Health Care on Life Support

From the Wall Street Journal, on the passage this weekend of health care legislation in the House:

The bill is instead a breathtaking display of illiberal ambition, intended to make the middle class more dependent on government through the umbilical cord of “universal health care.” It creates a vast new entitlement, financed by European levels of taxation on business and individuals. The 20% corner of Medicare open to private competition is slashed, while fiscally strapped states are saddled with new Medicaid burdens. The insurance industry will have to vet every policy with Washington, which will regulate who it must cover, what it can offer, and how much it can charge.

We have little sympathy for the insurers, or for that matter most of the other medical providers who signed on to this process only to claim now to be appalled by the result. The insurance lobby --led by Aetna CEO Ron Williams --made the Faustian bet that it could trade new regulations for more new subsidized customers who would face a tax penalty if they didn’t buy their insurance. The Pelosi bill includes the regulation but guts the tax penalty because it’s unpopular. Insurers will thus have to cover more sick people with fewer dollars, as healthy folk opt out of coverage until they are sick…

Unless the Senate has an epiphany of common sense, Americans will be paying the bills for this willful exercise for generations to come.

Historic moment: you are witnessing the demolition of America’s health care system, and the crippling of its economy for generations to come. When the public wakes up from their slumber to discover what “universal coverage” looks like in the flesh, it will be far too late to undo the disaster.

Best make an appointment to see your doctor now — you may not have many opportunities left…

Confessions of a Health Care Rationer

Over at First Things, you will find an excellent article on the topic of rationing in health care, written by a clinical oncologist now working for the insurance industry in evaluating claims for medical necessity. Despite what would at first glance raise concerns about being an apologetic for the private insurance industry, this proves to be a well-balanced essay on the difficult choices in allocating scarce health care resources wisely. It is well worth your time to read in its entirety:
Confessions of a Health Care Rationer

It \'s a mistake to think of health care as a right. It is not a right; it is a good. Freedom of speech, by contrast, is a right, as is freedom of religious belief. They are privileges that inure to individuals as a consequence of the primordial right, free will. That is why we see them as inalienable. The exercise of these rights does not depend on any action of government, but rather on its inaction. Government may not legitimately interfere with their exercise, but nothing mandates that the government provide us with printing press or chapel.

All modern societies ration health care. A wise society considers the options and chooses a method of doing so which best conforms to its values and capabilities. Thus we come to the terrible question we would so very much like to avoid: How shall we ration health care? How shall we explicitly ration it? So noxious a question is this, so offensive in its tacit assumptions and implications, that most politicians and wishful thinkers will deny that we need to address it at all. They will argue that the fundamental problem is one of distribution, not one of unmeetable demand. They will argue, with more enthusiasm than evidence, that an emphasis on preventive care would substantially reduce aggregate demand. Some will say we must reduce the role of government; others will argue that we should augment it. If only we will adopt their plan --they \'ll say --waste, fraud, and abuse will be abolished. There will be chicken --or at least chicken soup --in every pot, and a vaccine in every arm. People love honesty, but they hate the truth. To frankly acknowledge and address the ineluctable reality of healthcare rationing is not merely to touch the proverbial third rail of American politics; it is to lie across the tracks in front of the onrushing train.

Check it out.

On ‘Death Panels’, Compassion & Choice

I must confess to having had some misgivings about the uproar over Section 1233 of the proposed health care reform bill HR 3200. This section pertains to government payment for counseling on end-of-life options under Obamacare. From Sarah Palin’s ‘death panels” to an endless host of hyperbolic rhetoric about how this counseling is “mandatory” (it’s not) and will inevitably lead to euthanasia, I have felt that much of the discourse is over the top and poorly supported by the text of the bill, and may well prove counterproductive in the long run.

This is not to say that there is no reason for concern: the enormous financial strains which the proposed legislation will place on the health care system, combined with a government panel to decide the “appropriateness” of medical care, certainly introduces significant moral hazards in creating pressures to restrict expensive care at the end of life. Given the growing legality of physician assisted suicide (PAS) — first legalized in Oregon and most recently in Washington, with many other states considering it legislatively or by fiat from judges — it is likely that PAS will become one of the options which must be discussed as part of such end of life counseling, and that there will be pressure to use such “cost-effective” options. Oregon is now offering coverage for PAS while denying expensive palliative chemotherapy. It is not hard to imagine such a trend developing at the federal level as well.

