Physicians

Our President is on the Ropes

Stephen Kardos

Recent pictures of President Obama suggest he is battered and on the ropes. Our President can recover if he chooses to change his fighting strategy to improve health instead of budgeting health. There is clearly emerging consensus against yet another health plan sponsored by the federal government.

There is already much oversight at federal and state levels of all insurance programs, yet all of these programs experience unsustainable cost trends. Medicare, Medicaid and the Federal Employee Health Benefit Plans are modeled after private insurance plans and they do not work for our country. In the instances where profit incentives have been removed from government-run programs such as the federal employee health plans, the trends in these plans are not significantly different from private insurance plan trends.

One sustaining aspect of our health system is the belief in the patient/doctor relationship. This bond between patients and their physicians continues to survive insurer, government, and other third party interference. This patient physician bond must be strengthened in any successful strategy for change.

Instead of continuing to list all that is wrong with American Health and coming up with new unproven expensive plans for change, the president should focus on practical ways to improve quality in health care by leveraging our patient physician bonds.

First he has to communicate the message to everyone that on average clear evidence indicates that Americans receive substandard basic health care. This circumstance is driving up our health costs because without basic care we often develop catastrophic expensive illness. Less than 50% of all Americans participate in early cancer detection programs whether or not they have insurance coverage. Similarly for diabetes, many people develop complications of stroke and kidney failure because they do not follow basic treatment recommendations of the American Diabetes Association.

Physicians and their patients, contrary to their perception, do not have useful up to date information when making health care decisions that involve everyday health care.

One powerful source of information to improve health, and strengthen physician and patient bonds has been available for years, yet not shared. Medical claims, laboratory results, and pharmacy data stored in health plan administrators’ computers (Medicare, Medicaid, Private Insurers, and Third Party Administrators) are available and able to support individual and doctors efforts to narrow quality of care gaps. Proper organization of this data can link every diagnosis, test, and prescription for each patient in a way that each doctor and patient are unable to do for themselves. The government can make this happen by regulation.

Our President can no longer avoid sharing available and accurate health information that may be in conflict with some special interest groups that supported his campaign. Those involved in health plan administration must no longer withhold vital information about our health even though it may not be in their financial interest to disclose it.

Only with clearly understood reasons for change will change occur, patient physician bonds strengthened and special interests pushed aside. Changing the discussion to a “Moral Imperative” does not give a practical incentive for change that is ultimately determined by the people of America.  He has already won consensus on the need for change.

If our President does not get off the ropes quickly and change his strategy to improving health by empowering the patient physician relationship he will get knocked out of the health care arena very much like his predecessors and the opportunity for “Change” regarding health care in America will be lost. The President and the nation risk losing much more than the battle for our nation’s health.


Dr. Kardos is Chief Medical Officer Health Insight, Inc. a supplier of infrastructure for newly emerging Value Based Health Plans and Former Chief Medical officer of Blue Cross and Blue Shield of NJ. He is a Pediatrician.

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Margalit Gur-Arieinchoate but earnestJerrySocialist/Realist/CapitalistMatthew Holt Recent comment authors
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Nate
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Nate

“Your fears of EEOC, etc action are overblown; a cursory look at data on enforcement activity tells anyone that.”
You aren’t saying it is ok to ignore EEOC opinions becuase there is minimal enforcement activity?
“serenely confident that wiser heads will simply direct EEOC to reconsider their foolish position.”
Here you seem to acknowledge the EEOC does not allow this activity but you suggest going ahead and doing it anyways in the hope the EEOC wises up. My personal experience waiting for government to wise up is measured in lifetimes.

inchoate but earnest
Guest
inchoate but earnest

Nate said: “You apparently have never owned or ran a business. When you advise your client to do something illegal, even when there is little to no chance of them getting caught you are asking for lawsuits. Most honest business people try to avoid such activity. Not to mention I prefer not to lose my various licenses and E&O policy. Your obviously a liberal with the mentality of just ignore any laws you don’t like, liek tax laws and Obama cabinet members.” Nate, I advocated no illegal activity. If you feel I did, post details. You’re demonstrating you do not… Read more »

Nate
Guest
Nate

the legal structure allows for reduced risk and cheaper administration, small businesses wouldn’t have to copy the rich benefits, I’m certain small employer pools would be smarter about plan design.
Ideally I would love to see HDHP pools. Small employers join and have 3K-10K deductibles per employee. That risk is pooled then partially ceded off to insurers. Under the employers deductible they would offer employees benefits appropriate for their industry and location.
The rates for the pool would be based on the experience of the pool stabalizing renewals. The pool would be insulated from the utilization and consumption of paricipants.

