be for this panel to spend their time studying the best 5 (or 10) of these other health care systems to see which ones are the best. As Ross Perot said in his 1993 debate with Bush and Clinton when asked about what his plan would be for US health care his comments was approximately .. “There are all kinds of good health care systems out there. Let’s pick one and do it.” Ross Perot knew a thing or two about health care as his company, EDS, provided the computer software for the Blue Cross Blue Shields. Let’s focus our efforts and studying already successful, working health care systems and then pick the one that is best for the US.

  6. If the patient is denied a true account of what the treatment entails including all of the risks and basically manipulated into accepting a surgery or treatment. If a patient has no right to refuse expensive and unecessary steps in health care, if informed consent is merely a hold harmless agreement for the benefit of health care providers, then we will never get health care “reform.” We patients have an adversarial relationship with providers right now. We want to keep costs down and medical providers are trying to make it as expensive as possible. With this era of tort reform and villifying trial lawyers we have created a monster that has no oversight and no recourse for the patient. It’s a lie that Doctors and such are so scared of lawsuits! They are basically impervious to them and as a result, are out of control. They are careless, arrogant and patient rights and control over their own body are out the window. All they have to say is “we were only trying to help” and there is nothing that can be done. We need REAL reform and some consequences for Doctors attacking innocent patients and lying through their teeth in order to subject patients to the most expensive treatment possible. Medical providers are PREDATORS and need to be brought to heel. While we are at it, lets limit the number of personnel that are doing the same job. Anesthesiologists and CRNA’s, doctors and physicians assistants, scrub nurses, circulating nurses, OR nurses, radiologists and ortho surgeons, jeez how damn many people does it take? Mandatory random drug testing and psychological testing should be required for every person who has access to drugs and patients. Real reform would include a mediation department where if the patient is subjected to forced treatment or the surgeon is egregiously negligent, there should be some way of effecting recourse.

  7. You guys are NUTS. I live in Canada and thank God every day for our healthcare system! How you can be humane when so many of your citizens are dying from lack of healthcare is beyond me! I have choice of doctors and I have a good one! Lifestyle choices do impact health but most of the poor (yours and ours) do not have the education or the money to make healthy choices. Our doctors do compete for our business! If we don’t like our physician, we get another one. And they are accountable. Once again, if our doctors do not give us proper care, we go somewhere else. I am a self-employed diabetic (from heredity not lifestyle). I can only imagine my healthcare costs if I lived in the U.S.!

  8. Single payer is publicly funded, privately delivered heathcare. Rick Scott liked a lot of sick insured people in his hospitals who lived for a day or two and had millions of procedures and then died. Scott suggesting how we should provide healthcare is like Rasputin being the president. Just how much money do people think that they need to make in one lifetime? Do they really believe that they can take their money with them when they die?

  9. What good is the health care system if it is unaffordable and only the wealthy can purchase it. Did you know in NY that a family policy purchased directly costs $ 3,200 per month. One must earn a six figure income and it is still 1/3 of earnings. The poor get it free, the wealthy can afford it, what do the middle class do ? go without it and face health and financial catastrophy. I don’t know what the solution is but, those how are enriching themselves in the current system should help bring the costs down, or a special tax should be levied to subsidize the middle class, like the poor are.

  10. Great article, except I have trouble with competition within the health care industry: “Competition – In addition to increasing patient choice, eliminating state regulations on health insurance would allow for broader competition and lower prices for consumers.” This seems to work well in some areas of capitalism, but decreasing costs has been a challenge. Read a good summary on the health care plan.

  11. President Obama has said again and again that to fix our economy, we must fix health care. When that happens (and I feel it will) we need to make sure it’s an informed and balanced process. My colleague forwarded me this petition asking Obama and Congress to pursue balanced health care reform. http://snurl.com/fairhealthcare
    I’m particularly concerned about access to care and physician choice.

  12. http://www.huffingtonpost.com/kenneth-thorpe/massachusetts-is-not-the_b_182265.html
    Massachusetts is Not the Only Health Reform Model
    By Kenneth Thorpe
    Posted April 2, 2009
    As discussion continues on the President’s budget and whether the nation can afford to take on health care reform, a number of experts — and two of the nation’s leading newspapers — have suggested that we look to Massachusetts as the nation’s test case. These critics point to the cost growth which has occurred under Massachusetts’ new universal health care system as a demonstration for why the nation should proceed cautiously with its own reforms.
    But if we are looking for lessons, there are other “real world” examples that we can consider. A state just across Massachusetts’ Northern border took a different road to reform — and one that is actually much closer to the route proposed by President Obama and Senate leaders such as Max Baucus.
    In May 2006, a month after Massachusetts passed its own health care legislation, Vermont also enacted a sweeping set of health reforms. Whereas Massachusetts chose to make universal coverage its initial goal, Vermont’s primary focus was to make health care more affordable and at the same time expand coverage.
    While it is still too early to pass judgment on either state, there are three core elements that have Vermont showing early signs of promise, and which could be replicated at a national level:
    Health care legislation must be bipartisan and have something “in it” for everyone. Vermont’s health reform program was solidly bipartisan — enacted by a Republican governor and a Democratic legislature. Key to the reform’s political success was the recognition by both sides that the debate would need to be refocused on broader systemic ills, like cost and quality, rather than solely on the contentious and politically-charged issues, like coverage and payment. At the time reform was being debated, the vast majority of Vermonters — and almost all voters in the state — had health insurance, so policymakers had to communicate what these people would get out of reform, other than a higher tax bill, and the answer was lower health care costs.
    Health care legislation must be comprehensive. Vermont passed comprehensive legislation to modernize chronic care delivery models, create a statewide health IT platform, implement effective efforts to prevent disease and build a new insurance program for the uninsured (Catamount Health). By 2010, an estimated 96 percent of Vermont residents will have health insurance coverage.
    Health care legislation must address cost, which means getting a handle on the root cause of spending. For years now, many of the health reform proposals that have been introduced in this country have failed to control the root of increases in spending. More than anything, that root cause is that Americans are in poor health — and many of their chronic health problems are preventable. Recognition of these “unhealthy truths” helped to shape the types of policy solutions proposed in Vermont during the 2006 debate. Controlling chronic conditions through prevention and disease management featured prominently in Vermont’s plan to make health care more affordable.
    Less than three years have passed since both these states passed their health care reform plans, which is not enough time to pronounce either effort as a success or failure. In addition, Massachusetts has created a state commission to figure out how to control costs, which may yet yield improvements.
    What we can pull from both efforts is that in addition to moving to universal coverage, passing fundamental reform nationally will require legislation designed to reduce the growth in spending, provide high-quality, efficient medical and preventive care for all Americans, and roll out community level resources and support that make it easier for Americans to lead healthy, active lives.
    And for the critics, this means acknowledging what was done right as well as pointing out what was done wrong.
    Ken Thorpe, Ph.D., is Executive Director of the Partnership to Fight Chronic Disease, and Chair of the Department of Health Policy and Management at the Rollins School of Public Health at Emory University. Dr. Thorpe served as Deputy Assistant Secretary of Policy at HHS under the Clinton Administration in the early 1990s.

  13. When is someone in the republican party going to come forward with a serious, well developed, version of McCain’s healthcare reform proposals from his campaign? His plan was terribly underdeveloped and got picked apart on details, which is a shame because the concept of seperating coverage from employers is probably the only “reform” that will ever solve the intractible problems we are facing.