But despite my reservations about the current political firestorm on this issue, there may well be more cause for concern than I have previously believed: via the invaluable Second Hand Smoke, Wesley Smith picks up an interesting trail: the organization Compassion and Choices was deeply involved in helping to craft this section of HR 3200.

So who exactly are these folks? Does the name “Hemlock Society” ring a bell, per chance?

The Hemlock Society was founded by Derek Humphry in 1980, a rabid proponent of assisted suicide and euthanasia, as he himself makes clear:

Born in 1980 in my garage in Santa Monica, California, Hemlock went on to be the largest and oldest right-to-die organization in America fighting for voluntary euthanasia and physician-assisted suicide to be made legal for terminally and hopelessly ill adults.

But the name ultimately proved a little too close to the truth for comfort, and so eventually needed to be changed to something more anodyne: “We [also] need access to the halls of government in the states and in Washington DC – access that the name ‘Hemlock’ is currently denying us. The name Hemlock … is also baggage, baggage that we can no longer afford to have weighing us down or interfering with our being able to partner with such important and powerful organizations as AARP.” And so Hemlock joined other pro-death organizations in 2003 to become reincarnated as “Compassion and Choices.”

And now, clearly, they have the congressional access they sought. Ahh, the power of euphemism — what would a death cultist do without the words “choice” and “compassion”?

Compassion and Choices has become the shepherd and sole spokesmen of Oregon’s assisted suicide law — and were intimately involved in writing the Oregon legislation. They have been involved in over 75% of PAS cases in Oregon, and tightly control the media disclosures surrounding these suicides:

The group promoting assisted suicide, so-called “Compassion and Choices (C&C)”, are like the fox in the proverbial chicken coop; in this case the fox is reporting its version to the farmer regarding what is happening in the coop. Members of C&C authored and proclaim they are the stewards of Oregon’s assisted suicide law. They call it “their law”. They have arranged and participated in 3/4ths of Oregon’s assisted suicide cases. Their medical director reported she’d participated in more than 100 doctor-assisted suicides as of March 2005. A physician board-member reported in 2006 that he’d been involved with over forty such patients. Their executive director reported in September 2007 that he has attended more than 36 assisted suicide deaths. He has been involved in preparing the lethal solution. Yet, he is not a doctor.

Furthermore, there is no outside audit of PAS cases in Oregon; Neither Oregon’s Department of Health Services nor independent outside auditors may review them — and complications of the procedure are reported only by the prescribing physician, an obvious conflict of interest.

They have been involved in like manner in the PAS cases in Washington as well.

Hyperbole aside, there is plenty of reason for concern when government gets in the business of managing end of life decision making; assisted suicide will be a very tempting option when government desperately tries to reign in runaway costs for care of the elderly and dying.

And you can be sure if they implement these controls that groups like Compassion & Care will have a seat at the table.

H.R. 3200

If you have a serious case of insomnia, have far too much time on your hands — or have a vested interest in not seeing government take over your health care — then you will want to spend quality time reading the legislation which will change your life, irrevocably and disastrously, forever: HR 3200, “America’s Affordable Health Choices Act of 2009”. Various summaries and commentaries are floating about the web, and while helpful, they are tainted by too much histrionic commentary, often SHOUTED TO MAKE A POINT! which may or may not be be a valid inference from the legislation.

Here’s the HTML version with links.

So now you can go straight to the source, and judge for yourselves. Even though your elected representatives will try to pass this without reading it, that doesn’t mean you can’t do the responsible thing and get informed.

Here’s a good summary of HR 3200’s key aspects, from AAPS:

New bureaucracies: These include State Health Help Agencies (HHAs), with a federal fallback plan should states refuse to create them; an advisory committee to report annually on modifications of benefits, etc.; some mechanism to “adjust” the Medicare Part B premium based on whether or not each individual “participates in certain healthy behaviors”; other agencies to calculate payments, monitor individual behavior, set standards as for chronic disease management, check compliance with standards, monitor loss ratios and outcomes of chronic-care management, etc.