Stephen Kardos
Guest

“If small employers could pool like Union Taft Hartley plans their cost would drop overnight.” Nate, I like your spirit but really disagree with your statement. I am very familiar with Taft Harly Plans’ data in which benefits are extraordinarily rich, yet costs are rising at unacceptable rates. The members have complete access and little cost sharing. They guarantee their rising costs because they do not follow minimal guidelines for preventive health. They set the stage for being sure they develop lots of avoidable illness which is expensive emotionally, productively, and financially. This behavior among doctors and their patients is… Read more »

Nate
Guest
Nate

why small employers don’t offer coverage. Democrats, the left doesn’t want to hear this and will claim I lie and distort but it has been 23+ years of political decisions by Democrats that has made insurance unaffordable for small businesses. 1. They have blocked AHPs for the past 15 years. It’s funny they now propose co-ops for small businesses but they have blocked exactly the same thing to protect unions for the past 15 years. If small employers could pool like Union Taft Hartley plans their cost would drop overnight. 2. COBRA rushed into law in 1986 by the Democrats… Read more »

Nate
Guest
Nate

Which portion of the uninsured is the bigger problem Around half of the uninsured are already eligibile for free or heavily subsidized insurance and choose not to enroll. It is assumed the don’t enroll becuase they don’t need it. While it would be nice to have them in the system if they don’t need care that should not be the priority. We already have plans in place to help them. Kaiser has good info such as; “Almost two-thirds (65%) of the uninsured are from families with incomes below twice the poverty level (about $40,000 a year in income for a… Read more »

Nate
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Nate

Happy Labor Day Jerry. Those making over 50K can afford insurance is based on my general knowledge and no one study I could point to. I don’t beleive I have ever seen a study broad enough to quantify it. I currently spend half my time in Las Vegas, before that I lived in CA. I know for certain and I am sure there are studies to back it up but I don’t have one that people under-report their income. In Vegas the IRS has a program called TIPs where people with hard to verify income pay taxes on a fraction… Read more »

Jerry
Guest

Hi, Stephen. Thanks for the clarification, though I disagree with your assessment. I think the ground’s in place for the Senate to pass a bill with a public option via the reconciliation process (i.e., with a simple majority) – but that’s my own seat-of-the-pants assessment ;^) Now we have news of the outlines of the bill cobbled together by six members Senate Finance. It sounds like a non-starter to me – there’s something in it to annoy everybody. Finally, I though you’d be interested in this piece. I think Nate Silver’s overall analyses have been well- borne out, especially when… Read more »

Stephen Kardos
Guest

Jerry, Thank you for your polite reminder. The consensus I referred to is developing opposition to another insurance program run by the Federal governemnt that seems to be emerging in the Senate and the general news comments about the risk of another insurance company not being able to change any trend, only adding liability to an already overburdoned tax base. I do not have any specific statistics. Rampant conflicts of interest must be eliminated in order for successful improvement in health care to occur. The president has the opportunity to be up front and honest with the populace about dealing… Read more »

Jerry
Guest

Hi, Stephen:
You haven’t yet answered my question about your basis for saying “There is clearly emerging consensus against yet another health plan sponsored by the federal government.”
Are you talking about the republican caucuses in the House and Senate? A few Democratic senators from states with low populations? Other?
It’s unclear. Can you clarify?
Thanks, Jerry

Jerry
Guest

Hi, Nate. Thanks for the link – that’s a very helpful report. I was briefly confused because the page 23 you cited is page 23 of the actual report, though it’s page 31 of the pdf – but I found your citation ;^) So, those are the numbers. Now, with regard to your contention that “there is no reason most of the 6.6 million making 50K plus can’t buy their own insurance as well.” That’s a very big leap, and I have to believe that it’s based on some assumptions you’ve made, along with some personal bias, and not on… Read more »

Nate
Guest
Nate

Jerry, Kaiser has some decent data but if you want to go strait to the hard data; http://www.census.gov/prod/2008pubs/p60-235.pdf Page 23 Uninsured rates decreased for each consecutive household income group to 21.1 percent for households with incomes of $25,000 to $49,999, 14.5 percent for households with incomes of $50,000 to $74,999, and 7.8 percent for households with incomes of $75,000 or more. Talking about at least 3.6 million. Factor in under reporting of income and deductions and there is no reason most of the 6.6 million making 50K plus can’t buy their own insurance as well. Add to that the 8… Read more »

Jerry
Guest

Nate – do you have any specific evidence for your assertion, Take the millions of uninsured making over 75K per year?
Are you saying that ‘millions’ (how many – 2? 10? 37?) who earn more than the median annual gross income don’t have any kind of health insurance?
Where did you get that data?
Thanks, Jerry

inchoate but earnest
Guest
inchoate but earnest

Nate,
However much you desire to assume the mantle of “Voice of the Industry” hereabouts, you’re not the only person with deep group experience. Your fears of EEOC, etc action are overblown; a cursory look at data on enforcement activity tells anyone that.
Meanwhile, why not ac-cent-uate the positive, & tell everyone how enthused you are about the possibilities presented by Sec 224(c) of H.R. 3200, the America’s Affordable Health Choices Act of 2009. Let’s see what kind of imagination you have concerning possibilities other than boogiemen under your bed.

Margalit Gur-Arie
Guest

So let’s fix the communist(?) problem, Nate:
Force everybody to pay into the system when they can (taxes) and let them draw when they need to (universal coverage).
Should take care of all the questions you asked.