  14. A few points about Rick Scott:
    1) I wrote the first in-depth profile of Scott at the height of the Columbia/HCA years in 1995. In this contest, it might interest folks. You can find it here:
    http://www.well.com/user/bbear/columbia.html
    2) Scott clearly has a dog in this fight. The strategic advantage of Solantic is in being very organized in a disorganized healthcare system. He carries a study on his “Conservatives for Patients Rights” website that purports to show what a burden it would be to doctors to digitize. That’s a little like Henry Ford discouraging other automakers from trying integrated assembly-line production: “Oh, you don’t want to do that, it’s too hard.”
    3) His comments about physicians being forced to digitize make him seem unaware (and I cannot believe he is unaware) of the $40,000 per practice incentive in the ARRA, and the Ideal Medical Practice movement, and the absolute necessity of getting healthcare digitized if we are to improve efficiency and effectiveness. And don’t tell me Solantic is run on pencil and paper, I won’t believe you.
    3) Choice, competition, accountability, and responsibility are all great things. None of them are incompatible with universal healthcare, or even single payer healthcare. But they are being used as smoke screens to fight evidence-based medicine, clinical effectiveness research, and digitization – all the things that we need to make healthcare better faster and cheaper. “Choice,” in this context, means “whatever the doctor can get reimbursed for and talk you into, even if it has been proven ineffective and dangerous, like spinal fusion surgery for chronic back pain.”
    4) Evidence-based medicine does not mean a “nanny state,” in which faceless bureaucrats interfere with medical choice and practice. That’s what we have now, with the interference outsourced from the government to the insurance companies. Evidence-based medicine is the official recognition of the fact that medicine is and always has been a collegial art, that there are things to learn from other physicians, that a board of the prominent physicians agreeing on guidelines for a particular condition should have some weight in at least questioning the clinical choices of individual doctors who stand to gain from doing things that are less efficient and less effective.
    Rick Scott has always seen all healthcare questions from the point of view of a wealthy investor, insulated from all actual consequences of his proposals, except for the ROI.

  15. I just read the section in MMahar’s book on this guy.
    Of course he should be in jail. Sadly, the white-collar criminal gets off in so many cases.
    I use the word the Repubs now bandy about: generational theft.

  16. Peter: I believe Florida hosts it’s share of shady medical practice operators. As a state without a corporate practice of medicine statute, it enables non medical corporations to employ physicians.
    Both for profit corporations and hospital systems have staked claims in the space. Some are clearly more ethical than others.
    One of the more recent shady flame-outs include: ER Urgent Care Holdings. They pursued essentially desperate primary care practices, and presumptively cobbled them into a primary care network which they then attempted to market to payors.
    No doubt Solantic will be a well capitalized enterprise, and thus able to present a prettier face, with probable staying power; but the business model is likely to be essentially the same corporate driven affair.
    Hard to imagine physicians embracing this framework unless they are shareholders or otherwise vested in the cash flow of the network.

  17. As for health care reform that protects a consumer’s right to choose the health insurance that best fits their needs and budget. This leads us in the wrong direction. Allowing insurance companies to continue to offer bare bones coverage is not real reform. All patients deserve quality comprehensive health care coverage. http://www.BenefitStudio.com

  18. It’s sad to read what passes for political debate these days – instead of debating Scott’s points, the big-government health care types dig up an old story, twist the facts to smear their opponent, and pretend it bolster’s their argument.
    But the smears are long on innuendo and short on facts. As one poster has already pointed out, the issues faced by HCA were localized and it was an INDUSTRY-WIDE problem.
    Some 4,000 health care providers were under investigation at the same time. Scott’s company was the biggest, so it certainly had it’s share of problems.
    But to try and say that this somehow disqualifies Rick Scott as a valid commentator on how health care SHOULD be reformed is either the height of ignorance or a new low in deception.
    If anything, the industry-wide problems with Medicare should be illustrative of what you can expect when the program is expanded to ever-larger numbers of Americans.
    Some people never learn.

  19. I’ll not discuss whether or not Mr. Scott is an appropriate commentator on the issue. Instead, I’d like to really define the issue. In 1965 our healthcare system focused itself on the problems of the day: treating disease. It was a system based on what an aging population in 1965 faced. However, it’s 2009. Treating disease is exactly what is bankrupting our system; because while we’ve been so focused on this, and doing an incredible job, we forgot something. First of all, primary prevention works. But it’s only been a few years that Medicare has even paid for any preventive care! And second, treating disease isn’t the issue any more. Most of the diseases that affect our aging population and cost so much are too complex to be simply “treated.” They must instead be “managed.” Treatment of chronic disease is what happens when a chronic disease isn’t managed and there is a complication.
    A health care system that actually works to care for Americans will focus on prevention and early detection to limit morbidity and improve quality; and will focus on managing the chronic illnesses that are the results of an aging population and our lifestyles and habits.
    So instead of just re-form, maybe we should talk a bit about re-focus.

  20. see The Commonwealth Fund for complete TRUE analysis of the various health care plans.
    http://www.commonwealthfund.org/
    See http://www.healthcare-now.org
    for decent analysis of House Resolution (HR) 676- the most feasible plan to expand & IMPROVE Medicare (for all). Most of us don’t care who finances our health care, being typical independent “freedom of choice” Americans, we just want our CHOICE of providers. Let the market play out. Over-priced/arrogant/crummy doctors & hospitals will get DE-selected. Stockholders be damned. Take your cut like the rest of us investors. Comparisons to Fannie Mae & the banking industry are curious, warped propaganda.
    Affordable, quality health care thru’ Public financing is what the majority of Americans want.
    Consider the source author of this FALSE twisting of the facts. For crooks like former HCA CEO, blowhard Richard Scott to spend $20million on their propaganda machine to attack Obama administration & the 30 million of us in professional and consumer organizations dedicated to serious health care reform–YOUR DAYS ARE NUMBERED. give it up. END profit-making insurance companies strangle-hold on American health care system. Ready or not, the times are-a-changing..

  21. “Providers compete under a heavily regualted structure. In some states providers need government approval before offering services or facilities. Providers aren’t free to offer us what we want, the way we want or when we want it.”
    It doesn’t look like that’s the case in Florida as Solantic is showing. I wouldn’t hold Florida up as the standard bearer for medical oversight.

  22. That Rick Scott can go anywhere near a boardroom of a healthcare concern is a troubling fact of life in America today.
    His self righteous outrage, and positioning of seemingly on-point yet fundamentally sound byte “faux issues”, is perhaps more about attempts at “blogosphere echolalia” than material engagement of health reform facts.
    IMJ, this man is both a crook and a scoundrel, who has demonstrated the virtual absence of either a conscience or ethics for the “commanding heights” to which is compulsively aspires; though whether he should enjoy this legal standing is another question.
    My, my, we do indeed live in the the United States of “Amnesia” if this ilk of executive can effectively recycle himself into both the corporate board room, and tragically, the national psyche as well.
    The vicious attack on the public and private health care domains during his insatiable quest to be the for profit industry’s “roll-up king”, still reverberate today. The “stench” of Columbia/HCA’s tactics remain a nuanced component of other health care concerns; with only the usual suspects being caught and prosecuted.
    That this man can step into the limelight and be empowered to carry a banner for a cause for even a “nano” second of legitimacy strains the mind for credulity.
    http://2healthguru.wordpress.com