Individual mandate. All adults must buy a government-approved Healthy Americans Private Insurance Plan (HAPI) [love the abbreviation!] and constantly report on compliance, at every interaction with federal, state, and local government, including at voter registration, motor vehicle departments, or other checkpoints, as well as when filing tax forms. This applies to all legal residents, including non-citizens, although not to illegal aliens.

Penalties. The penalty includes the average monthly premium, plus 15%, for all “uncovered” months. Penalties are not subject to discharge by bankruptcy. This means that the HHA, which receives the penalties, takes precedence over other creditors.

Insurance mandates. Guaranteed issue, community rating, coverage of “wellness” without copayments, annual physicals, a required “health home” (gatekeeper), mental health parity, and reconstructive surgery post mastectomy are all mandatory. Each HAPI plan “shall” make available supplemental coverage for abortion, unless affiliated with a religious institution.

Progressive taxation equivalent. Premium subsidies are phased out incrementally up to 400% of poverty. This means that working harder and earning more is punished by higher mandated health insurance “premiums” (which are the functional equivalent of taxes). People will constantly be reporting on their income status.

School-based clinics. Care must be provided at no cost, or on a reimbursable basis, by school-based clinics, which must provide, “at a minimum,” mental health services, and use electronic medical records by 2012.

Job killer. Every employer “shall pay an employer shared responsibility payment,” which increases for each additional employee in excess of 50. Employers must deduct the individual shared responsibility payment from wages “as and when paid.” This amount is not allowed as a deduction from the employer \'s taxable income.

Savings. To offset the costs, Medicare and 90% of Medicaid disproportionate share (DSH) payments are to be “recaptured.” Tax exclusions for health benefits will be limited (sections 661-666). According to section 801, “private insurance companies will be forced to hold down costs and will slow the rate of growth because they are required to offer standardized Healthy Americans Private Insurance plans.”

These cool cats in Congress are, of course, only interested in your welfare, and always have the interest of their constituents first and foremost in their minds:

So give them a piece of your mind, here.

The hour is late, and the corrupt political class wants to radically transform the health care system — not for your benefit, but for theirs.

Get to work before its too late.

Newt’s Reform Ideas – 1b: More on Fraud

The second in a series reviewing the health policy proposals by Newt Gingrich as listed at the Center for Health Information.

 ♦ Part 1: Stop Paying the Crooks

We’ve been looking at the health care reform proposals recently put forth by Newt Gingrich at the Center for Health Information. Before moving on to the topic of computerized medical records, a few more points come to mind regarding the whole fraud and abuse problem and its proposed solution.

The real problem with the federal health care programs, the seed ground for the vast majority of the fraud problems in health care (and elsewhere), is complexity. Simple systems are hard to defraud. When you buy a box of cereal at the store, and pay the checkout gal your money, there’s no opportunity for fraud. If the IRS wanted to eliminate tax fraud, they would deep-six their hundreds of thousands of pages of regulations — which even an army of accountants and lawyers can’t decipher — and have a simple, one page, flat tax form: Here’s what I earned, send the Feds x%. Complexity in any realm — be it software development, business models, government and legislation (e.g. the 1000-page-and-growing health reform legislation being considered by the House, which John Conyers says no one will read, and, hey! no big deal!), vastly increases the opportunity for the dark side of human nature to find loopholes to benefit themselves — and creates deadly traps which even the most honest may be hard-pressed to avoid.

Our current health care reimbursement system is beyond complex — Medicare regulations in the Federal register are 3-4 times the size of the IRS tax code. (Lord knows what they will be if “reform” gets passed!) Chew on that for a moment. Such complexity engenders huge inefficiencies, and contradictory or nonsensical rules can make it all but impossible to comply, or even understand what they mean. They also engender a certain amount of moral hazard, even for the honest.

To wit: a prime example of this in medical coding and reimbursements is something called edits. I’ve explained these before, but in a nutshell they go like this: if certain sets of complex conditions are met, you get paid; if not, then no dice. For example, if you perform surgery A at the same time as surgery B (as they are related), Medicare or an insurance company may refuse to pay for either A or B, as they are bundled — that is, they are considered as one procedure for payment purposes, even though more time and complexity was involved to do both. Often this makes sense (since unbundling components of procedures was sometimes abused by fraudulent providers), but with increasingly frequency the exclusions are arbitrary, and have become vehicles for payers to cut costs by denying payment capriciously. Physicians who, quite legitimately, submit modifier codes (which may allow payment for both, if there is good reason) may also become targets of auditors ever on the search for “fraud,” since such a billing pattern may suggest they are trying to bilk the system.

