A Defeat That Should Have Never Happened!

I hope someone out there is just as outraged as I am. Sixty U.S. Senators cut deals instead of doing the will of the American people and now we’ve lost Ted Kennedy’s seat. This is what happens when politicians don’t stand on their principles and our President wavers like the wind. We never wanted healthcare exchanges and piecemeal healthcare run by a conglomerate of self-interests. The people wanted universal healthcare coverage for all.

Well, now that the Democratic Party has received a smack down in Massachusetts, maybe someone will FINALLY listen to the people. Our window of opportunity for change is now apparently closed and my patients and profession will continue to suffer.

MLK said it best: “All that good men need to do for evil to flourish is nothing.”

Health Care Reform: An Unkept Promise

 When I heard the final Senate version of the healthcare reform bill, I had a complete meltdown (please see An Open Letter to President Obama). I had been sucker-punched by people who I thought I could believe in and it was clear that the democratic process had been replaced by corporate agendas.

 Louisiana Senator Mary Landrieu received an additional 100 to 300 million dollars for Medicaid, Nebraska Senator Ben Nelson cut a deal that guaranteed federal Medicaid payment for life (although this is now being challenged by several State Attorney Generals) and Connecticut Senator Joe Lieberman killed a public option because of his wife’s affiliation as a consultant and lobbyist to pharmaceutical and insurance companies.  Hadassah Lieberman was a consultant for Pfizer, who is one of the largest U.S. pharmaceutical companies and recently ordered by the U.S. Department of Justice to pay a $2.3 billion dollar lawsuit for healthcare fraud. Government lawyers settle $2.3 billion dollar Pfizer fraud lawsuit.

On Christmas Eve, the US Senate’s version of HR 3200, aka America’s Affordable Health Choices Act of 2009 passed. The House of Representative and Senate bills must now converge into one bill. The dynamics of that process will be interesting and we will need to watch our backs.

I challenged Doctors for America, an organization of approximately 16,000 physicians to answer the following questions regarding HR3200:

  1.  Will the premiums for people with pre-existing conditions be higher and by how much?
  2. Will there be some outside regulatory agency to govern the insurance companies in the event of misdeeds?
  3. Will there by co-pays and deductibles and by how much?
  4. Will there be a limit of services provided by these so-called state regulated insurance plans, i.e., will the poor receive less services based on the type of insurance they have?
  5. How much assistance will poor people receive regarding insurance premium payments? 10%, 20%, or 30%?
  6. Is there a cap on how much an insurance CEO can earn?
  7. Will there be reductions in payments of Medicare and Medicaid to physicians?
  8. Will these plans be taxed to people who earn above a predetermined income?

To the organization’s credit, they provided the following answers:

         1.   Older people will have to pay higher premiums at a ratio of 2:1 in the House bill and 3:1 in the     Senate bill. This means that as an “older” person, my premiums will either double or triple           based on the new “reform”. If you are a smoker, be prepared to pay higher premiums as well     and no, you can’t conceal your habits because they can do urine and blood tests in search of        nicotine.

          2.  Insurance companies will be required to report to the government on their performance, profits,  etc. A health insurance’s ability to participate in the Exchanges will depend on its performance.   If an insurance company increases its premiums prior to the Bill’s final approval, they will be  excluded as a candidate for the exchange.

        3.    Yes, there WILL be co-pays but there will allegedly be no more lifetime or annual limits on how  much an insurance company can pay on your behalf.                                       

         4.   Allegedly, there’s a minimum benefits plan on the Exchanges, and then several levels of plans above that. The minimum benefits plan provides “significantly” more benefits than the average individual plan today.

         5.   People earning 400% below the poverty line will have their insurance premiums subsidized.       Who are these people? Any individual who earns $43,000 or less and families of four who earn  less than $88,000. The table listed below illustrates provides an example of a subsidy.                                

         6.   At present there is no cap on the earnings of insurance CEOs but allegedly companies must spend between 80 to 85% of their revenues on medical care. They are also required to report profits annually and pay dividends to their customers if their profits exceed the cap.

         7.   Allegedly, there will be no cuts to either Medicare or Medicaid physician payments.

          8.  There is allegedly going to be an “excise” tax on “Cadillac” plans described as plans that cost  individuals more than $8500 per year or families more than $23,000 per year. Individuals  earning more than $200,000 and families earning more than $250,000 per year will pay 2.35%  more in Medicare payroll tax.    

                What does HR 3200 offer small business owners? Small business, with payrolls less than $250,000 per year will be exempt from the employer responsibility requirement. Allegedly, new small business tax credit will be available for companies who want, but can’t afford to provide their employees with healthcare insurance.

 As a physician, my main concern is patient care and safety both which have declined under an insurance-driven market. Have no doubt about it folks, the insurance companies are running the show and “old-school” physicians like me are growing weary of fighting near-impossible battles.  With the demise of the public option, who’s going to ensure that insurance companies play by the rules? Proposing that states assume that responsibility as suggested by the Senate Bill is unrealistic. The federal government had to enforce the Civil Rights Act back in 1964 and the same principle applies now. Without federal intervention, state governments will do nothing and insurance companies will conduct business as usual.

