Is This What You Want to Hear in the 2019 State of the Union Address?

President Reports Great Progress in US Health Care in State of the Union Address

 

 

(PRESS RELEASE: March 1, 2019) The President, in her third State of the Union Address, reported that the Nation’s Health Care system is making great progress, and that we are finally beginning to deliver on the promises made when we began revamping our health care system in 2009.  She commented that while there continue to be challenges ahead, all American’s could look forward to improved health care in the future.

She stated that a number of new initiatives designed to correct deficiencies in the programs were beginning to take hold.  Specifically,

·      The doctor shortage is beginning to be reduced, with an estimated 81% of positions filled, up from 79% in 2018.  The President stated that our physician recruiting program from Indonesia and Zimbabwe were successful, as the US doctor salary cap did not discourage recruiting doctors from these regions.  Unionization of the Nation’s doctors has also helped as it has facilitated cooperation without interference from special interest groups like the American Medical Association.

·      Although the costs of the National Health Program have exceeded $2.5 trillion dollars, cost growth has abated to below 19% per year. Two key cost containment programs are having a significant impact:

o   The Government Service Center program is helping to reduce administrative costs, where citizens have “one stop shopping” for all government services, including health care, motor vehicle services, social security administration, veterans benefits, and workers compensation.  She cited that service levels have improved, with over 57% of Americans reporting that they had a positive experience at the Centers.   She said that while at the Centers, citizen’s seeking health services could also take care of other important needs while waiting to see a physician such as renewing their motor vehicle registration.

o   The Right Care for the Right Reasons legislation has been successful in reducing unnecessary medical procedures.  The Regional Medical Approval Committees, composed of locally elected representatives, are able to make treatment decisions within 4 weeks of submission.  The age appropriate evaluation criteria are working to prioritize waiting lists for complex medical procedures.

·      The President noted that bankruptcies of the independent health insurers are largely behind us, and the government has been successful in assimilating these organizations into the newly established Federal Department of Public Health.  She commented that health care is a public responsibility and that there is no need for private business to be involved in this arena.

·      Finally, The President cited that over 86% of Americans had enrolled in the National Health Care program, with only the wealthiest Americans seeking to obtain health care privately.  She proposed that this be addressed with a new Federal 20% surtax on private health care expenditures to encourage the remaining 14% of Americans to enroll in the Federal programs.

The President summed up her report by stating that the U.S. was well on its way to creating the leading health care system in the world, one where all Americans could count on access to care.

Health Care Reform - Be Heard - Contact your Representative

As many of you may agree, I think we have the potential of significantly damaging our health care system with the reform proposals being discussed. Also, given the economic challenges we face is the is the right time to undertake a massive challenge like health care reform? Shouldn’t we be focusing on the economy and getting that fixed before we take up a challenge like health care?

If you agree I suggest you ACT and contact your elected representatives to communicate your concerns. This is very easy to do via email. Below is a suggested communication – all you have to do is cut and paste it into the “contact” form on their web pages.

You can locate your Senators at http://www.senate.gov/general/contact_information/senators_cfm.cfm
You can locate your congressman at https://writerep.house.gov/writerep/welcome.shtml

If you feel strongly about these issues I strongly urge you to take action and not sit by and let this happen to our country. Our health care system is a valuable asset and while it sorely needs reform, this is not the time nor the highly rushed way to do so. We run the risk of creating long term damage which will be very challenging to reverse.

Also, if you agree with this please pass this along.