And then there are the procedure / diagnosis code edits. If you submit a legitimate, medically-indicated service for payment, Medicare or the insurance companies may deny payment if they don’t like the diagnosis code (called ICD-9 codes) you used. Medicare is pretty transparent about which codes they will pay for, while insurance companies often are not (so-called “black-box” edits) — but in both circumstances the decision to pay or not for a given diagnosis is often utterly capricious and not at all medically-based. Savvy physicians and medical billers learn which codes pay, and which don’t — and since there may often be more than one diagnosis which is proper and ethical to use, one may get you paid while another may not. But this insanity also creates a temptation to push the envelope a bit, to receive payment for an entirely legitimate medical service — and yes, one determined to be so under peer-reviewed standards and outcomes research — by using other diagnosis codes which may not be quite as close to the most accurate clinical code. And even if it is entirely legitimate and ethical to change codes, the Feds view this coding-for-reimbursement as fraudulent.

So let’s say your patient has diabetes and high blood pressure. You perform some service to evaluate his high blood pressure. Medicare won’t pay for this service when submitted with the high blood pressure diagnosis code (even though it’s entirely appropriate medically and ethically to perform this service for high blood pressure) — but will pay for it when submitted with a diabetes diagnosis code. Since the service was legitimate and medically appropriate to provide for high blood pressure, and since the patient also has diabetes, you submit the service for payment with the diabetes code — and get paid. (This specific example is entirely fictitious and conjectural, BTW, used only for the sake of demonstration — but such code mismatch problems and incorrect denials are legion in health care billing). Technically, you are committing fraud if you do this; medically, you have done absolutely nothing wrong — the problem lies in the bizarre mismatch of payment edits and the mind-numbing complexity of the payment system. Many physicians play strictly by the rules — and as a result perform a lot of care without pay. Not a great business model by any stretch (since it’s not free to provide the care) — but preferred by many to the dreaded Federal auditor flashing his badge and demanding to see your ID as you check your patient’s prostate.

So the fraud problem is far more than a bunch of shady sheisters shilling the system for big bucks by billing for faux services. It’s also a lot of honest and hard working physicians who are struggling to understand and comply with an enormously complex payment system, fraught with egregious capriciousness which often denies payment for entirely legitimate services. It creates a morally hazardous environment which can easily push physicians into areas of ethical grayness — or worse — when they are arbitrarily denied fair payment for legitimate and medically-appropriate care.

Enough for now on the fraud issue — although I could go on much longer. As long as the payment system remains phenomenally complex, you will have fraud — whether real or simply perceived by payors. And there is no serious consideration in any current proposals to reform this monetary madhouse. You cannot eliminate fraud in such a complex system without turning your medical payment bureaucracy into a police state — and punishing, and driving out even more honest, competent physicians from their profession. Can you say, “Access problems”, boys and girls? But then, if we’re left with no doctors standing, no doubt “fraud” will decrease, substantially.

Anyway, time to move on to part 2, on computerized medical records.

Newt’s Reform Ideas 1 — Stop Paying the Crooks

Over at the Center for Health Information (HT: Hot Air), Newt Gingrich and Nancy Desmond have proposed a series of principles for reforming our health care system, to wit:

1. Stop Paying the Crooks. First, we must dramatically reduce healthcare fraud within our current healthcare system. Outright fraud — criminal activity — accounts for as much as 10 percent of all healthcare spending. That is more than $200 billion every year. Medicare alone could account for as much as $40 billion a year.

2. Move from a Paper-based to an Electronic Health System. As it stands now, it is simply impossible to keep up with fraud in a paper-based system. An electronic system would free tens of billions of dollars to be spent on investing on the kind of modern system that will transform healthcare. In addition, it would dramatically increase our ability to eliminate costly medical errors and to accelerate the adoption of new solutions and breakthroughs.