President Obama admitted that members of the US Senate and Congress have the best health insurance plans in our country. Why should WE settle for anything less?

The Betrayal by Congresswoman Kosmas

4898_10195_healthcare_largeNo, I’m not psychic, but I can spot a snake-in-the grass when I see one.  The procrastination and fence-sitting of Congresswoman Suzanne Kosmas regarding healthcare reform were red flags that she clearly had another agenda.  She never had intentions of fulfilling the “will of the people” and “represented” no one but herself.

The Orlando Sentinel reports that Kosmas said: “It was a difficult decision” to vote against her party regarding healthcare reform. She would have preferred the “Senate” version and not “tax the wealthy.” Suzanne, who are you kidding? Please do not insult our intelligence. You rode into Washington on the coattails of a popular presidential candidate and had no intention of serving anyone except your checkbook and bank account. How much did Big Pharma pay you? What under-the-table deals were made? You are spineless, shameful and an embarrassment to the decent citizens of our District. And we WILL have the memory of an elephant. The only reason that I am not picketing your office is because I’m too busy taking care of the medically underserved; the uninsured and the voiceless patients of our community. However, when the campaign begins to boot you out of office, I’ll be the first in line to offer my wholehearted support.

Please do not sign a long-term residential lease in the District of Columbia or its outlying communities because your days are significantly numbered. I intend to support anyone (along with a check) who plans to challenge (and rightfully so) your elected position be it a Republican; another Democrat (hopefully); heck — I’ll even support Daffy Duck or the Cookie Monster.

My late aunt once said: “When the snake bites you once, it’s an accident. When the snake bites you twice – it’s YOUR fault.

Congresswoman Kosmas, I do NOT intend to get bitten again.

Invoking the Miraculous: A Case for the Public Health Option

lp_c_insuranceIf JT had private insurance and not Florida Medicaid, her baby would probably be dead. 

JT’s pregnancy was miraculous, considering she had conceived with only one fallopian tube and ovary and she had no prior children.  Things went well until her 27th week when she developed vaginal spotting.   She went to a local hospital and was discharged home with a clean bill of health although they never ordered an ultrasound.

Bleeding during pregnancy is not a normal phenomenon.  When I saw JT three days later during a routine prenatal visit, I ordered an ultrasound although the bleeding had stopped.  A few hours later, the radiologist emergently reported that the placenta completely covered the opening to her womb and the baby’s umbilical cord was wrapped tightly around its neck three times.  JT had a complete placenta previa and someone at the local hospital had regretfully missed the diagnosis.

I discussed JT’s case with a high-risk obstetrician and we both agreed that she should be admitted to the  specialty hospital if only for observation.  Thankfully, JT had state-sponsored Medicaid insurance because a commercial insurer would have made us jump through hoops.  They would have required pre-authorization, endless forms and an inappropriate premature discharge home where she would have subsequently returned to the hospital with a dead baby.

What was supposed to be a 24-hour admission turned into a sixty-four day hospital stay because JT bled on a weekly basis.  The cord remained around the baby’s neck and the prognosis was guarded regarding successfully carrying the baby until it was full term. 

At 35 weeks, JT had an amniocentesis to make certain that her baby’s lungs were mature.  She was subsequently delivered by cesarean section with the umbilical cord STILL wrapped around her baby’s neck.  Because of skill, compassion and medical expertise, both mother and baby are just fine. 

Marie Curie once said, “Nothing in life is to be feared.  It is only to be understood.” 

Please do not let fear cloud your judgment.  Support the public health option, America.  We need these miracles to continue.

President Obama, Please Rock the Boat

RALEIGH, NC - JULY 29:  U.S. President Barack ...
Image by Getty Images via Daylife

President Obama, don’t even try it.  If you think that eliminating the public health option would enhance healthcare reform, please think again.  There IS no reform without the public health option despite the deceit and spin.  First you eliminate the single-payer plan, then the universal health plan and now Secretary Sebelius states that the public health option “is not essential”?  This is where we draw the proverbial line.  I stand in full support of Congresswoman Maxine Waters and Senator Nancy Pelosi who are adamant about maintaining the public health option.  You have no idea what it’s like to practice medicine with one hand tied behind your back.

I had to contact a hospital administrator prior to leaving for vacation a few weeks back because one of the radiology technicians refused to give my patient an ultrasound.  My order allegedly did not have a diagnosis (which in fact, it did) and the order was not “dated” so (God forbid), the hospital might not get paid.  When the billing codes takes precedence over patient care and technicians are practicing medicine without licenses, you know that our healthcare system is in deep trouble.  This was not the first time that I had to contend with the technician’s overreaching behavior so I have opted to send my patients to the hospital’s competitor. 

Having recently celebrated yet another year added to my life, I’ve come to the conclusion that despite our best efforts, there will be people who will never like you.  Therefore accept it and move on.  Hillary and Bill buckled under pressure of the insurance lobbyists thirteen years ago and look at the mess we’re in.

Sometimes you may have to rock the boat to shift the course of progress but fear not, Mr. President.  We’ll be in that boat right beside you.

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