  23. Providers compete under a heavily regualted structure. In some states providers need government approval before offering services or facilities. Providers aren’t free to offer us what we want, the way we want or when we want it. Take the example of providers not being allowed to offer me their services on a capitated basis.
    I’m not free to offer my administrative services where ever I like. Some states will let me conduct business with minimial license fees, others have such onnerous requirements its not economical for me to offer my service thus depriving those employers of cost saving alternatives.
    I’m not sure you understand the scope and totality of regualtion in our system.
    Medicare only allows you to see providers who accept their reimbursement and more impotatnly agree to pratice according to their guidelines. So no we don’t have that now.
    Take a step back and look at our system, would anyone calssify receiving medcial treatment as efficient and easy? Most providers and hospitals keep you waiting hours, that is terrible inefficient. The best healthcare experience I have had was at a Walgreens clinic, walked right in, everything was electronic, and I was out in 30 minutes. I have never had that quick of an experience at a regular doctor. For what they provide they along with CVS and WalMart offer a far superior product. Government entities in a number of liberal cities and counties block their licensing, that disproves both your arguments right off the top.
    “CVS executives said they plan to open 25 to 30 MinuteClinics in Greater Boston before the end of the year, although they have not specified how many of those will be within the city’s limits.The Boston Public Health Commission spent nearly an hour discussing the impending arrival of the clinics and ways they could potentially be stopped.The panel took no action, but instructed the health agency’s attorney to investigate whether it could adopt regulations forbidding stores with clinics from selling tobacco products, forcing them to make an untenable financial choice.”
    “The Illinois State Medical Society, which represents more than 13,000 doctors, is pushing a proposed law to more closely monitor hundreds of in-store clinics being opened by retail giants Wal-Mart Stores Inc., Walgreen Co. and CVS/Caremark Corp.”
    In my home state of NV we had a terrible dentist shortage driving up cost and waiting time. THe state allowed the dental board to license and thus limit new dentist.
    http://www.reviewjournal.com/lvrj_home/2001/Dec-15-Sat-2001/news/17675877.html
    I could go on all day, but it all shows no we don’t have nearly the freedom you think we do.

  24. Choice? When 47 million lack insurance? When only 4% of medical students do into primary care because they can triple their income as a specialist? When our outcomes put us in the bottom of infant mortality but at double the cost of other developed countries? When patients on Medicaid can’t find a doctor and seniors on Medicaid are dropped so their doctor of 20 years can start up a concierge model in order to make $400,000 a year?
    Your kidding us right? This was an “onion” type sarcastic article not a real opinion?

  25. “Having a marketplace that can compete aggressively, allowing open access for all consumers and then layering that with accountability on all sides will result in better care.”
    Don’t we have that now? Don’t hospitals compete for my business? Don’t docs compete for my business? Don’t insurance companies compete for my business? Didn’t real estate agents compete for my business? Didn’t lenders compete for my business? Didn’t Wall Street compete for my business? Didn’t Bernie Madoff compete for my business? Didn’t Columbia/HCA compete for my business?
    “Allowing individuals choose who they want to see and where to be seen will force providers to do more and do it better.”
    Don’t we have choice now?

  26. Maggie, so it’s clear now why you and Jack Lohman are so intent on the bashing. Book sales! That makes sense. Generally, a good dose of bashing and negative press will help you sell books – it’s always the easiest and less honorable road to be critical and point fingers.
    Regarding your point to me – do you honestly expect for those intelligent folks on this blog to consider and support your “subjective” views? The most outlandish of them that Wall Street didn’t want the market to crash so the government didn’t press the issue??? Are you serious? That’s not rhetorical – really, are you serious? Because that would clearly label your integrity and thoughtfulness to this discussion. Lastly, you also say that you have these feelings and views because of one meeting with Rick years ago where you were “taken aback” by him in an interview. I tell you what, Maggie we have never met but frankly I’m taken aback by your short-sightedness. I definitely will not read the book – that would be my biggest waste of money and time this year. Had you had one solid, valid or otherwise non-subjective point I might have picked it up. You lost me on that one.
    My fear is that what you fail to realize (you, Jack, Jason Rosenbaum) is that listening and debating and fighting for health care to be accountable while providing for patients is the key here. Not your rants and sad feelings. (I should note that all 3 of you are writers. Jason and Jack call for disclosures and complain about opposing views without offering substantial facts — all you do all day is write…) Ladies and gentlemen – it’s time to get your hands dirty. This isn’t your time spout off about personal feelings. You want disclosure – I’ll give you some. My degree is in healthcare administration, I have worked for two of the largest health providers in the country, I have worked for three of the leading eHealth web-based companies providing for doctors and patients. So yes I have a passion and knowledge for this topic. More importantly, I currently own a company that provides for the needs of diabetics (250,000+ of them) and the best part…we only charge $39 for the whole year to assist them with registered dietitian assistance, meal plans, etc…also I own a successful breast cancer business that is fully free of charge to those that use it which this last October was over 275,000. You want personal? Both my grandmothers died from cancer. My dad is a liver transplant patient. I have had my fair share of issues with insurance companies and providers, such as when my daughter was born – BCBS didn’t want to pay (said it was a pre-existing condition) and the hospital East Cooper charged us for two births – however, I only seem to have one child and yet they have yet failed to realize that I have the more solid proof to bear – in her crib at this moment nearly eight months old. So look, please let your personal feelings and meaningless rants subside and get beyond yourself. Get your hands dirty and do something meaningful NOW that has a direct impact (as I am doing) and then write about that. It doesn’t work the other way around – it’s just talk otherwise.
    To end, the unfortunate side-effect of the arguments here is that at the core is the patient. Jason works for Healthcare for American Now – so he more than anyone should know better. Jason, your home page states that the HCANs primary goal is “quality and affordable care for all.” Fantastic, so how do you expect quality is going to compare when there is no competition to support that quality? If everything in life is universal and free – how do you create incentive for better care, for better outcomes, for more progress? All three of you have heavy subjective POV’s and I won’t comment on that further but seriously, do more – because your posturing from behind your pens and computers isn’t actively helping anyone.
    Having a marketplace that can compete aggressively, allowing open access for all consumers and then layering that with accountability on all sides will result in better care. Allowing individuals choose who they want to see and where to be seen will force providers to do more and do it better. Why? Because no one goes to a store, restaurant or other shopping option because the prices are too high, the service sucks or the options are limited – they go where they get value, they get service and the end outcome is positive. More than anytime in history consumers now have the power to force that – and I hope Congress, the President and others will see that a marketplace based on those principals can create more value and better outcomes. In that market we all win. Bloating the system with inefficiency and equality will drive the system to ruin.
    If you would like to discuss more – I’d suggest that Matthew Holt and team offer up a panel or two on this subject at the next Health2.0 conference. I’d be more than happy to be involved in having that discussion, as I’m certain would others.
    Be healthy,
    Steve

  27. Please, give us a smarter speaker. He throws all the trillions around, knows all the solutions, but in the end, it is a miserably ignorant piece. Why didn’t he approach conservatives while they were in power and save us all by implementing his solution?

  28. I am disappointed with this recent post, I hold THCB to higher standards, we can have great debates but first we need pick our speakers who are well respected.

  29. I am a 2 time cancer survivor. That brought with it a hose of health issues. Fortunately, I made sound decisions about my healthcare insurance, as well as my husband did. I also bought the LTD and extra life ins. I am now having to tap in to those resources, as I am on LTD now, and have been given the option to retain all life ins. All of these decisions I made were at a time years ago when I was a very active, healthy 26 year old. Now at 48, I thank the good Lord that I made them.I too believe that until the banks, and other businesses that are asking for bailouts, are held accountable, and made to face the consequences of their actions, they will never learn. This also applies to the regular Joe! Granted, our health system could use a tweak here and there, it certainly does not need a $600 billion+ overhaul to nationalize it! I emailed my congress reps. and senators this morning. I fully expect them to read every word, and make educated decisions BEFORE they vote on anything!

