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Health & Fitness

The Affordable Health Care Act- Part 1 The nuts and bolts. The nuts in D.C. and the people who are bolting.

 Allow me to paraphrase Hemingway who famously said that “the most essential gift for a patient in our current Health care system is a built-in, shock-proof, bullshit detector.” 

 

Part 1 of the continuing saga...

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The change in the way that health care will be delivered under the new Affordable Health Care Act (AFCA) is like anything else within the natural universe; there is the yin and the yang. Not necessarily a good and a bad, but a good and not so good, if you will. Although I fear being labeled a misogynist, I will use the ancient philosophy expressing the universal truth that the dichotomy in nature is not only what maintains its balance, but is the mechanism that allows its very existence. As in yin and yang we have opposing concepts. The Yin as the ancients have expressed represents; Female, passive, negative principle in nature, the moon, shaded orientation, north or shady side of a hill, south of a river or as we like to call them the Republicans. While the Yang represents male, active, positive principle in nature, south or sunny side of a hill, north of a river, the Democrats. You see the Republican push us towards the precipice screaming about fire and brimstone, while the Democrats take our hands and leads down that same path singing Kum-Ba-Ya.  But back to our thought.  Although the ancients at times realized some very insightful concepts about life and nature, they were hindered in their verbal expressions by the frame of reference dictated by the time in which they lived (as we all are). Today we understand that matter cannot exist without the existence of anti-matter. We cannot appreciate light unless we have experience the darkness. We cannot even begin to define love without the knowledge of apathy. Yes, apathy not hate is the opposite of love. And my personal favorite is that you cannot enjoy the buttered side of a slice of bread without eating the unbuttered side as well. What I am demonstrating here that nothing can ever be perfect. There is always a gentle balance, a term seldom used in Washington these days, "compromise", or as we like to say in healthcare, a homeostasis.

 

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Does the AHCA have some problematic issues? Yes of course, after all it was created in Washington, D.C. by a bunch of people who have neither a medical background, nor a background in the insurance industry. As a matter of fact most of those people in Washington who voted on this law have no vested interest in the outcome at all, since they themselves had included a mechanism whereby they are not mandated to participate in this great experiment. Remember Princess Pelosi stated that she had not even read the law in its entirety before the vote, saying "it was too voluminous to read". Maybe she should have ordered the Cliffnotes. Anyway, we can thank the AFCA for finally bringing bipartisanship to Washington. The Republicans and the Democrats found something they could agree upon. They voted  not be forced to join the party. They voted to maintain their own unique health care system, paid for by the humble masses that must now deal with a bill that is so complicated that many of those folks up in the capitol admitted they could not read it all before voting. The first positive effect  seen already which I am sure the present administration will be promoting  is the  creation of some new jobs. A cottage industry of "professionals" who claim to understand the law are offering consolation and charging hefty fees for consultations to all aspects of industry.

 

This law has many stumbling blocks to its enactment. It still needs to be funded. Many states are challenging still its constitutionality, although the Supreme Court has already ruled on that. It is true that the law could be an economic burden on some states. It might also place an undue stress on many states with an already delicate medical infrastructure. So, yes maybe it should have been taken into consideration that some states might need different kinds of help in implementation. But the Democrats were rushing this through and  the Republicans have become experts in throwing out the baby with the bath water. They are hell bent on paralyzing the health care change for the betterment of their "constituents", wink, wink. And so what if a few more families go broke or a few more babies die, as long as President Obama is denied a political win it is  all "collateral damage". The reality though is that the Democrats as well have turned a blind eye to implement needed changes the will effect some of their PAC friends,  Trial Lawyers Association, Big Pharma,  Hospital Worker's Unions, The AMA, AARP. But wrestle with it as you will, changes  do need to take place. Healthcare in the U.S. is twice as expensive as in the majority of the industrialized  countries in the world. According to studies these other countries are twice as healthy as the Americans. For those of you who can’t do the math that means we, in the U.S. are four times more screwed. Change must begin somewhere, somehow, and we must begin somewhere ad can fine tune the details as we go. (see blog Part 2)

 

For real changes there needs to be an attitude adjustment in this country before anything else can be fixed. As a people we need to understand that yes, as an industry the pharmaco-medical industry cannot be heavily burdened  because it represents a huge portion on the economy. But, can medicines be made more affordable? They already are . Just one example of a place to save. A drug named Levamisole was used for a long time to de-worm farm animals at 50 cents a pill. This same drug was found later to be a very good treatment for human colon cancer. Now the same pill, rolling down another shoot, is $50 a pill. What  was the justification, R&D?  The federal government could intervene in this type of situation. The same U.S. companies besides gauging the patients outright, sell their medicines cheaper in other countries, and by law cannot bring those cheaper drugs to sell in the mainland US. Many pharmaceuticals are produced outside the U.S. mainland, like in Puerto Rico. There they had  huge tax incentives to bring down the overhead. These drugs are sold cheaper outside the U.S. But brought into the U.S. the prices were much higher. A few years ago people were buying their meds from Canada. The FDA said there was a problem of product purity and safety. Please! It's the same drug companies as in the U.S.! The FDA was just protecting the Pharma monopoly and price fixing, which would be considered illegal under The Sherman Antitrust Act in any other industry. But let's not just single out Big Pharm. There is plenty of blame to go around. Last year the Boston Globe ran an article stating that for the same heart surgery, sometimes performed by the very same surgeon, one hospital in Boston charged and was paid $17,000 and another teaching hospital charged and was paid $34,000. The rationale was that it was a teaching hospital. But, don't teaching hospitals already get federal aid because they are teaching facilities? It sounds like the case of the boy who kills both his parents, then seeks clemency from the court because he is an orphan. So, can healthcare be made more affordable? Is there fat to be trimmed? Of course. But first the ground work must be laid down.

