Revisiting Healthcare Debate (and a Poll)

medicalVSA Virtizen libertyordeath it turns out is a practicing physician who explains his views on the healthcare system in the USA and the Affordable Care Act (aka, “Obamacare”).  This is only an excerpt of a larger discussion over in the Health Care discussion group forum here.   Please visit that link to delve more deeply into this subject as there is much more to be discussed and analyzed.  It is a complicated subject and requires much thought and discussion, especially if you believe like VSA that the ACA/ObamaCare law is flawed and corrupt and therefore not the end of the healthcare debate in the USA.


Begin excerpt from libertyordeath:

I will attempt to respond point-by-point to the questions posed by bcnbuda.

First, the question about ”cui bono?” (who benefits?) pertaining to the ever-increasing costs of medical care. That one is a bit complicated, but the simple answer, indeed, returns to the precept of following the money. As I stated in my initial post on this group, lobbyists for Big Pharma and Big Insurance basically wrote the parts of the bill that pertained to how their portions of the bill would benefit them financially. This was the fascist component of the bill. Then, the Big Government brain trust got busy loading it with new taxes and breaks for the special interest groups favored by Obama et al (remember that when this bill was shoved down the throats of the American people, both houses of Congress were firmly in the hands of the ”Progressives”). This was the socialist component of the bill. So, the mega-pharmaceutical companies got their cut, the mega-insurance companies got their cut, and the federal government got its cut in the form of higher taxes. Beautiful. So where, you may ask, does that leave John Doe, the sick American citizen? Where does that leave the average hospital? Where does that leave the ”rich, 1%, doctors”?

Well, John Doe ends up paying more for the same, or even less, health care that he had before, in the form of higher taxes, higher insurance premiums, and, though this has been mitigated somewhat for those on Medicare/Medicaid drug coverage, higher prescription drug costs for most people on private insurance plans. I don’t really have the time to post specific links to the various articles that are to be found on the ”net which substantiate what I have just said, but simple Google searches will reveal them in abundance. But besides articles proving my point, what has your’s, the reader’s, experience been with your own medical insurance? That is assuming you still have any, as many employers have been forced to abandon attempts to offer medical insurance coverage to their employees. Reports of many insurance companies jacking premium costs by double digit percentages in many different states are easily found on the ’net.

As to the hospitals, well they, too, are under attack by the government through a process that, to be fair to our present Fearless Leader, was put in place during the Bush administration. Under the guise of combatting ”fraud and abuse”, the medical charts of Medicare/Medicaid patients are now being audited up to 3 years after discharge from the hospital by private companies called ”Recovery Audit Contractors” who have RN’S removed from the real-time decision-making processes of the MD’s involved in the actual care of the patient by up to 3 years in time and possibly hundreds of miles geographically who decide if the patient could have been treated at a lower level of care. When these RN’s have judged the MD’s decision process faulty, the RAC (again, stands for ”recovery audit contractor”) company, which operate on the basis of contracts with the government, there being about six of these companies (last I heard) covering all 50 states, demands ALL the money be given back to the government pertaining to that case. Not the doctor who made the decision about the appropriate level of care at the point of evaluating the patient’s condition, BUT THE HOSPITAL!

Now, there is an appeal process that the hospital can take, and most of the time does take, to try and keep the money. This appeals process is lengthy and expensive, and while it is on-going the money involved is in limbo. A whole cottage industry has developed that is composed of MD’s who have learned the ”game”, as it were, and for a fee (and it’s not cheap) will assist the hospital in its efforts to keep money it was already paid by the government which, as I said earlier, may extend back up to 3 years and has certainly already been spent in routine operating expenses. If the hospital loses the appeal process, it loses the original money, the fee it paid the consultant (if a consultant was hired; some hospitals try to use their own personnel to wage the war, but more and more are going the consultant route), and the INTEREST the government has charged them for the use of that money for whatever the time period may have been! So, lets review, and remember, this little piece of work was already in place BEFORE Obamacare. A new layer of bureaucracy was instituted by the government, this RAC to combat hospital ”fraud and abuse”, which benefits the companies which contract with the government. One’s mind begins to spin at the thought of the potential there for bribes and kick-backs, pay-offs for political favors, etc., etc.