  30. Steve Parker:
    I do know the details of the investigation.
    Read my book (Money-Driven Medicine) where I
    make it clear that Rick Scott did not invent
    the book-keeping at HCA — the Frists (or more accuately, Frist Jr.) did that.
    Scott oversaw continuation of over-billing and
    keeping two sets of books. He also oversaw kickbacks
    to doctors and said all of the things that I quote him
    saying.
    In doing my research, I talked to Wall STreet analysts who were covering HCA–and looked into the FBI investigations very, very carefully. They didn’t want to see the stock crash. They had every reason to say “Oh, this isn’t so bad. Scott wasn’t involved.” They didn’t say that.
    I read what employees had to say about Scott’s operations.
    And, finally, I met Scott in person and interviewed him in person (for Barron’s) when he first took over the operation. I’ve met a great many CEOs–some corrupt, some dumb– but I was truly taken aback by Rick Scott.
    Why didn’t Scott go to jail? The people at the top of corrupt for-profit hospials rarely go to jail. (Again, see the book).
    In this case, I suspect that what Scott knew about how the Frists had been operating their hospital chain may have protected him.
    Finally, I agree with whoever said that if the conservatives need Scott, they truly are in trouble.

  31. Why are we approaching this like we’re on “sides” to begin with? When you politicize something these days, you create a divisive atmosphere that delays necessary action. That’s precisely why reform has not gotten anywhere in the last 15 years. This is healthcare, folks. While we sit around and say “My side’s better than yours”, businesses are getting crippled with high costs and people are getting sicker and dying because they can’t afford healthcare. The way some of you talk, it seems that you’re more proud of your liberal or conservative label than the American label. If all of your beliefs fit nicely into a package like liberalism or conservatism, you are most like a closed-minded person.
    Personally, I would like to have a reform discussion where ideology is checked at the door and we develop pillars with a 100% pragmatic approach. I don’t care if Peter’s a liberal and Nate’s a conservative. They are both Americans and my mind is open enough to see good points from each of them.

  32. I appreciate that Rick Scott’s bio was amended to note the massive fraud he was at the heart of. I would again say that publishing someone like Rick Scott damages THCB’s credibility, and I would hope someone less tainted could be found to put out opposing viewpoints.

  33. I think we should be open to all discussion from all sides because everyone should have their opinions challenged. This has been a better blog because of Eric Novak and Nate (insults aside) because it forces us all to think through our arguments and presents a forum for lively discussion. It sure didn’t take long for bloggers to figure out Richard Scott, so there’s not much chance of THCB becoming a forum for misinformation, and the other side looks pretty stupid when they use the Scotts of healthcare to argue their case. The only comment I will make about the suitability of Scott’s contibution is that even if the message can be separated from the messenger, I wouldn’t want to take even valid financial advice from Bernard Madoff. Yes, Scott’s contribution IS self serving, from a financial standpoint, but can his “Four Pillars of Patient’s Rights” only be fulfilled with a for-profit private insurance healthcare system. Single-pay should also give us the four pillars (private insurance aside). I want to choose my own doctor, I want my doctor to compete on the basis of his/her skill, I want my doctor to be accountable and responsible for their diagnosis and treatment plan. We can have this (or should have it) with single-pay along with affordable care, good access and cost controls. I have tried to research the Solantic business model to figure out why it seems to work better than other primary care models. The good thing is it may relieve ERs of expensive non-emergency cases, but if PCPs are complaining they can’t make enough money to keep them practicing, then how does Solantic attract them? In Florida it seems that the number of uninsured (20%) is the growth market for Solantic coupled with either traditional PCP shortages or concierge medical clubs reducing access. Can the Solantic model work with single-pay, maybe – I’m open. But I do question the charges listed on their web site and wonder why they don’t charge less to cash pay patients over insurance pay. I recently used a private urgent care walk-in and did so because 1. I’m uninsured (choice – the system stinks), 2. I don’t have a personal doc, 3. the price was right ($65, which is less than Solantic charges). 4. I waited about an hour (not great/not terrible but I had to tolerate it). I do think Solantic is cherry picking though as well as taking advantage of a failure in healthcare, and the model does not solve the high cost of hosptial care, which is really the affordable crisis in this country. As for continuity of care that traditional docs argue is lacking from these walk-in clinics, that may be solved IF (big if) a workable system of EHR can be established. I’m also not convinced the model works with chronic illness that really does require continuity of care and affordability.

  34. Matthew:
    I am not in your business, but I think your business is to spread the information. You were already called a propagandist for lie #68.
    The hot seat is not a fun place to be, but I can guess it is [at least part of] your value.

  35. All, I have to weigh in here. Matt you and I know one another well and as you know I have always been a big fan of you and the work you do with THCB and Health2.0 – still will support that. However, I have to disagree with some of your points – at the same time I applaud you for keeping the playing field level for opposing views. THCB would not be what it is if only one view supported on this website. For that thank you – for some of your comments – well, we will just agree to disagree.
    On another note that is more matter-of-fact, I have never met the likes of Jason Rosenbaum, Maggie Maher, Jack Lohman and others that have posted here in this commentary but a message to you – one thing all of you need to consider is that you continually point fingers at Rick for having run a company fraught with Medicare inconsistency, overbilling and defrauding the government. However, you lack the details on the actual investigation and from where issues stemmed. Many of the allegations came from hospitals owned by Columbia/HCA at the time (yes) – but there are many instances that originated at points prior to Columbia/HCA purchasing or operating those facilities. The local levels were ultimately at fault in this situation. Also as an FYI – Columbia/HCA had better patient satisfaction than most medical facilities in the country during Rick’s helm. There are many details perhaps you should consider, including the fact that during this same time period a majority of hospitals in this country were under investigation for the same issues.
    Regardless, I won’t get into a legal or tit-for-tat – you of course have a right to your opinion, and at the same time you have the right to be wrong. The point here is that Yes, Americans should have the right to choose. We should have the right to choice. We should have the rights of accountability that the medical industry receives and yes – ALL people SHOULD be intimately aware of their actions and the consequences of their actions – hence, personal responsibility.
    The bottom line here is that we as Americans should STRONGLY voice our concerns over the Presidents plan and urge Congress and our policy makers to act with caution. Simply passing a reform without a fully filtered plan of attack, a fully formed execution and accountability for results should carry a penalty to fire those that pass without solid reasoning. Yes fire – if the President or Congress passes a plan that fails – they should all suffer the consequences (the rest of us in America certainly will). Simply passing a measure by saying “all should receive free care” is littered with inconsistency and failure. Should people deserve great care, service at a fair cost? Of course, but that does not mean we should swoop in with a plan that was penned and passes just to create a “plan” with new change
    Be smart America. Question and question hard the decisions our politicians are making. I applaud the administration for working for change – but not all change is created equal.
    Be healthy (and smart),
    Steve
    (Disclosure – yes I support CPRights.org)

  36. Of course it’s all about patient-doctor relationship, but also it’s about the regular income and healthy environment, healthy food and good water which is all provided by healthy state institutions…So, first things first…

  37. Mr. Scott does raise some several valid points including breaking the link between employers and health insurance, excess of certain state mandates which have little/no benefit at greater cost, the importance of maintain the issue of patient “choice” in any reform attempt, some type of increased patient responsibility, etc.
    He also should mention the very real budget issues of adding tends of billions (and likely much more) to a federal budget over the next 7 years that is already being stretched incredibly thin. Just because Obama inherited a financial mess doesn’t mean he should try to stuff down as much spending as possible because he is guessing that the U.S. will be able to issue this debt in the form of Treasury auctions at a very cheap price and reinflate if needed.
    Playing an incredibly dangerous game of international financial chicken which some of the more negative effects including the dollar getting crushed and potential that Treasuries yields have to increase substantially in the intermediate term to attract enough foreign buyers like the Chinese, Japanese, Saudis, Russians, and others.
    Still, the reality of what is largely being advocated by Mr. Scott is just not a reality today (or in the next 2-3 years) given the current infrastructure and systems in place in the healthcare industry. Frankly i amazed at how often policy wonks talk about these issues without giving real merit to where the system capacity is today and what is likely in the interim of the next 2-3 years.
    Just as the left oversells the ideas of evidenced-based medicine and cost-effectiveness analysis to control future costs in a large way, the right has been overselling the idea of transparency in the same manner. It doesn’t mean that either idea doesn’t have some very solid merits but neither is likely to fundamentally impact future health care costs.
    Additionally, we are nowhere near being able to effectively and efficiently generate the type of quality, safety, and cost information that is needed to truly make transparency work as advocated by people like Mr. Scott. I am constantly baffled by the insistence of those who advocate contrarily. At best, it is a lack of detailed awareness on the ability of the current system to generate this type of information. At worst, it is intellectual dishonesty.
    Additionally, the idea of personal responsibility is much more difficult and complex than advocated by Mr. Scott. Issues such as smoking are more straightforward but what about the issue of food, exercise, and other daily lifestyle choices. If you take Mr. Scott’s example to its logical endpoint, his policy would take into effect issues like how much you weigh, the types of food you eat (indirectly though cholesterol and other tests), and potentially exercise patterns. Is this not a huge intrusion by the state (or private industry) into the most fundamental daily matters of most individuals?
    Besides some of the obvious deficiencies in the points that Mr. Scott advocates, the conservatives are doing a real disservice to themselves and ability to buy credibility from the American public/healthcare industry by having him as their primary spokesperson in healthcare reform efforts.

