Radical Surgery for Health Care

Republicans who went ballistic over the stimulus bill had better check their blood pressures for the Big One--the taxing and spending the Administration wants in order to revolutionize American health care.

"President Obama," the Washington Post reports, "intends to release a budget tomorrow that creates a 10-year, $634 billion 'reserve fund' to partially pay for a vast expansion of the U.S. health care system, an overhaul that many experts project will cost as much as $1 trillion over the next decade."

The New York Times adds: "President Obama will propose further tax increases on the affluent to help pay for his promise to make health care more accessible and affordable...That plan, coming after recent years in which more wealth became concentrated at the top of the income scale, introduces a politically volatile new edge to the emerging Congressional debate over the new president’s top domestic priorities."

The surprise here is that, with his reputation for pragmatism and prudence, the President seems to have decided to go for broke on health care reform now instead of, as Congressional Democrats have suggested, moving "incrementally" during the economic crisis.

The mother of all legislative battles will have Republicans screaming "socialized medicine" over a proposed cap on itemized tax deductions for couples earning more than $250,000 a year to raise a $634 billion “reserve fund” for broadening health care coverage, along with ending billions of dollars in Bush-era subsidies to insurance companies under the Medicare Advantage program.

Drug company lobbyists will go berserk over a proposal to increase the rebate for medications sold to Medicaid patients from 15 percent to 21 percent, and hospitals will hate a new flat-fee plan to keep them from profiting on readmission of Medicare patients within 30 days of discharge, as they now do.

In any case, the "Harry and Louise" commercials that killed the Clintons' reform efforts in 1993 won't work in a time when Americans are worried about much more than having the government involved in doctor-patient relationships.

This time, if the health care industry wants to hold onto its bloodsucking profits, they and their Republican allies will have to offer substantive arguments to an all-out Obama offensive for some of the reforms that are long overdue.

Maiming Medicare

Having failed to privatize Social Security, the Bush Administration is trying to wreck Medicare on its way out the door, but MDs are mad as hell, and they're taking it out on Congressional Republicans.

The focus this week is on trying to undo a 10.6 percent cut in payment to care providers for millions of older Americans. Before the Fourth of July recess, the House passed a bill to prevent the Medicare pay cut by a vote of 355 to 59. In the Senate, Republicans blocked efforts to take up the bill, so the cut took effect on July 1st.

Now the AMA and its incensed members are targeting such former friends as Sens. John Sununu, Roger Wicker and Arlen Specter, who all voted against cloture.

As with the SCHIP legislation to expand children's health care coverage, Bush and his allies are favoring the insurance industry over a government program that is working well for those who need it most.

If the new reimbursement rates were to stand, more doctors would be joining the legions of those who refuse to take on Medicare patients as economically unsound for their practices.

Perhaps the next step would be the "Ice Floe HMO" solution favored by one in three British doctors who would deny treatment to the old "if it were unlikely to do them good for long."

Unless Republicans relent, as they almost surely will, members of the AARP are certain to send them a don't-get-well message in November.

Notes From the Ice Floe HMO

The British have a solution to their health care crisis--cut off the undeserving sick and send the old off on ice floes the way Eskimos did a century ago.

In a new survey, doctors call for National Health Service treatment to be withheld from patients who are too old or who lead unhealthy lives, an idea that may appeal to the Bush Administration as a solution to runaway Medicare costs.

One in three British doctors said that "elderly patients should not be given free treatment if it were unlikely to do them good for long," according to the Telegraph.

As an octogenarian candidate for that Ice Floe HMO, I can report that American insurers have made significant headway in that direction. The doctor and hospital performing my shoulder surgery had to make do with Medicare allowances, since my supplemental insurer deemed that, for a person of age, the need to be pain-free would be an unwarranted luxury.

But all is not lost, even in Britain. Responding to the survey findings, a doctor speaking for the British Medical Association said: "If a patient of 90 needs a hip operation they should get one. Yes, they might peg out any time, but it's not our job to play God."

Tell that to the Republican Congressmen who recently voted once again to sustain President Bush's veto of expanded S-CHIP coverage for poor children.

Stealing from the Sick

Over the next year, Presidential candidates will prattle about health care, but none of them will talk about the elephant in the operating room--the massive fraud that bleeds the system.

Another piece of the picture emerges today in a whistle-blower lawsuit that, according to the New York Times, claims "improper sales practices, together with erroneous accounting, are invisibly draining millions of dollars out of vital public programs like Medicare through overcharges or unauthorized uses...systemic fraud across a whole network of companies and more than 7,000 health care institutions."