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SUGGESTED COMMUNICATION




I am writing to express my serious concerns about the discussions underway and the alternatives being proposed regarding reforming our nation’s health care system. While I agree that the system needs to be changed, I am very concerned about the alternatives under discussion. I believe we should take a more moderate, staged approach to tackling such a massive challenge as health care reform, especially in the current fragile economic environment.
For example:
• Our nation is struggling with the worst economic conditions since the great depression. Life has taught me that you can only do a few things well at one time, and if you focus on too many things none get done well. I do not understand why we are trying to take on such a massive challenge as reforming the health care system in the midst of such an enormous economic challenge.
• The responses to the economic challenges have generated unprecedented government debt, which is going to have to be paid from future tax revenues. The $1 Trillion cost of health care reform is also going to have to be paid from tax revenues. I learned in my basic college economics course that you don’t raise taxes in the middle of a recession. We need consumers and businesses to start spending again – increasing tax rates is not the way to build confidence and encourage this.
• The small business environment is very fragile, with business weak and limited availability of credit. Small business is the “lifeblood” of our nation, where the majority of job creation takes place. The proposals in the health care plans may have a devastating impact on small businesses and reduce small business formation in the future.
• Creating a public plan health care option is creating a situation where the government is competing with private business. This is not healthy for our economic system and provides the government with a number of competitive advantages, including not having to make a profit (actually the “acceptability of running a deficit), and not paying taxes. It will be impossible for private insurers to provide the same rates as the government provided program. We will be creating a “slippery slope” towards a single payer system, which hasn’t worked in any other country in the world. Furthermore, the government does not have a good track record of managing and providing services.
Obviously reforming health care is a complex issue, and there are many sides to the discussion. All the more reason to not rush to pass a massive overhaul, but to “triage” the problems and deal with them in manageable stages. I ask you to strongly advocate for this approach and will be closely watching the discussions.

Thank you

The Reality Behind the Talk of Reducing Health Care Costs

from the Wall Stret Journal

Of NICE and Men

Speaking to the American Medical Association last month, President Obama waxed enthusiastic about countries that "spend less" than the U.S. on health care. He's right that many countries do, but what he doesn't want to explain is how they ration care to do it.

Take the United Kingdom, which is often praised for spending as little as half as much per capita on health care as the U.S. Credit for this cost containment goes in large part to the National Institute for Health and Clinical Excellence, or NICE. Americans should understand how NICE works because under ObamaCare it will eventually be coming to a hospital near you.

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Associated Press

President Barack Obama speaks about health care during a town hall meeting at Northern Virginia Community College last Wednesday.

The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used "best practices" in medicine. As the Guardian reported in 1998: "Health ministers are setting up [NICE], designed to ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere."

What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:

In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs -- including Sutent, which costs about $50,000 -- that would help terminally ill kidney-cancer patients. After last year's ruling, Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere.

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: "When treatments are very expensive, we have to use them where they give the most benefit to patients."

NICE has limited the use of Alzheimer's drugs, including Aricept, for patients in the early stages of the disease. Doctors in the U.K. argued vociferously that the most effective way to slow the progress of the disease is to give drugs at the first sign of dementia. NICE ruled the drugs were not "cost effective" in early stages.

Other NICE rulings include the rejection of Kineret, a drug for rheumatoid arthritis; Avonex, which reduces the relapse rate in patients with multiple sclerosis; and lenalidomide, which fights multiple myeloma. Private U.S. insurers often cover all, or at least portions, of the cost of many of these NICE-denied drugs.

NICE has also produced guidance that restrains certain surgical operations and treatments. NICE has restrictions on fertility treatments, as well as on procedures for back pain, including surgeries and steroid injections. The U.K. has recently been absorbed by the cases of several young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.

We could go on. NICE is the target of frequent protests and lawsuits, and at times under political pressure has reversed or watered-down its rulings. But it has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.

The NICE board even has a mathematical formula for doing so, based on a "quality adjusted life year." While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn't adjust for either overall or medical inflation.

Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).

The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price -- the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000?

One virtue of a private system is that competition allows choice and experimentation. To take an example from one of our recent editorials, Medicare today refuses to reimburse for the new, less invasive preventive treatment known as a virtual colonoscopy, but such private insurers as Cigna and United Healthcare do. As clinical evidence accumulates on the virtual colonoscopy, doctors and insurers will be able to adjust their practices accordingly. NICE merely issues orders, and patients have little recourse.

This has medical consequences. The Concord study published in 2008 showed that cancer survival rates in Britain are among the worst in Europe. Five-year survival rates among U.S. cancer patients are also significantly higher than in Europe: 84% vs. 73% for breast cancer, 92% vs. 57% for prostate cancer. While there is more than one reason for this difference, surely one is medical innovation and the greater U.S. willingness to reimburse for it.

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The NICE precedent also undercuts the Obama Administration's argument that vast health savings can be gleaned simply by automating health records or squeezing out "waste." Britain has tried all of that but ultimately has concluded that it can only rein in costs by limiting care. The logic of a health-care system dominated by government is that it always ends up with some version of a NICE board that makes these life-or-death treatment decisions. The Administration's new Council for Comparative Effectiveness Research currently lacks the authority of NICE. But over time, if the Obama plan passes and taxpayer costs inevitably soar, it could quickly gain it.