  38. “Moreover, by publishing him you attract ideologues like Nate. Nate is not interested in healthcare;he is interested in a forum for his view that all Democrats are wrong all of the time.”
    I have been here fact checking you Maggie long before Scott posted. What attracts people like me are ideologues like you or Ezra that have no background in healthcare/insurance spouting propoganda trying to confuse the public. It is my deep rooted concern for healthcare/insurance that I spend the time correcting your countless mistakes and misinformation. I think HC/Ins is one of the most important topics of our time and demands an honest discussion to solve the problems we are presented with. If you think a single claim I have made is wrong challenge it and back it up, you won’t find one but good luck. When I blame a specific party it is because they did something specifically wrong. And I back it up. The simple fact is Democrat policy and programs created most of the problems we have today. Your argument was as bad as Michael Moores claiming Nixon was responsible for HMOs. We have the quotes, at the time of passage you where proud of what you did, only years later when it blew up and failed you try to disown it and project the failure elsewhere.
    I have contributed more solid facts and actual insight then your entire career of writing on the subject. I actually work this everyday, my livelyhood depends on me keeping insurance affordable for my clients. You just write for profit, when this is all said and done you will move on and write about what ever else will get you paid. Seems the only thing worst these days then for profit insurers is for profit journalist.

  39. The two sides are not “All Gov’t v Status Quo”. Like other conservative health-policy analysts, Mr. Scott advocates a version of the government returning health-care dollars to the patients who need them – not giving them to corporations or government agencies like the government does now.
    Last year, Sen. Obama made sure that the mantra of “change” did not apply to his health-care proposal. Instead, he accused Sen. McCain of “radical” proposals for health care. His scare tactics worked.
    As a result, President Obama is executing the same plan for health reform that has been executed for over forty years: More government spending, more rules to deform private health insurance into a public utility, more rules to make health spending a burden to employers instead of a resource to patients, etc.
    Most Republican politicians, who largely failed to reform health care during the Bush “regime” (although I’m still confident that Health Savings Accounts may be bulletproof) are even more gun-shy than they were before, because of Sen. McCain’s experience. We cannot rely on those politicians to commit to reforms that will return health-care dollars to the Americans who earned them, so that they can buy health benefits that they prefer – instead of their bosses or the government.
    I, for one, welcome Mr. Scott to the struggle.

  40. Rule of thumb: (applies to this debate)
    Always stay open to receiving the message but be ever vigilant not to confuse it with the messenger.
    In order to “solve” the US health care cost problem, neither side (All Gov’t v Status Quo) will get all they want.

  41. To Matthew –
    I’m all for a spirited debate on issues, and I’m fine with THCB publishing opposing viewpoints. That’s not my point here.
    Richard Scott is not credible on health care, because he led his company in defrauding the government. If THCB wants to publish opposition viewpoints, that’s fine. But the presence of Scott here undermines this blog’s credibility.

  42. Matthew–
    I just read your comment.
    When it comes to publishing both sides of an argument, I agree—as long as both sides are doing their best to tell the truth.
    To publish a string of lies is simply to spread
    misinformation–there’s enough misinformation in the
    blogosphere as it is. And, as you know, Scott totally misrepresents what kind of reform the Democrats and the Obama administration are talking about.
    This is why most editors –even editors of conservative magaazines–would not publish Scott if they
    knew who he was. Media Matters exposed Fox for
    showcasing Scott without disclosing his background.
    Moreover, by publishing him you attract ideologues like Nate. Nate is not interested in healthcare;he is interested in a forum for his view that all Democrats are wrong all of the time.
    Nate and Rick Scott and Rush Limbaugh are not the people who will be debating health care reform in Congress. Publish Chuck Grassley–or another Republican Senator.
    Matthew, as you know I have great respect for you and this blog. But when you decided to publish Scott–
    I can’t help but think of the little boy putting a cherry-bomb in the mail-box, just to see what will happen..

  43. Its funny that Mr. Scott brings up Fannie Mae and Freddie Mae. I have a friend in the FBI who is now working on mortgage-related security fraud cases for the bureau (which have been overwhelmed by the number of ongoing investigations and have had to shift considerable resources to deal with all of the financial-related fraud investigations ongoing). This same friend due to his accounting background all worked on the HCA case in the late 1990s for the bureau.
    He wasn’t high up on the food-chain at the time but he was amazed the sheer size and complexity of fraud being committed. As for Scott, he was smart and savvy enough to leave no “smoking guns” for the federal gov’t to indict and convict him on.
    If the feds are going to go to federal gov’t with that high-level of a case where there is going to be a bunch of public scrutiny, they want to make sure they almost be 100% assured a jury will convict. This means you likely need that “smoking run” not only in the form of witnesses but also other testimony/evidence too.
    It is one thing to have dissenting conservative voices on here. In fact, I think they offer some very valid point that I agree with. However, this should not be the place for this individual to espouse his viewpoints given his incredibly suspect history/background in the healthcare industry.

  44. I think it is important for readers of this post to know who Rick Scott is.
    Rick Scott over-saw HCA/Columbia, the huge for-profit hospital chain for three years–until it was raided by the FBI. In July of 1997, the FBI swooped down on HCA hospitals in five states.
    Exeutives were indicted on Medicare fraud.
    The board ousted Scott.
    The investigation revealed that HCA had been bilking Medicare while paying kickbacks to doctors who steered patients to its hospitals. (One can only wonder how many of those patients did not need to be hospialized)
    HCA did not fight the charges. In 2000 it pled guilty to no fewer than 14 felonies.
    Over the next two years HCA would pay $1.7 BILLION in criminal and civil fines.
    Now Scott is back, heading up a group of conservatives that, according to Politico.com are organizing a multi-media campaign to resist any movement by the President and Congress toward universal coverage. They say they plan to spend $20 million.
    Scott has devoted some $5 million of his own money toward the cause.
    I have written about Scott on http://www.healthbeat.org.
    For some reason, I cannot cut and paste the URL, but if
    you scroll down, on the right hand side of Main page of HealthBeat you
    will find “Archives”. Click on “March”, and you will find the post, dated March 3.
    Since I am a THCB contributor, I’m hoping that Matthew will agree to cross-post the piece on Scott as a response to his post.
    Scott has every right to express his opinion, but I do think that disclosue of his past connection with a major hospital scandal is important.
    When he was head of HCA nurses and other executives allege that he was not terribly concerned about patient’s rights. He was more focused on money as he cut back on the nursing staff.