3. Tax Reform. The savings realized through very deliberately and very systematically eliminating fraud could be used to provide tax incentives and vouchers that would help cover those Americans who currently can \'t afford coverage. In addition, we need to expand tax incentives for insurance provided by small employers and the self-employed. Finally, elimination of capital gains taxes for investments in health-solution companies can greatly impact the creation advancement of new solutions that create better health at lower cost.

4. Create a Health-Based Health System. In essence, we must create a system that focuses on improving individual health. The best way to accomplish this is to find out what solutions are actually working today that save lives and save money and then design public policy to encourage their widespread adoption. For example, according to the Dartmouth Health Atlas, if the 6,000 hospitals in the country provided the same standard of care of the Intermountain or Mayo health clinics, Medicare alone would save 30 percent of total spending every year. We need to make best practices the minimum practice. We need the federal government and other healthcare stakeholders to consistently migrate to best practices that ensure quality, safety and better outcomes.

5. Reform Our Health Justice System. Currently, the U.S. civil justice system is the most expensive in the world — about double the average cost in virtually every other industrialized nation. But for all of the money spent, our civil justice system neither effectively compensates persons injured from medical negligence nor encourages the elimination of medical errors. Because physicians fear malpractice suits, defensive medicine (redundant, wasteful treatment designed to avoid lawsuits, not treat the patient) has become pervasive. CHT is developing a number of bold health-justice reforms including a “safe harbor” for physicians who followed clinical best practices in the treatment of a patient. Visit CHT’s Health Justice project page to learn more.

6. Invest in Scientific Research and Breakthroughs. We must accelerate and focus national efforts, re-engineer care delivery, and ultimately prevent diseases such as Alzheimer’s Disease and diabetes which are financially crippling our healthcare system.

My first reaction to this? Meh. Obamacare light.

On deeper reflection, however: Mini-meh. Not entirely without merit, but loaded with silliness and false assumptions.

What is it with these so-called policy gurus? Knowing little or nothing about how health care really works, they haul out the bromides and throw around statistics based on taking small numbers and projecting them across large populations, to come up with scary percentages which then echo around the web and inside the hollow heads of the parrots in media newsrooms. Oh, and our politicians then use this crapola to formulate policies, which always end up having massive unintended consequences and which never achieve the results promised. Newt’s a pretty bright guy — generally a far better idea man than a politician — but he’s whiffing at softballs thrown slowly, by and large, with this one.

So what’s my gripe? Where do I begin? How about at the beginning?

 ♦ Stop Paying the Crooks: Of course, brain-dead easy. Just find ’em and lock ’em up. Problem solved; billions saved; next problem!

Not quite so easy, in reality.

Look, fraud exists in Federal programs; it may actually be a pretty large chunk of change, although I’m more than a bit skeptical of the numbers being tossed around. Why? Well, first, if we knew exactly how much fraud there was in Federal health programs, we would, you know, go after it, no? All these numbers are nothing but projections — and projections based rather thinly on hard data, then amplified by applying them to large populations. Great for media play and making a political point, but invariably far, far off the mark.

Ever hear those public service ads which generate guilt by saying “One in five kids will go to bed hungry tonight in America.” Believe them? Of course not — they’re ludicrous on their face (unless you count the corpulent kids whose last Big Mac was 2 hours before bedtime…) . The gimmick used is non-representative sampling — and sampling is a huge problem: if 2% of physicians are found fraudulent in Miami, does that mean 2% are crooks in Topeka, or Flagstaff, or East Podunk? Highly unlikely — but that’s how these estimates are typically generated. So the line goes, “Eliminate fraud and we can have XX billion dollars to spend on such-and-such!” End result? There’s never as much fraud as you say (and a good deal of it is impossible to track down), and the promised billions never materialize.

Next problem is definitions: to paraphrase Bill Clinton, it depends on what the meaning of “is”, is — how exactly are you defining fraud?

Sure, no one argues with the dude who steals or fabricates a provider number, then bills Medicare for millions of dollars of non-existent medical services (although it is surprising how long it takes Medicare to catch on to such schemes). Some are almost as clever as politicians at stealing money. Bust ’em, lock ’em up, problem solved.

But what about the honest doc utterly befuddled, or too busy to spend half her time on, the mind-boggling complexity of medical service coding? Or the solo practitioner who can’t afford the huge hassle and administrative costs and burdens of a full-fledged compliance program? In the world of Medicare & Medicaid, such providers are also fraudulent. Try to be charitable to a poor Medicare patient and not bill them for their copay and deductible?

