WOW

So many generalizations occurred in the President’s Q and A that it is mind boggling. These include:

--Everyone is interested in changing Health care

--The status quo is untenable

--We can’t afford not to act

--We can retrain medical bean counters to be health care providers

First of all if a scientist wants to prove a theory he can set up an experiment, control the variables and see what happens. The other, less scientific way is to determine the result first then build the experiment backward.

In the Q and A the audience was pre-chosen so that essentially the entire audience thought that health care needs to be changed. Almost all raised their hands when asked that question. This flies in the face of the polls that over 85% of the people are satisfied with their health care. The odds that the room was randomly filled with the that group is infinitesimal. Therefore the room was selected to be in favor of the President’s theory—everyone wants health care change. The pre-conceived agreement was then like a spring headed doll in the back of the car window.

The next strange fact was that it seemed that the questioner already knew what the questions were going to be. Somehow I do not think they needed over 130 people to ask a handful of questions except the show question with the “raise your hands” at the beginning. I bet they had already practiced it. (Just my opinion). It seems that even the CEO of one of the largest health insurance companies in the US did not take offense that the Government was going to set up a company funded by the Federal taxpayer that will then compete in the market place against the major health insurance carriers. He did say it was hard to compete against the company that makes the rules. Don't think that an employer is not going to choose the cost of Government over private insurance. Employers will always opt for the cheaper health care plan.

If payments will move from fee-for-service to outcome based payments, how does the Federal Government accomplish that without controlling health care at all levels? The “British” health care system is a socialized program apparently because they call it one, but other one party health care plans do not call themselves socialized so they are not . We will obviously not call ours a socialized plan and therefore it will not be one. You can change the name of a skunk but it still stinks.

Another great myth told by the Government is they are interested in quality care. There is a plan of “Best medical practices” that the President has talked about, which is being instituted by the Federal Government. The title sound great. This is how it works. Certain things are called “never events” including wrong patient procedures, wrong side surgery, etc. These in fact are good ideas. The Government should not pay when the wrong patient has a surgical procedure. No one would disagree.

Included in the “never events” are also things like surgical infections, particularly bowel and heart surgery. The problem is that a chest wall infection following open heart surgery requires a long treatment process which, as you can imagine is very expensive. Medicare will not reimburse for that complication. They are even considering not paying for the doctors to treat the complication either—meaning the infectious disease doctors required to treat the infection will not be paid for potentially weeks of care for these “never events”.

Who will treat the patient with “quality care” when the Government disallows payment to the hospital and doctors. Think this out. If a severely ill patient who is predisposed to a “never event” needs surgery, do you think the hospital wants the patient and/or the doctors will want to provide care which may not be reimbursed? This is OUTCOME BASED MEDICINE. The severely ill patient will be sent to the tertiary care facility, if that facility will accept the patient, and then wait in long lines for the treatment if they get it at all. Better yet from the Government’s standpoint, no care will be provided, the taxpayer does not have to pay for care not given and costs go down. I seem very cynical but I have seen the government in action.

The question from the audience about whether the lady’s 105 year old mother would have received a pacemaker was answered that it would be considered and “people “would decide. It would, according to the President, not be decided on the person’s condition. It must therefore then be based on AGE? The reason for medical decision makers is to decrease care!!! I agree that knowledge of what recent labs and test have been performed is important, but for a new conditions is a 6 month old CAT scan good enough for the committee so that the tests ordered will not be medically necessary? The devil is in the details and all we saw was the HYPE.

Medicare has operated under a budget neutral policy for several years now. The way to balances the medical budget has been to continue to provide the care but cut reimbursement to doctors and hospitals. Medicare reimbursement is already substantially less than it was 20 years ago for exactly the same care. Imagine adding 45 million people to the same Federal pot. The only thing left in the pot will be people with disease and care that needs to be provided but no money to pay for it in the budget-neutral new national health insurance plan. The Government needs for the competition not to be there so that most people will not have anywhere else to go.

I could not get to the greatest myth of all—the Government can run a better system. Hold on to that thought and wait for my next update.