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Health Care Reform It's True Meaning

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In my professional role as an ARNP I am afforded the opportunity to see first hand the many layers of problems associated with our current health care system.  Likewise, I am also in a fairly opportune position to look forward as to what lies ahead with the somewhat less than eagerly anticipated impact of the Affordable Care Act.  Physicians with whom I often discuss these issues are not eager to encounter the changes that are coming. 

For example, according to Kaiser Health News, hospital and physician groups are complaining that the proposed new delivery model called Accountable Care Organizations creates more financial risk than rewards, and imposes onerous reporting requirements. "The American Hospital Association estimated that starting an ACO could cost a hospital $11 to $26 million in the first year, while the proposed regulation put the cost at $1.8 million." 

The purported advantages of managed care at its inception though still not realized, are again being touted for the Accountable Care Organization ACO model, basically a "re-branding" if you will of HMO/PPO's.  The fundamental objectives of measuring quality while managing costs can often be conflicting which is a major goal of this new organizational model.  In my experience when care is rendered, by definition there is in fact an associated cost.  The care is not free.

A component of the affordable care act is the expansion of Medicaid coverage.  I can tell you the physician population is "ecstatic" about that... LOL!  One physician told me that she could have retired on all of the Medicaid that she has NEVER billed for, because it costs more to BILL it than she would get paid.  Another even more inefficient aspect of this plan is the MANDATE that everyone purchase private health insurance including those that would not be able to afford it, but would have their PRIVATE health insurance subsidized by the federal government.  While the debate regarding the constitutionality of this continues and is being challenged by a number of states, the patent inefficiency of such a clearly designed pathway to government subsidy of private business is outrageous.

Such plans are characterized as providing "basic" health care.   What is "basic" health care?   Having worked in the emergency room of a number of hospitals throughout my career, I recognize as does anyone else who has spent time in one of these settings, that health care transitions from "basic" to comprehensive often in mere moments.  One CT scan result can demonstrate clearly that you have metastatic cancer for instance... Then in such circumstances WHERE does "basic" take you from here. 

We have a Secretary of Health and Human Services who was previously a Governor and not surprisingly, a State INSURANCE Commissioner.  Who is in control here over America's health care?  Why certainly not America's health professionals, but instead the insurance companies.  The goose was cooked of course when Obama unveiled his proposal flanked not by physicians and nurses but rather CEO's of BIG INSURANCE and BIG CORPORATE HEALTH CARE. 

This is truely a plan where class warfare is being waged by the "Haves " against  the "Have Nots."  Health care should be a right in this country not just one more commodity  to be bought and sold by those who are well comported to pruchase it.  Quite frankly a good deal of the professionals who provide health care sefrvices across the vast demographic of patients seeking care are those who will never have the kind of resources that a coupon based system would require us to have in order to obtain the full spectrum of health care services.

I knew well before this that we were the proverbial back side of an ass kicking contest long before that, but again with even more emphasis when Margaret Flowers and a host of other physicians and nurses were unceremoniously tossed, and in some case arrested in the Senate hearings on health care reform where Medicare for All/Single Payer proponents were merely requesting a "seat" at the table.   Worse yet when these civil minded health care professionals were dragged kicking and screaming from the Senate hearing the cackles and jokes were coming from all quarters including Democratic Senator John Kerry and of course chair Max Baucus.

The talk now is more than ever about cutting costs in an era of an aging population where health care is commensurately more in demand than ever before.   So people are enticed by slick advertising to trade in their Medicare for a bewildering variety of Medicare "Advantage" Plans.    Let me tell you, if you through no fault of your own fail to choose the proper plan for yourself, and subsequently happen to get the wrong illness then you are cooked.  The real death panels are surprise surprise... The INSURANCE Companies!

An example that I've seen is Her-2-Nu positive breast cancer.  The appropriate treatment is the drug Herceptin which costs $7,000.00/month.  As you can imagine insurance companies are not too fond of that.  However that IS the first line treatment in addition to any surgery required not withstanding.  So if you chose the wrong Medicare advantage then you get the SECOND line treatment.  which may not be quite as beneficial to your long term survival.   Just one example!

The Paul Ryan plan is built around trading traditional Medicare for "coupons" to again buy private health insurance.  Now just how enthusiastic are the insurance companies going to be about insuring people at the end of life or pretty close?  Not too much you say.  Because how do insurance companies make money in health insurance... you guessed it, by NOT providing care, delaying payment to providers or not paying at all.  In some instances if they delay long enough, the patient dies and no cost is incurred because the care was NEVER rendered, hence no cost to the insurer!  This my friends is the basis for health care going forward.

Give Mr. Ryan points for his honesty but that is no help to the majority of us as we reach our golden years.  In the age of automation and technology the need for human workers has diminished markedly.  Whatever manual labor is needed has been "off-shored" to nations where near slave labor is the standard fare.   Social Security has in the same vein somehow been characterized as a major drain on the federal budget when the reality is it was NEVER a part of the budget at all... but alas we have to get a fiscal handle on entitlements so Social Security and Medicare must be cut but never defense! 

The future is that for those of us who are not financially well off, we have become a very undesirable cost center demographically when it comes to things budgetary.   There will be abundant care for those who have considerable assets at their disposal to pay for care, but for the rest of us future NPC's (Non-Productive Citizens) a term coined by an ex-congresswoman and former friend of mine, another way must be found.  

The back room talk perhaps sans cigar smoke, is that we need to cut into the cost of this demographic.  It is not blatant of course, on its face but what Mr. Ryan describes IS the backroom talk that puts in place a plan that will deprive the vast majority of us in OUR old age back where people were in the 1940's and '50's when no insurance company would cover a person over much more than age 40.  The concept is that in order to decrease costs especially in considering the aging population of baby boomers, the way we cut costs is for people w/o  resources to not live quite so long as they should.  The less time these people (US), hang around, the less will be the "costs" incurred by Social Security and Medicare.  Less access to preventative care, new drugs and procedures, as well as diminished financial status leading to less healthful diets and living conditions will result in a large demographic dying sooner and thereby leading to lower costs.  I mean if you have to buy lesser quality insurance w/ coupons and you cannot afford the co-pay what are you going to do.  I see people right now who do not buy theri drugs because they cannot afford the co-pay. 

One gentleman for example who I learned had tremendous talent in an artistic trade and who had supported himself and his family well through his work had a very unfortunate outcome due to matters of cost.   When the economy went south, the artist consequently was unable to obtain his meds to control his high blood pressure ended up having a massive stroke leading to total incapacity.  Now society must bear the cost of care for him and he can no longer contribute all because he could not afford to pay for his monthly medication which was several hundred dollars per month.  Just one example. 

How do we avoid this exceedingly unfair scenario?  Quite simply implementing the sort of plan that I have advocated as first a health professional and also as a candidate for congress... Medicare for All!  No need for complicated new programs "re-branding" managed care, just allow people of ANY age the option of "buying in" to Medicare through a premium that is pro-rated according to income with a maximum cap such that for sake of argument, Warren Buffett would pay no more than Donald Trump as a monthly cost.  This sort of program is precisely the sort of plan that the insurance industry fears the most, in that people on average would jump at the chance to "Buy in" to Medicare. 

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I am a Nationally Certified Acute Care Nurse Practitioner/ARNP with an MBA in Health Systems Management and a former financial advisor Series 7 and 63. I was the Democratic Nominee in both 2006 and 2008 for Florida's 5th District U.S House seat in (more...)
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