Fraud! Honest to God.

When physicians hear about new measures to stamp out fraud and abuse, they know exactly what that means: federal auditors, not health care professionals but bureaucrats, with infinitely deep pockets and unlimited time, sweeping into a busy medical practice, demanding hundreds of charts to review, disputing countless interpretations of complex, confusing, vague, and often contradictory regulations on what code should have been charged for such-and-such a service, with mind-boggling penalties per offense, no matter how trivial. Be prepared for a 6-figure attorney bill, on your dime, with little or no formal avenue for review or appeal — and still expect to settle in the end, hopefully for less than a mil.

Oh, and that settlement will become part of the national fraud statistics, finding some convenient multiplier, and generate some more truly shocking numbers about crooked doctors — when the chances are rather high in reality that that no real fraud occurred.

There is a pretty simple way to vastly reduce such fraud, of course: pay physicians by time, like virtually every other profession. Kill the complex coding system which by its very complexity breeds fraud, error, and confusion.

Will it ever happen? When Skip Gates dons a white hooded cape and burns crosses on lawns.

Human nature being what it is, you will never completely eliminate fraud. But you sure can crush a profession by trying.

There’s lots more to come, not all critical. Next post: Newt Part II: Move from a Paper-based to an Electronic Health System.

Back soon.

Texas Tort Reform

Over at the Belmont Club, Richard Ramirez has a post citing a proposal by a physician for reform of the health care system. The proposal is thoughtful, with some excellent suggestions (which will never get implemented in today’s environment, sadly).

What caught my eye in the comments was a summary of the changes which tort reform has brought about in Texas by a commenter, Leo Linbeck:

I \'m pretty familiar with tort reform in Texas, as my dad was the founding Chairman of Texans for Lawsuit Reform. TLR started in the mid-1990s after forty years of steadily increasing tilting of the civil justice playing field in favor of plaintiffs. There were two major inflection points in this fight:

The 1995 session (with George W. Bush was Governor)

Limited punitive damages
Reformed joint and several liability
Restricted venue shopping
Restored the Deceptive Trade Practices Act to its original purpose of protecting consumers in ordinary consumer transactions
Enacted a half dozen other reforms to curtail specific lawsuit abuses

The 2003 session (with George W. Bush was Governor)

Enacted comprehensive reforms governing medical liability litigation, including a $750,000 limit on non-economic damages
Initiated product liability reforms
Made the burden of proving punitive damages similar to criminal law, requiring a unanimous jury verdict
Comprehensively reformed the statutes governing joint and several liability and class action lawsuits
Imposed limits on appeal bonds, enabling defendants to appeal their lawsuits and not be forced into settlements (this is what pushed Texaco into bankruptcy in its famous lawsuit against Pennzoil)
Further limited the filing of lawsuits that should have been brought in other states or countries

The changes to medical liability in 2003 were extraordinary, and had a very substantial impact, including:

1. In August 2004, the Texas Hospital Association reported a 70% reduction in the number of lawsuits filed against the state \'s hospitals.
2. Medical liability insurance rates declined. Many doctors saw average rate reductions of over 21%, with some doctors seeing almost 50% decreases. (Recent information provided to The Perryman Group during the course of this study suggests that premiums are declining even further in 2008.)
3. Beginning in 2003, physicians started returning to Texas. The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. Perryman has determined that at least 1,887 of those physicians are specifically the result of lawsuit reform.
4. In May 2006, the American Medical Association removed Texas from its list of states experiencing a liability crisis, marking the first time it has removed any state from the list. A recent survey by the Texas Medical Association also found a dramatic increase in physicians’ willingness to resume certain procedures they had stopped performing, including obstetrics, neurosurgical, radiation and oncological procedures.

Last year, TLR commissioned a study by The Perryman Group to figure out the impact of these reforms (the above are excerpted from that report). Here are the economic impact findings of that study:

$112.5 billion increase in annual spending
$51.2 billion increase in annual output – goods and services produced in Texas
$2.6 billion increase in annual state tax revenue
$468.9 million in annual benefits from safer products
$15.2 billion in annual net benefits of enhanced innovation
499,000 permanent jobs
430,000 additional Texans have health insurance today as a result of the medical liability reforms

The complete Perryman Group report is here.