  45. Kudos for identifying that “patient’s rights” and universal coverage are in opposition. And as for the call for a common claims form, I couldn’t agree more.
    Everything else is utter, self-serving clap-trap born of willful ignorance.
    1. Freddie & Fannie’s “failed experiment”: Are you aware that the default rate on those GSE’s mortgages is far less than those by private lenders to the same cohort? The sources for the default rate differential have been exhaustively chronicled elsewhere. And the belief that the current financial crisis is the sole consequence of lending to low-income people by GSE’s – I don’t know of a single, informed, observer of the crisis who believes this. Review the last six months of the FT; read any of the posts financial economists at major universities; study the indicators of the shadow banking sector (aware of trends in gearing? composition of counter-party risk? CDS impact on reserve requirements?). Further, note that Freddie and Fannie are GSE’s, not government agencies. IF they had remained agencies, they would not have been lobbying legislators like they did, would they?
    2. Any talk of “rights” in the context of limited resources (a physician’s time is a non-rivaled good? I don’t think so) makes no sense – it is oxymoronic.
    3. Each of the four pillars place a heavy requirement on provision of information, principal’s ability to rationally assess the information-including pricing risk, and neutral incentives for agents. Short of this, market failure currently experienced in the US will persist. You are deluding yourself if you think these will obtain in the near, and not so near, term.
    My favorite sentence:
    “Any serious discussion of health care reform that does not include choice, competition, accountability and responsibility – the four “pillars” of patients’ rights – will result in our government truly becoming a “nanny-state,” making decisions based on what is best for society and government rather than individuals deciding what is best for each of us.”
    Oh, god forbid that pubic policy be based on what most improves society.
    Funny how Scott seizes upon an “individual rights” argument that dovetails neatly with what also best serves his corporate interests.

  46. It always disturbs me a bit when talk of healthcare reform focuses primarily of the funding side of the picture. In my opinion, it is the delivery system that is even more important. The fee-for-service payment methodology used by most payors is really just a “fee-for-quantity” system, and is inherently inflationary. The delivery system encourages usage of services (physicians are compensated for the amount of RVUs they produce), and, as has been shown by numerous studies (primarily out of Dartmouth), “more” is not the same as “better.” In fact, “more” services is correlated with worse outcomes, owing to higher morbidities caused by excessive unnecessary services. And simply pouring money into a broken system just makes for a bigger broken system.
    One of the corollary results of paying for quantity of service is that higher RVU-generating specialties attract physicians emerging from training, and the lower end of the reimbursement scale (primary care physicians, who live-and-die on office visits rather than procedures) suffers from severe, crisis-level attrition.
    Healthcare reform needs to be focused on changing the delivery system, and encouraging the emergence of local mutually-accountable service-delivery systems. That means that the isolated individual physician’s judgment is not the sole determinant of what is “best” for the patient – there needs to be peer-to-peer accountability around medical decision-making (and not top-down beaurocratic infelxibility). The Patient Centered Medical Home, which is a delivery and compensation model that has emerged out of the AAFP and the AAP, and recently accepted by the AMA itself, is more along the lines of what needs to take place. The central role of primary care in coordinating care, and making sure that patients receive appropriate care (not excessive care) needs to be rewarded, so that the dwindling ranks of primary care are re-filled with the “best and the brightest.” Electronic tools, such as well-functioning EHRs, can be helpful to PCPs if built right and used right – however, the real crux of the issue is the nature of the delivery system (more than the nature of the tools).
    My hope is that the discussion on healthcare reform will move away from “throwing money at big institutions” (like is being done with the banking system), and move more to rational discussion of reforming the underlying delivery system.

  47. R.L.Sauer MD,
    All lies.
    “He has cancer and can’t switch jobs and risk losing his insurance for now he is uninsurable.”
    HIPAA clearly allows for him to switch jobs and have no application of pre-ex applied. COBRA would allow him to extend his current coverage for 18 months. The term uninsurable means unable to insure, if he has existing group insurance he is guarantee insurable. He can either pick up other group coverage or is guaranteed a HIPAA individual policy.
    “elderly mired in poverty go from over 30% to less than 10% in about two years after Medicare”
    This is an Urban Myth playing lose with the facts and would never be brought up in an honest discussion.
    “The pro-Medicare pitch was that this presumptively deserving and financially precarious group should receive medical benefits without regard to need in order to protect elderly persons from the indignity of a means test. However, data submitted for the record from a 1960 University of Michigan study showed that “87 percent of all spending units headed by persons aged 65 or older” had assets whose median value matched asset ownership of people aged 45-64 and exceeded the asset ownership of people under age 45 (U.S. House Hearings 1963-64: 242-43). While HEW Secretary Celebrezze waxed eloquent about the necessity to furnish protection “as a right and in a way which fully safeguards the dignity and independence of our older people,” Rep. Curtis questioned whether it was appropriate to “change the basic system” when 80 to 85 percent of the aged were able to take care of themselves under the existing system, recommending instead that we “direct our attention to the problems of the 15 percent, rather than this compulsory program that would cover everybody” (U.S. House Hearings 1963-64: 31, 392).”
    There was no 30% senior poverty rate, it was all lies to trick people into passing Medicare.
    “Some in Congress clearly recognized that one effect of the proposed program was to require the working poor to subsidize the retired rich, as when Senator Long (D., La.) asked, “Why should we pay the medical bill of a man who has an income of $100,000 a year or a million dollars a year of income?” (U.S. Cong. Rec.-Senate 9 July 1965: 16096). Nonetheless, the predominant political motif was misleading allusion to the financial plight of the elderly, what Rep. James B. Utt (R., Calif.) called the false assumption “that everyone over 65 is a pauper and everyone under 65 is rolling in wealth” (U.S. Cong. Rec.-House 8 April 1965: 7389).”
    http://www.forhealthfreedom.org/Publications/MedicareMedicaid/RxDrugPlan.html
    Myth #1: Medicare has reduced seniors’ out-of-pocket costs.
    Fact: In 1965, the Medicare program was sold to the American people as the best way to help reduce seniors’ out-of-pocket health care costs. Yet after it was created, costs skyrocketed and by 1985, Rep. Claude Pepper (Dem.-FL) reported that Medicare beneficiaries were paying 20 percent of their income for health care, the same as in 1964–the year before Medicare was passed.3 Seniors end up paying more for health care when costs skyrocket under a government-financed monopoly for medical care. All told, seniors’ out-of-pocket health care costs have gown from $4.5 billion in 1977 to over $26 billion today.
    Myth #3: Medicare was the main factor in reducing poverty among seniors.
    Fact: Considering that Congress gave no Social Security cost-of-living increases to seniors between 1959 and 1965, it is no wonder seniors’ income fell below the national average prior to Medicare’s passage. After Medicare was passed, median total incomes of the elderly grew about 50 percent between 1969 and 1983. However, most of the income gains were due to increases in Social Security benefits, according to the National Academy of Social Insurance.
    It is also worth noting that in 1965, Congress tied a seven-percent Social Security increase to the proposed Medicare bill. Thus, seniors couldn’t oppose the proposed Medicare program unless they also opposed a Social Security increase.
    If Congress had not withheld a Social Security increase for seniors between 1959 and 1965, the senior poverty statistics would show a very different picture, possibly one that reveals a large number of seniors were lifted out of poverty before Medicare was enacted.
    Funny you attack the credibility and honesty of someone then spew a bunch of lies. Seems honesty is lacking from both sides of the isle.
    “Many had the insurance company refuse to renew at the anniversary date.”
    The only policy not renewed at anniversary would be individual polices years ago, it’s been illegal for a decade+ I believe and back then only a couple percent of the population had individual polices. You either had a practice specifically geared towards the handful of people over a decade ago with individual policies or your lying.
    Talk about BS Jack E Lohman! Medicare is the most expensive healthplan in the country. Full Patient choice would mean you can see a doctor not in their network, not allowed. Medicare loses ten cents of every dollar hardly efficient. It’s barreling towards insolvency, it shifts cost to the private sector because it is unsustainable. Finally no hospital in the country could survive with Medicare reimbursement rates for all the business so Medicare for all isn’t even an option.