Cynthia Fitzgerald's sickening account of her experience in the medical supply business involves kickbacks, bribes and bid-rigging. For complaining about such illegalities, she was, of course, fired as a trouble-maker.

Now she is suing under the False Claims Act which, according to Taxpayers Against Fraud, has helped the government recover more than $20 billion from health care companies since 1986, $5 billion of it in the last two years.

But that may be small change compared to the blood money that is hemorrhaging everywhere. According to the FBI, health care crime by hospitals, doctors, pharmacists and other care providers is adding up to between $60 and $100 billion a year in the system that is saving us from socialized medicine.

If we could stop that, it would pay for almost six months of the war in Iraq.

Health Care Crime

Of all the ills of American health care, least visible is the pervasive fraud it encourages in everyone involved--doctors, patients, labs, hospitals and, most of all, the insurers who manage the mess.

One small symptom can be seen today in a New York Times report of 91 Medicare audits showing “widespread violations of patients’ rights and consumer protection standards” in private drug plans for the elderly that were supposed to save them money but, in some cases, are endangering their lives.

Slap-on-the-wrist fines totaling $770,000 on 11 companies won’t make a dent in the billions they are raking in from the most vulnerable Americans, who might have been helped by authorizing Medicare to bargain with pharmaceutical companies or allowing medications to be imported from Canada instead of devising new ways for insurance companies to fleece them.

Other clues about the enormity of health care fraud emerged this summer when the new Justice Department Medicare Fraud Strike Force announced measures to crack down on medical companies that send phony bills or provide excessive treatments, pointing to 2,400 investigations last year and warning that more cases were on the way.

The FBI, which estimates health-care stealing to total between $60 and $100 billion dollars a year, lists a few of the ways it’s done:

Hospitals, doctors, pharmacists, and other care providers submit fake bills for services never rendered--or overcharge for those delivered.

Service providers bill insurance for unnecessary and costly procedures.

Doctors sell prescriptions to patients for cash.

Companies charge insurance for expensive equipment but provide poor substitutes.

Crooked M.D.s entice patients to visit their offices for "free services" or gifts, then steal their personal information and use it to file fake claims.

If you have a strong stomach, you can Google “health care fraud” and get 23 million hits, many reporting convictions of providers across the country. But reading too many may make you sick and in need of medical attention.

Harry and Louise's Golden Years

In the early 1990s, they were on TV all the time, a middle-aged, middle-class American couple named Harry and Louise, sitting around the kitchen table, worrying that Hillary Clinton’s health care plan would get between them and their doctor.

Today, that Clinton woman will be back again with her radical ideas about insurance for everyone, but will Harry and Louise still be worrying about socialized medicine?

Not Harry. When his company went bankrupt a few years later, he and Louise lost their insurance and couldn’t get new coverage because of Harry’s asthma and coronary history.

They lost the family doctor they loved so much, too. He switched his practice to “concierge care,” but Harry and Louise couldn’t afford the $2000 annual dues to stay on his roster of patients.

Louise can’t be sure but, if Harry had been getting his annual checkups and follow-up visits, he might have avoided or survived the heart attack that killed him at the age of 60.

As a widow, Louise has now reached the age of being eligible for Medicare. She is still free to see any doctor she chooses, but it bothers her that the government is involved in her health care and she is waiting with some annoyance to see what mischief Hillary is up to now.

Health Care Slum: Tear It Down!

If Boeing, Lockheed Martin and Raytheon were deciding who dies and who gets maimed in Iraq, there would be a public outcry. Why, then, is it acceptable for HMOs and insurance companies to make those decisions for Americans at home?

In all the talk about health care, none of the ’08 White House aspirants has been willing so far to take a wrecking ball to the termite-infested structure that has been deteriorating for half a century.

The slum lords, who take one out of every three dollars collected from the victims, are interested only in profits, some of which they use to lobby against any attempt to provide decent public housing instead,

As Clinton, Obama and Edwards duel over their palliative remedies and the Republicans snarl about “socialized medicine,” there is no serious debate about extending the Medicare model, which works well for older Americans, into a single-payer system that would provide better care at far less cost.

If all the moviegoers who are enjoying their righteous outrage after seeing “Sicko” would demand it, we could have a serious discussion instead of sound bites.

Will any network will step up and offer the time for it? From the sampling of YouTube videos so far, there would be no shortage of good questions.