In Praise of Elizabeth Edwards, Champion of Healthcare Reform

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The day Elizabeth Edwards announced that she had breast cancer, my heart sank. Finding a lump in the breast only heightens the suspicion that the prognosis may not be good. In Elizabeth’s case, it wasn’t. We all admired Elizabeth for different reasons. In my case, it was her love for healthcare reform that quickly grabbed my attention and we were both older moms of two small children. Elizabeth advocated universal healthcare and comprehensive insurance for all Americans, not a “compromised” version based on partisanship and politics. As the years wore on, she discussed her diagnosis of incurable breast cancer with passion stating that she knew that she had access to the best possible care but empathized with women who were not as fortunate.

It is said that behind every successful man lies the power behind the throne and we know this to be true about Elizabeth. She was an accomplished attorney in her own right who took a back seat to raise her kids and support the presidential candidacy of her husband. For a while I thought Elizabeth had won the battle against breast cancer during its remission but then it resurfaced its ugly head in the midst of her husband’s presidential campaign.  She handled it with both dignity and grace. We collectively winced when she faced the infamous scandal that violated principal and moral authority and embraced her even more. The last years of her life were a celebration of uncertainty as she became more and more vocal about healthcare reform. As recent as last night, members of our healthcare advocacy group, Doctors For America, discussed sending Elizabeth a letter of gratitude for all of her efforts regarding healthcare reform. Alas, we were too late. She made her transition this morning.

Elizabeth might have lost the battle with cancer, but she certainly mastered the art of living. In her own words she explained “I have found that in the simple act of living with hope, and in the daily effort to have a positive impact in the world, the days I do have are made all the more meaningful and precious. And for that I am grateful.”

We’re grateful, too, Elizabeth.  Very grateful.

Will Americans Die Because They Are Poor?

“Let them eat cake” was the response uttered by a French aristocrat upon learning that her impoverished citizens did not have bread to eat. The US State Medicaid offices have essentially said the same thing. (See US States Slash Medicaid by Tom Eley) If the proposed Medicaid cuts are enacted, being poor will become equivalent to having a death sentence in one of the most prosperous countries in the world.  Don’t believe it? A 76-year old woman in Michigan died from dental abscesses in Michigan when her dental coverage was revoked.

If you’re poor and need eye services? Forget about it. Live in Arizona and have children in the CHIP program? It might very well disappear. Have mental health problems and live in poverty? You might not be treated.  Pregnant and live in California? You’ll have to be poorer than dirt in order to receive insurance. Your doctors’ Medicaid and Medicare payments have been slashed severely so very few will be able to treat you. No one wants to work for free. Are you incontinent with urine? Sorry, no more adult diapers. If you live in Tennessee, please don’t have a car accident or heart attack. Your state is only going to pay a lifetime Medicaid benefit of $10,000 for inpatient care.

If state legislators need money to fund our healthcare system why don’t they start by commandeering the obscene salaries and fiscal perks of insurance CEOs? Make the lobbyists empty their deep pockets. Raid the trust funds of spoiled brats who never did an honest day’s work in their lives.  Empty the bank vaults in the Cayman Island and bring home all of that tax-free money. Tell the oil barons in Dubai to stop milking us dry. How about manufacturing something “Made in the US” for a change?

Billy Graham once said “Hot heads and cold hearts never solved anything.” Performing slash-and-burn maneuvers will NOT eliminate our healthcare’s fiscal problems. The poor are sick and the sick are poor.  Please do not increase their numbers.

An Open Letter to Pres. Obama and Democractic Senators

I’m a physician, a Columbia University graduate, and I supported you for President. However, this watered-down “healthcare” bill is TRAGIC!! Not only is this a gift to the insurance companies but I will now have to pay triple premiums because I have a “pre-existing condition.” I’m extremely disappointed in you! Our House of Representatives had more courage than all of you.

You’ve heard the horror stories of American people held hostage by insurance companies. As a public health physician, I’ve witnessed it first-hand. I can’t order a diagnostic test without first providing an ICD Code and the name of the patient’s insurance  company. It’s all about getting paid.

I have to fight for the dignity and health of my patients on a daily basis. I had a pregnant patient with uncontrolled Diabetes denied a hospital admission because she had Medicaid. This is NOT change that we can believe in. I’m sitting at my computer wailing with grief. You’ve given the insurance companies everything that they wanted. Regretfully, I will NOT be voting for you or any other Democrat in the next election. I will sit home instead and pray for the day when compassion outweighs money, egos and politics.

The Democratic Senators are nothing but a pack of dealmakers dedicated to vested self-interests. You have made me ashamed to be a Democrat. You have failed the American people.

May God have mercy on your misguided souls.

Senator Joe Lieberman: An American Mercenary

There is no silver lining in the healthcare bill that Senator Joseph Lieberman proposes. Special interests have won once again. The late Senator Ted Kennedy is probably rolling over in his grave and I sit in front of my TV in stunned silence. Why are people so fearful of change? And why are Senators sacrificing the health of innocent American people for the sake of money? Is money that darn important? More important than human life?

I was brimming with optimism after hearing President Obama’s State of the Union Address regarding healthcare reform. The insurance companies would finally be held in check and the reign of healthcare returned to the skillful hands of nurses and physicians. We had finally matured as a nation who was willing to reach out and assist the “least among us.” I envisioned

 • forty-eight million uninsured Americans finally entering the rolls of our healthcare system and receiving life-saving medical treatment

 • A dear colleague finally being able to insure both herself and family members through the Public Health Option because she, despite being a physician, cannot AFFORD healthcare insurance

• The ability to find obstetricians willing to do tubal ligations because they were being reimbursed appropriately

 • New moms finding Pediatricians willing to do circumcisions because they would be compensated fairly

• Hospital schedulers would ask for a patient’s diagnosis FIRST and NOT the name of her insurance plan or billing codes

However, my vision ended prematurely. Our lawmakers were not ready for Prime Time.

Rest assured we are now headed down a perilous path and political gluttony has struck again. And when China and India emerge as new world leaders because America is bankrupt, you can place the blame squarely on Joe Lieberman. For thirty pieces of silver, he sabotaged the health of our Nation. Can you imagine what he would have done as our Vice President?

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?