As these numbers show, tort reform can have a substantial impact on economic growth and wealth creation, and a huge impact on the healthcare system in particular. Any serious national healthcare reform must include comprehensive tort reform to reduce the practice of defensive medicine and other perverse incentives.

Which is why I do not consider the current proposals from the Obama Administration to be serious (other than being seriously flawed).

Our current re-invention of the health care system, for all its complexity, completely ignores the problem of runaway malpractice lawyers and the costs of defensive medicine. While not surprising, given the huge contributions to the Dems from attorneys, this deficit alone virtually guarantees a disastrous outcome should it be implemented.

Health Care Links

There’s lot’s of discussion going on about health care lately– very little of substance from our politicians (is anyone surprised?), who are more interested in ramming through a massive government “solution” than actually figuring out what a good solution might be.

Here’s some articles worth looking through to get yourself better informed:

 ♦ TennCare’s troubling history: Tennessee tried universal coverage with a public option in 1994, similar to what is planned for Obamacare. The result? Employers dumped patients onto the public option; massive cost overruns; doctors ran for the exits due to gawdawful reimbursements; rationing; activists endlessly demanding even more money be poured into the abyss. Hey, let’s try this at the national level!

 ♦ Health Reform \'s Hidden Victims. The Prez was asked at his presser which patients would need to sacrifice, and how much, in order to get health care reform done. He didn’t answer, but John Fund does. The victims who aren’t now paying attention are in for a very rude shock.

 ♦ Peggy Noonan has some good insights on why common sense may sink Obamacare. Here’s one in particular which I haven’t seen mentioned before, but which is definitely true:

The first [reason for Americans’ hesitance about government health care] has to do with the doctors throughout the country who give patients a break, who quietly underbill someone they know is in trouble, or don \'t charge for their services. Also the emergency rooms that provide excellent service for the uninsured in medical crisis. People don \'t talk about this much because they \'re afraid if they do they \'ll lose it, that some government genius will come along and make it illegal for a doctor not to charge or a hospital to fudge around, with mercy, in its billing. People are afraid of losing the parts of the system that sometimes work — the unquantifiable parts, the human parts.

Note to Peggy: its already illegal for your doctor not to charge the patient under Federal health care programs: Federal programs consider it fraud if you do not balance bill a poor patient for their Medicare./Medicaid copay and deductible, and your doctor can be fined or excluded from Medicare if he does this.

No joke.

That having been said, there’s a huge, undocumented financial pillar to the current system, which is charity & unreimbursed care by ERs and physicians. The former has been talked about a fair amount; the latter not at all. This charity care will disappear with universal coverage, and will be a large — and unanticipated — additional cost burden to be picked up by the taxpayer.

 ♦ The AMA sells out doctors:

“I think AMA has become part of the whole government-medical complex.” [Vuckovic] argues that the AMA has complacently accepted the transformation of the medical profession into a “service-delivery model, with both physician-providers and patient-customers slowly but surely becoming servants of the same paymasters: the private and public insurers.” The idea of returning medicine to a fee-for-service model has been all but abandoned in Washington, where AMA lobbyists spend most of their time.

Spot-on — the AMA is a bunch of elitist fools who are only interested in schmoozing with the politicians and pretending they are the voice of medicine. They are not, which is why their membership rolls look like the New York Times readership stats. Worthless traitors, as dangerous as they are ineffective.

Update: This from the AAPS:

In December 2008 the AMA had 236,153 members, of whom 20% were students and 13% residents; thus about 157,000 were practicing physicians — about 17% of some 900,000 eligible practitioners, compared with 22% in 2004. … in a recent online survey, 75% of some 4000 respondents said they were not AMA members; 89% said they did not believe the AMA speaks for them; 91% said the AMA does not accurately reflect their opinion as physicians.

Also noted: more than 85% of its $282 million annual revenue comes from sources other than membership dues.

See also this: The AMA Has Sold Out Physicians for a Few Bucks.

Stay informed, folks — and keep the phone lines to your senators and representatives singin’. Trust me, you do not want this monstrosity they are trying to shove down our throats.