  48. I agree that it’s important to know what lies the lying liars are telling, but this guy is more than a little bit beyond the pale.

  49. Yes, Matthew, it’s good to hear what our enemies are arguing, because this is the BS that is being carried to the politicians they own. But I would suggest that when you do, you provide a disclaimer that this is not what we as a group believe is in the best interest of the country. When I first read this I thought THB supported it.

  50. To Jason and the others wondering why THCB published this. Yes I believe that Rick Scott essentially induced his employees to defraud Medicare. The fact that the not entirely purer than pure Frist family kicked him out of HCA and settled with the government for #1.7 billion makes that pretty obvious. Yes, I think that almost everything he says about international comparisons is utter BS, and almost everything else he brings up is a smokescreen for screwing over those who suffer from our current system.
    But it’s worth noticing 2 things. 1) THCB publishes LOTS of things I personally dont agree with as a matter of policy and to tell both sides of the opinion war, even if this side is mostly conjecture. 2) There will be well funded opposition to reform–better to expose it and challenge it here–that’s what the comments are for. 3) Enough commenters agree with Rick Scott to show that there’s going to be one hell of a fight.

  51. As an emergency physician for the last 3 decades, I agree with all of your comments but I am afraid things aren’t quite as simple as we would like them to be. Sixty percent of every health care dollar is already taxpayer money and regardless of what “reform” gets to Obama’s desk, I predict this will increase. Furthermore, as you know, there are innumerable perverse incentives that motivate physicians to do more and more without regard for cost. So, who is responsible for making sure “we” are getting the most health and the least suffering for our public money? At some point, we are going to have to determine what cost effective services “we” can afford FOR EVERYBODY. Yes, that would be called rationing. If we can’t afford it, you can still have it, but not with taxpayer money. This isn’t going to happen with the current system based on multiple payers. The only chance we have of rationally rationing our public resources in the name of Social Justice is to have a system that can fairly be called publicly financed, privately delivered care. Rationing public health care resources is inevitable. Otherwise, the pressures of technology, liability, self-interest, profits, and inflated (unrealistic) expectations will bankrupt us.
    Please tell me, do all those insurance companies add anything to health? Or do they just add a layer of cost? Frankly, I don’t trust the government very much either, but I KNOW that the insurance companies are only in it for the money. Yes, sad but true, I trust the government more than I trust The Industry that has a firm grip on every aspect of what is happening within the Beltway, determining not just what gets put on the table but who is let in the room. How in the world do we expect to get real reform from those whose primary motivation is to manipulate public policy so they can continue to make profits at taxpayer expense?
    (for a video about the perverse incentives that drive up cost: http://www.ourailinghealthcare.com)

  52. I find it interesting that you would use the example of Fannie Mae and Freddie Mac in your call for reduced regulation of insurance companies. The Community Reinvestment Act of 1977, Freddie Mac founded in 1970, and Fannie Mae founded in 1968 actually did improve access to home ownership for many low- and middle-income families. It wasn’t until regulations were reduced for other lenders that the recent problem developed in the low-, middle-, and high-income real estate markets.
    But hey, why let actual data interfere with your political beliefs? If this country didn’t have so many poor people, then highly paid insurance executives wouldn’t have to pay any taxes at all.

  53. I agree with Jason Rosenbaum. So now we have the fox telling us how to design the hen house?
    See “Medicare-for-all is best corporate bailout…” at http://moneyedpoliticians.net/2009/01/05/medicare-for-all-is-best-corporate-bailout/
    The best, simplest, least costly, most effective thing we could do is expand what has been working so well for years, Medicare. You get sick, you get care, and the caregiver gets paid. Nothing could be simpler. Full patient choice and the doctors decide care, not the for-profit CEO whose bonuses are determined by how nuch care he can deny.
    This blog entry is an industry scam.

    Jack Lohman
    jelohman@gmail.com
    http://MoneyedPoliticians.net

  54. I agree with the posters that question the need to even publish this self serving screed. Scott should be banished from any discussion regarding health care and for profit insurance. Like the MD who is mad as hell, I am too. But on the other side of the coin.
    I practice medicine before Medicare and watched as the per centage of elderly mired in poverty go from over 30% to less than 10% in about two years after Medicare was enacted. Social Security didn’t do as much.
    I’ve watched my patients go into bankruptcy over medical bills. They had the best care (I’m close to the Mayo Clinic) but we impoverished them in the effort. Like all the statistics, most had insurance when their problems and care started. Many had the insurance company refuse to renew at the anniversary date.
    Two days ago I met an old patient walking in and exaggerated sailor fashion who was just home from the sea. She cannot afford to have the joints in her legs fixed. She has employer insurance from her husband but it will not pay enough for them to swing the rest. He has cancer and can’t switch jobs and risk losing his insurance for now he is uninsurable. None of these things are a result of poor patient choices.
    Archeologists have found evidence in pre homo sapien beings of prehistoric individuals with healed severe injuries that had to make those individuals of no use to the family or clan during or after the healing process. Yet, these “sub human” beings were cared for by other “sub human” beings. We’ve come a long way baby. I am totally disgusted with all these people who want to blame the victim. Mad as hell does not do justice.

  55. “The path to effective health care reform must be approached from the perspective of individual patients and their relationship with their doctors, and not from a top-down, big government perspective. Anything that interferes with an individual’s freedom to consult their doctor of choice to make health care decisions defeats the purpose of meaningful health care reform.”
    Yet you’re advocating a deregulation that would allow insurance companies to interfere between patients and doctors even more than they do now. And the idea of forcing doctors into cut-throat competition is appalling.
    I don’t see that universal health care and patients’ rights are at odds at all, any more than universal suffrage and voters’ rights.

  56. > Competition – In addition to increasing patient
    > choice, eliminating state regulations on health
    > insurance would allow for broader competition
    > and lower prices for consumers.
    Does this include repeal of “No Corporate Practice” and “Any Willing Provider” laws? How about “Can’t Pay Extra for Conservative Practice”, “Can’t Pay Less to Out-Of-Network Providers”, “Some Benefits Shall be Unlimited”, “Mandatory Point-Of-Service”, “No Prior Authorization Required”, and all the rest?
    Oh Wait!!!! That might lead to something that interferes with an individual’s freedom to consult their doctor of choice to make health care decisions. Like a contract. God forbid that a patient should squarely shoulder the responsibility to pay for something he wants and hasn’t already bought (from you!).
    It sounds to me like Mr. Scott thinks Solantic will profit from continued fragmentation, that the greatest problem in medicine is restrictions placed on doctors(!), and that he knows the trrrrue purpose of meaningful health care reform and the meaning of meaningful.
    t

  57. To control the pain we must attend to the specialist because we can give him what is appropriate and what we need, for example I take Oxycontin, which is a medicine used to counter the chronic pain that I have for years, but I rioja prescribing doctor, I take it in moderation because I read in findrxonline.com which is a medicine that causes anxiety, and we must control it as it can affect your nervous system, so do not take medicines without consultation because it really can be dangerous.

  58. Thanks for the excellent summary of issues. I’m not sure I completely agree with everything but I can respect your opinion.