 

How can we ask a doctor in this country to work for the same wages as his/her counterpart in let us say, England or France. A doctor in this country begins his professional career with a huge educational debt. While in England or France the schooling is inexpensive or free.  Then there is the malpractice insurance for which doctors must pay tens of thousands of dollars annually. In England and many other countries in Europe medical errors are dealt with in a codified manner many through arbitration boards. In the European countries many physicians work in government clinics where they do not confront the 50% of gross overhead that we find in the U.S. The federal government has within its power to deal with these issues. Will it? I think not. The trial Lawyer association and their PAC$ (Political Action Committees) never even allowed tort law reform  into the conversation in Washington. All the talk in D.C. and never a mention of forgiving medical school loans or even minimizing them for doctors who will become primary care physicians and work in rural, or inner city clinics, where the need is great. Oh, excuse me student loans were discussed this year. They wanted to RAISE the interest rates on what is considered to be the greatest portion of consumer debt in the country. Good way to pop another balloon. The more you look at these buffoons in congress you wonder if they have the capacity to learn from their mistake. Oh, wait you only learn from your mistakes if you actually have to suffer some consequence.

 

The medical schools and hospitals in this country are unresponsive to the needs of the country. Now  with the influx a new patients into a medical insurance market, who is going to attend to these patients? We need more primary care physician. The baby boomers are ageing we are going to need more gerontologists. Unfortunately, primary care and gerontology are not very sexy fields. So, we get a lot of plastic surgeons when we need primary care physicians. Instead of fixing the problem, by obligating hospitals and medical schools, who receive tons of cash from the government to educate and train the doctors that society needs, what happens? NOTHING! It is only fair that scholarship students, and federal loan money recipients should be obligated to fill the needs of the community for a few years. Then they can go on to fix noses and boobs. But instead of addressing the real problem and perhaps ruffling some feathers  the ideas proposed is to give us more Nurse Practitioners and  Physicians assistants who with all respect do not have the same training as the medical doctor, oh, but they do work for less. Only one problem now the Nurse Practitioners and the Physician Assistants also want to specialize according to the latest AMA bulletin. No one has the leadership ability to step in and say how it must be. So now there are people kicking around the idea of cutting medical school down to 3 years instead of 4. Since when is less education a resolution to anything. So as we can continue to dance around the 500 lb. gorilla in the room, or grab the bull by the horns. (A little too Freudian?)  The medical infrastructure in this country need to be revamped. Are people going to be upset? Yes. There are always growing pains, and people are upset now anyway, so it's a lose, lose situation, the perfect compromise.

 

On the business side all must comply offering medical insurance to all (as long as they can afford what is offered), if not government will offer alternative insurance (how affordable is this alternative?) Some companies have decided to cut back hiring. Some have decided to relocate to states that do not want to participate. Either way initially, it does not appear to be a smooth transition. Why? Because the ground work was not laid out. The confusion even for seasoned accounting firms is alarming. Yes, this was the governments fault.  The naive assumption that once the law is pushed through everyone and everything would just fall in line has caused much descent even amongst the people who originally supported the law. The law states that the insurance companies must now assume more risk, offer more services, maintain costs, and return a portion of the monies that they do not spend on the policy holders to the policy holders. (that is a trick that could only be contemplated in Washington). Oh, by the way about maintaining costs, the insurances already have begun raising their rates in anticipation in some cases 17% over last year. What has the government done about that? Nothing?  Many medical doctors are already opting out of the system, dropping Medicare, leaving HMO's and many considering Burger King franchises.  So that's a great start with compliance. These are problems that could have been avoided with the proper preparation.

 

So, when that army of patient's with newly minted health care insurance cards  ascends upon the doctors' offices, the emergency rooms and pharmacies, like so many locust upon the Egyptians.  I believe we will see the same effect. The ill prepared sources of healthcare will not be able to support the load. Healthcare will again be rationed according to the golden rule, "He who has the gold, makes the rules".  You have the cash you get that MRI A.S.A.P. No cash? Ok, you have an appointment for that MRI in 5 months.

 

To sum it up , the ground work should have been laid out first. Creating the medical infrastructure that could support the needed changes. Running around trying to play catch up never works out well. But, the stage is set. Some say set to fail! Some say that was the Republican's plan B. The old, "we told you so" play. As I said, since those good ole boys in D.C. are not in the least affected, what do they care.

 

Please stay tuned of Part 2, What The Heck Is Really Going On?

 

 

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