LIE, CHEAT AND STEAL . . .

Disingenuous: dis·in·gen·u·ous

–adjective

lacking in frankness, candor, or sincerity; falsely or hypocritically ingenuous; insincere

 

This morning, the health insurance companies spoke out, once again, defending the position that their monopolies and double digit premium hikes during the past year were, of course, not their fault. Health costs are rising (“but let’s not have health reform”), companies are merging in order to give better service to their subscribers at reasonable prices (yeah, right!), and really, it’s OUR fault for even considering reforming health care and the way it’s paid for.

Health insurance companies are not evil, they say, just attempting to “maximize shareholder wealth;” which is another way of saying we got ours by taking yours, now go find some more for us to take."

Besides, why do non-profits need to maximize shareholder wealth when there are no shareholders? When will the other half of the people in this country (the ones who really believe it’s the evil lawyers, greedy doctors and “socialist” politicians who are to blame for trying to ruin “the best health care system in the world” open their eyes? When will they understand there is a difference between the best doctors and Medicine in the world (which is true) and the best health care system which is patently false? To them, I ask, “which planet do YOU come from?”

When one or two companies control more than 80% of each market, they can (and do) raise premiums as high as possible without justification, refuse to cover legitimate care, and then spend millions of premium dollars, not on health care, but on lobbyists to defeat health care reform.  That leaves the 48% of you that are saying, “I have health insurance so it isn’t my problem,” to turn off Glenn Beck (watching slapstick comedy is fun, but doesn’t help), read your own policies, and get ready to pay through the nose. Or, you can join the rest of us and demand that our politicians pass comprehensive health care reform NOW! The choice is yours, but I warn you, the rest of us will be too sick to catch you when you fall.

THE BITTER END . . .?

After reading two separate articles today regarding “end of life” issues, I feel compelled to comment upon the two aspects of end of life care that were raised. First, it is well known that health care in the US follows the 80/20 rule – 20% of the population account for 80% of our health care expenditures. For the most part, that 20% represent the frail and elderly.  

The questions are: 1) should we “squander” our scarce resources on the 20%, thus questioning the value of a single life and, 2) whether it is worth utilizing expensive treatments to prolong someone’s life for only a few months, even if we do not know their wishes.

For these issues I have two answers. First and foremost, as a physician, an attorney, but mostly as a patient, if there is a chance to cure or substantially extend life, we must make that chance available! Imagine the loss to the world if Stephen Hawking’s life had been allowed to end many years ago because he developed ALS and, statistically, any attempt to extend it would be expensive and probably futile, while providing very little “quality of life” in an individual that would become unproductive. It was expensive, but futile . . .? He may be unable to move, but unproductive? I may not be Stephen Hawking, but my life is equally as valuable to me, and I want and deserve that chance.

Secondly, what about the ethics of artificially maintaining life in a terminally ill patient  with invasive and potentially painful procedures, perhaps without knowing their wishes? The answer is that you and I have the opportunity to make our wishes known and mandated with an Advanced Directive (Living Will) which has the authority of law behind it. This makes sure our end of life wishes are carried out while relieving our children or others of the responsibility of making life and death decisions for us. Such a document is easily, quickly and inexpensively drafted by a health care attorney and should be in everyone’s pocket.

If we must die (and some recent research has begun to cast doubt upon this premise), we owe ourselves, our relatives and our society the ability to extend reasonable quality of life as long as possible and, where it isn’t possible, to make sure the end is not “bitter.”

BUILDING THE HEALTH CARE WALL . . .

Today, I opened an email labeled, “Health Care Administration,” just to see what it was. It turned out to be an ad for both health care administrative jobs as well as continuing education. What struck me, though, was the list of organizations that were scheduled to hold “conferences.” The list included the American College of Healthcare Executives, the American Academy of Professional Coders, the American Association of Healthcare Administrative Management, the Association of Health Care Administrative Assistants, and the Medical Group Management Association.

Now, I’m sure these are all fine organizations, and I’m equally sure that the jobs performed by their members are necessary in today’s health care system in the US. What I do not understand is why coding, for example (simply telling the insurance companies what was done and why), should be so complicated that we not only need “professionals” (people who do little else)  to translate a physician’s office visit into “99214,” but they need their own organization and continuing education credits. Imagine what the cost of a hammer would be in a hardware store that operated that way.

When a system becomes so bloated and complex that its most rudimentary functions become the subjects of entire professions, the explanation for why we spend more than any other industrialized nation on health care and get the least for it stands out in stark relief.

We spend our health care dollars on meaningless bureaucracy rather than actually caring for anyone’s health. Moreover, lest anyone believe that this is merely poor (or lack of) planning, close examination reveals the real reason – greed. This is simply one more (and very effective) way for insurance companies to ration care without admitting they’re doing it. Place enough hurdles in the way of getting care and, after a while, people will stop trying and give up (and you won’t have to pay for it).

You may remember the movie line from Field of Dreams, “If you build it they will come.” The health insurance version of that is, “If you build it high enough, they can’t get through!”

REFERENDUM!

Today, President Obama spoke at Arcadia University about the need for health care reform, while the Republicans, through Senate Minority Leader Mitch McConnell, declared that if the Democrats pass health reform legislation without them, then every election in November will be a referendum on the current health care bill. Mr. McConnell forgets one thing – if the Democrats do not pass the health care legislation, then every election in November will be a referendum on the Democrats’ legislative incompetence and inability to govern!

As I stated in previous entries, while I do not like this bill, and would make significant changes to it if I could, I would rather have it than nothing and let the insurance companies get away with the fraud, larceny, misrepresentation and intentional prevention of people getting life saving care, not to mention knowingly ruining the medical profession (especially Internal Medicine and Family Medicine), just to boost their “bottom line.”

To the President, I say, I agree,” Mr. President; “If not now, when, if not us, who?” To Mr. McConnell, I ask; How many more people must die before Republicans admit to the problems with private insurance companies running everything (AIG did a great job, didn’t they)? Finally, to the insurance companies, I offer the only thing they really need and deserve – a fair trial at Nuremberg!

“DID YOU EVER HAVE TO FINALLY DECIDE?”

There is a song I remember from many years ago that asked the question, “Did you ever have to make up your mind?” The time has arrived with respect to health care. As President Obama said last week, “all the arguments have been made” while all the lies, innuendoes, half truths and fear mongering along with repeated explanations and denials have been laid out and either accepted or dismissed. The time has come for Congress to make up its mind and move on to other areas that await its attention.

Let’s be clear; I don’t like the current health care bill. It is too long, too complex, leaves many problems unsolved, provides insufficient payment to large numbers of physicians, and is neither “Universal” nor the single payer system that would eliminate most of the bureaucratic morass and allow physicians to return to the practice of Medicine.

There is no need for the complexity Congress has built into this legislation (Congress should think, “Occam’s Razor”), and it is likely to lead to enormous problems down the road. Still, it will accomplish things that are desperately needed. Only the Insurance lobby and a few “wing nuts” stand in the way now (if the Democrats ever get their act together), because they want more. More money, more power . . . more for them and to hell with the American people!

I don’t like this bill, but the time has come to prevent “perfect” from remaining the enemy of “good.” The time has come to make up your mind and vote. The time has come to leave the rhetoric behind and provide (at least, better) health care for our citizens so we can have one less thing to worry about and go back to work.

Let ALL incumbents beware; “WE, THE  PEOPLE” are watching!