  59. Your choice of patients rights and your definitions are interesting…
    – Choice.
    I haven’t heard any proposal to limit patients right to choose. There is a lot of discussion about limiting what various insurance schemes will pay for. Right now, our limited private insurance schemes place lots of limits on what is paid. Are you advocating that all insurance schemes should pay for anything patients and their doctors want?
    – Competition.
    You seem to be advocating for no regulation of private insurance plans. This would allow insurance companies to offer less coverage (hopefully at lower cost) and to charge people more based on prior illness, genes, demographics, etc. This will produce an even more dysfunctional system than what we have now.
    – Accountability.
    I really don’t understand what you are saying here. Tax breaks for everyone is accountability? A simple insurance form will foster accountability?
    – Responsibility.
    What a great concept. Surely someone addicted to nicotine should be penalized for their poor choice. How about someone who eats too much fast food? How about someone who is unlucky enough to be born with a genetic disease? I fail to see how individual responsibility applies to some of these situations. Who will decide which of these is a ‘personal decision and the patient should suffer’ and which is an ‘act of god’? Will god pay for these?
    This seems to be a lot of fuzzy thinking with words defined in odd ways. Other than ‘fear of government’ what are you really trying to say?… or is that your only message.

  60. As a long time reader, I’m really disappointing in The Health Care Blog for publishing this post.
    Richard Scott, as CEO of Columbia/HCA, defrauded the government of millions of dollars, as Chris Hayes in The Nation explains (http://www.thenation.com/doc/20090330/hayes?rel=hp_currently):
    “They were ‘basically keeping two sets of books,’ says Schilling. The company would maintain an internal expense report, what it called a ‘reserve’ report, which accurately tallied its expenses. ‘And then they would have a second report, which…they would file with the government, which was more aggressive.’ That report would ‘include inflated costs and expenses they knew weren’t allowable or reimbursable. The one they filed with government might claim $5 million and the reserve would claim $4.5.’ Columbia/HCA would pocket the difference.”
    Scott led his company to the largest fraud settlement in history, $1.7 billion. This record still stands.
    I’m not sure a quality publication such as this should be abetting someone like Richard Scott. There are plenty of other credible writers out there who can toe the conservative line about patients rights and responsibilities. And then we can have an informed discussion about the merits of those ideas.
    But nobody should be listening to Richard Scott.

  61. Now the time for politicking has come. In this article, we have squarely ignored the responsibility of provider. It is the responsibility of the provider to provide appropriate care based on the latest facts and data. You can not have a meaningful healthcare reform unless there is a clear definition on “meaning of ideal/world class healthcare system” then you can see who are all involved and how much it is achievable at what cost. I posted an article “Defining the Ideal Healthcare” on http://blogs.biproinc.com/healthcare
    It takes a genius to put more money in already overly expensive system to solve the problem……
    rgds
    ravi
    blogs.biproinc.com/healthcare
    http://www.biproinc.com

  62. Great concise summary of what the public needs to demand. To get their I think we need to educate them on how we got into the mess we did today.
    When Medicare was sold to the public in the 1960s it was a catastrophic plan to prevent grandma from losing her last dime and dignity. In fact this was only true if she got better or died within 60 days.
    Medicaid was a government handout and nothing more. “At the end of the first year of Kerr-Mills, 60 percent of the enrollees and almost 90 percent of the expenditures for the aged medically indigent were in three States: New York, Massachusetts, and California
    (U.S. Senate Special Committee on Aging, 1962). This distribution changed some what toward the end of the program, yet even in 1965, New York, California, and Massachusetts accounted for 45 percent of the recipients.
    “Far from Kerr’s estimate of coverage for 10 million people, or the more realistic early estimate of 2 million, Kerr-Mills covered 264,687 people in 1965—less than 2 percent of the elderly (Social Security Bulletin, 1965).”
    “Among the perverse consequences of Kerr-Mills was to bequeath to the future Medicaid Program the traditions of public assistance, welfare medicine, unmet need, and institutional biases, some of which persist to this day.”
    “In a later account, Mills spoke less about his own perspective and more of the work of the House Ways and Means Committee as a whole. He emphasized that the three-part package (Medicare Parts A and B, and Medicaid) was not just pieced together, but intended as part of a long-term plan.”
    Next read what Ted Kennedy promised us about HMOs in 1973, they where going to drastically cut cost while improving care. This was the next step in the Democrats incremental take over of healthcare. To consume the working population they passed a law that said every employer with more then 25 employees had to offer an HMO if one was available in their market. To make sure one was available in each market and that they would dominate the other options they heavily subsidized the HMOs.
    Since the 1930s Democrats have clearly desired to force everyone into a compulsory national health system. Every step they have passed to date was passed with lies and has failed miserably to live up to the promises made. What I would like to know from Peter and Margalit and anyone else that supports reform is why you think it will work? I always assumed you support these ideas because you just weren’t aware of the history and truth. People like MM, EK, and MH I believe know what they say are lies but the politics is more important to them then the results. But to the average person do you believe the sales pitch more then you believe history? There are a lot of highly educated readers here on THCB, if you can pass your boards and practice medicine I assume you’re highly capable of research, study and its application to present day situations. Do you think Medicare, Medicaid, and HMOs are successful despite the pending financial crash and untold hard inflicted on their members? What about the past leads you to believe the results will be different this time?
    In parting I want to link to this story;
    http://insureblog.blogspot.com/ Medicare vs Social Security: The Untold Story
    Briefly, a group of fellow citizens has filed suit against the Fed’s because Social Security officials claim that folks must forfeit their Social Security benefits if they withdraw from (or choose not to enroll in) Medicare.
    So why was the Social Security Administration telling Mr Hall that it was all or nothing? Is there something in the original Medicare legislation that dictated this? Surprisingly, the answer is no. Social Security states that one who is 62 years old and otherwise eligible “shall be entitled to” Medicare [ed: this was obviously added after the initial legislation, which of course predates Medicare]. Nothing in the Social Security or Medicare statutes state that one must take Medicare in order to receive Social Security payments (or vice versa). There are explicit conditions set forth under which one might lose Social Security benefits, but lack of a Medicare card isn’t among them.
    So how did this come about? Well, according to Mr Brown, there are three provisions in the Social Security Program operating manual that bear on this subject; it’s important to note, though, that these are not laws or even regulations. This came about not by statute, but by bureaucratic fiat. The first two of these provisions were inserted in August of 1993 [ed: interesting timing, no?], and the last one in 2002.
    Think about that, the government is so afraid of people having options to Medicare they will take away your SS benefits. There is no law that allows them to do this, just fear of what a public with choice might decide to do. By all accounts Medicare is going bankrupt, you would think logically saving a few million here and there by allowing people to opt out would be a good thing. But allowing them to do so would raise the risk of people seeing there are better alternatives to Medicare. What happens when ten thousand, a hundred thousand or then a million see Medicare is not a good deal? Now you have a vocal minority that would advocate for change and possibly even a refund of past or future premium.
    The next time a Democrat promises you their reform won’t take away your choice or freedom remember this example. This “rule” was never debated, the public never had a say or even got to express an opinion, we just woke up one day and our freedom was gone.

  63. Makes sense to me. The real crisis is that the government programs are bankrupt and the private programs are not. CMS needs to grab the money in order to prevent political pain for the dems who will have to say “no” to the entitlement for lunch bunch.
    Deficit spending for healthcare is theft from our future.
    Patient respnsibility; what a great concept. Same as paying your credit card bill or your martgage.

  64. I agree with the overall concept of focusing on patient-based, ‘four-pillar’ approach to reform, and the fact this may fall in direct opposition to government run/funded universal health care.
    The comparison to Fannie/Freddie highlights the potential and probable shortcomings and failure of the concept of “homes (or health care) for everyone” but home-ownership has always had a more ‘affordable’ option of rental and low-income government housing which was just felt to not be as economically productive/acceptable. What is the equivalent alternative option for ‘low-income’ health care, and how do we adhere to the concepts you highlight under such a model?

  65. Fantastic summary of the key issues and the way to solve them. I couldn’t agree more. I’m not so sure about the Fannie Mae comparisons, but that aside, your Choice, Competition, Accountability, Responsibility is dead on.

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