Mr. Obama and Democrats claim they can expand subsidies for tens of millions of Americans, while saving money and improving the quality of care. It can't possibly be done. The inevitable result of their plan will be some version of a NICE board that will tell millions of Americans that they are too young, or too old, or too sick to be worth paying to care for.

The Economics of Socialized Medicine

Prescient talk by Milton Friedman (in 1978!) about the dynamics of socialized medicine. Thoughtful perspective for the health care discussions underway.

Will the uninsured, who generally cannot afford to pay for health care and who are using emergency rooms today, be better served by socialized medicine? Think about going to the Motor Vehicle Bureau for healthcare, while the more affluent pay for private alternatives.

Single payer is only one short step away from the socialized, government provided health care Friedman discusses. If you listen carefully to the various health care proposals, rationing is already being discussed in code as it is suggested that costs can be reduced through "elimination of unnecessary procedures". Who is going to decide what is "unnecessary"?

Yes we need health care for all, but not this version. Get involved in the debate.

http://www.youtube.com/watch?v=VPADFNKDhGM&feature=player_embedded

We Need Public Support for Mass Transit

Check out http://www.economist.com/world/unitedstates/displaystory.cfm?story_id=13611479.

Illustrates why we need public support for transit systems. Transit, especially rail, should be less expensive to the passenger and provide better, faster service than alternatives to encourage usage and divert people from cars and planes. May be the "green" initiative with the highest potential, especially as the population grows. Doesn't the public benefits of reduced pollution and higher energy efficiency (less oil consumption) justify public subsidies?

The Health Care Debate

Interesting article in today's WSJ illustrating the complexity of the health care debate.  The author does a good job of outlining some of the possible unintended consequences of the current proposals - one wonders why anyone would want to become a doctor if these come to pass.  Most doctors I know are unhappy they entered the profession today!  If a doctor's life evolved this way, in addition to the care issues discussed what will happen to the quality of individuals attracted to this profession  - would out best and brightest want to live this way?

At the same time, the author's prescription (pun intended) that the current private system is the answer negates his argument.  No one is satisfied - patients and doctors - with the current system.  It is broken, not only with the issues of the uninsured, but with the wasted effort expended by patients and doctors over reimbursements.  Who is satisfied with their insurance company?

Health care is a broken system which evolved over time , made more complex by the various constituencies (doctors, hospitals, patients, unions to name a few) arguing to their piece of a fixed pie.  We need a robust, public debate to find our way out of this mess.


How ObamaCare Will Affect Your Doctor
Expect longer waits for appointments as physicians get pinched on reimbursements.
By SCOTT GOTTLIEB

At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.

The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.

There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.

Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies .

 

Those Bonuses

When it comes to our economic dilemma, rather than consistent focus and execution of a well articulated plan, what we get out of Washington each day/week is the issue of the moment. This week's topic is pay (again), driven by the egregious AIG bonuses.

Unfortunately, the AIG bonuses have hit a sore populist nerve, and justifiably so given all the money the taxpayers have poured down the AIG drain. However, rather than focus on fixing the problem at AIG, our elected representatives have seized this issue to make a federal case (pun intended) against "high levels" of executive compensation. Today they are focused on the banking industry and on banks which have received federal aid. Tomorrow - who knows where the focus may go.

There are many good and talented people at these companies who did not create the problems and are working hard to fix them. The compensation structure at financial services firms is commonly low base (fixed) compensation and high variable (bonus) compensation. By capping bonuses these individuals are forced to take significant pay cuts. As they are not indentured servants, in a free market they will go elsewhere, either now for the best of them, or in the future as the economy begins to improve. This will have the perverse effect of driving the top talent from the very institutions which need them the most.

There also is an insidious aspect to the compensation witch hunt, that there is something evil about making money, or there is an absolute level of compensation above which is "too much money". We are in dangerous territory when government is telling us how much we can earn. This isn't what free enterprise is about

Seizing on an easy, populist issue, while avoiding the tougher issues of what needs to be done to fix the economic mess, is a cop out of the highest degree.