Then, to combat that layer of bureaucracy, another layer of health care expense has originated, this time funded by the hospitals in an attempt to protect themselves. Two new pigs at the health care $$$$$ trough. And how much of the money spent in this fashion goes to direct patient care? Of course, the answer is NADA… for the hippo….. nuthin’….. ZERO! Thus far, this process only involves Medicare and Medicare PPO’s administered ”for” the government, and for Medicaid patients. Thus far. How long it will be for all the other insurance companies to follow along is anyone’s guess. Oh, and before I leave the consideration of the RAC racket, let me inform you of how these RAC contractors are paid by the government. They are paid ON A COMMISSION BASIS!!! Last I heard, somewhere around 8% of the money they ”recover” for the government. Now, I ask you, with their income directly tied to the amount of money they demand be returned to the guv’mint by the hospitals, how objective do you think the indoctrination of the RN’s who evaluate these cases is going to be? An MD who has been in the fight against this lunatic system since its beginning about six years ago now had a most apt description of these companies: bounty hunters!

And lastly, let us contemplate those rich, 1%, scheming, greedy, no-good doctors. Well, as I said in my initial post, they are being squeezed into a most unfortunate mold, that of being employees in an industry that is making them into serfs (though, admittedly, well paid serfs….at least for the time being). Real income for most doctors is now based on working for hospitals or PPO’s who give base salaries plus incentive bonuses based on number of patients treated, procedures done, etc. If it’s an MD in some sort of private practice setting, every January the Congress votes to give MD’s about a 2% raise in fees they can charge for Medicare/Medicaid patients, an amount which does not even cover inflation. Other insurance companies usually act lock-step with the government.

The reason for the charade of the yearly vote? Some years ago, I forget how many, one brain-dead session of Congress mandated cost cuts in what MD’s receive for treating patients tied to some unrealistic formula: to be honest I will have to tell you to look that one up for yourself. The bottom line is, though, that if Congress DIDN’T vote each year to basically forget that formula, the cut in payments to MD’s would be so onerous that no doctors would take new Medicare/Medicaid patients, and might even start getting rid of old established ones. Best example of this lunacy: this year, if Congress had not included their customary yearly patch in the recent ”fiscal cliff avoidance bill”, doctors would have had to deal with a cut in fees paid to them for M&M patients of 27%. Yes folks, TWENTY SEVEN PER CENT. As it is, doctors got their usual paltry one or two % fee increase, which as I said earlier, doesn’t begin to cover inflation. Private medical practices are a dinosaur, thanks to all of this B.S.: doctors in America are being forced into the position of well paid (again, for the time being) technicians and commodities, just another type of cog in the socialist/fascist/crony-monopolistic capitalistic economy that our nation tragically has has evolved into.

As I said in my initial post, I have practiced internal medicine for 32 years, the first 30 as an owner/partner of a private practice. Two and a half years ago, seeing what lay ahead, my partner and I sold our corporation for a very modest sum to the local hospital, and I have been employed by them ever since. I, too am a dinosaur. I love taking care of my patients and helping them enjoy healthy lives, but the changes in the system have made the practice of medicine in this country in so many ways so unpleasant that the bureaucratic B.S imposed from above by an increasingly tyrannical government has outweighed the immense personal satisfaction derived from trying to help my fellow man. Like so many doctors of my generation, fine men and women who did not get into medicine for the bucks (I started medical school 40 years ago this August; at that time there just weren’t a lot of bucks to be made, especially in the Arkansas Delta!) but as a calling similar to a call to be a pastor, I am looking for an exit point.

*** end excerpt from libertyordeath ***

VSA asserts that the entire Affordable Care Act process was corrupt and flawed and is in favor of a message being sent to President Obama and Congress that this is not the way to run our country.  While it is probably not feasible at this point to repeal the law it is not to late to radically change and improve it based on a rational and transparent process  and honest debate.

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