“There
is really is no such thing as a nonprofit. A nonprofit is an organization that
claims on its books at the end of every year that it didn’t make any money.”
But the people that work at nonprofits score like bandits. The low-information
voter thinks nonprofits are people sacrificing for the common good and they’re
not burning any money and they’re not getting rich.” (Rush Limbaugh, January 9,
2012 broadcast)
“Our
track record suggests that handing over responsibility for social goals to
private enterprise is providing us with social goods of lower quality,
distributed more inequitably and at a higher cost than if government delivered
or paid for them directly.” (Eduardo Porter)
The crux of the New York Times article is
that we should not rely on the private sector at all to satisfy “broad social
needs” like health care delivery, we should allow the federal government to do
it all because it can do it better. Obamacare, with its government run
exchanges, will show us soon enough how well the feds are delivering health
care. The health care insurance will be enforced and wayward citizens penalized
by the vigilant 16,000 IRS agents. A 15-member death panel will be tasked with
approving and denying care and procedures.
“By
many objective measures, the mostly private American system delivers worse
value for money than every other in the developed world. We spend nearly 18
percent of the nation’s economic output on health care and still manage to
leave tens of millions of Americans without adequate access to care.” (Eduardo
Porter)
Any
thinking American knows that when compared to a small island like Cuba, third
world nations, or communist China, U.S. does not deliver worse value, it is
misinformation aimed at low information voters. What good is access to care and
insurance if that care is sub-standard and lacking in training, equipment, meds,
and procedures?
Socialized
medicine is used as an example of success in Europe. Medical care works to an
extent in Western Europe because, by comparison, those countries are small and
they handle simple medical problems while rationing care for complex medical
issues and testing. They are generally strapped for cash and doctors receive a
government set salary. These western Europeans have relied on the United States
to provide military protection while the freed funds were used for social
programs, medical care, and lavish welfare.
Why
are most foreign nationals, who can afford and have free health care in their
countries, flee to the United States when serious health issues are at play?
Could it be that we have the best trained doctors in the world, the best
hospitals and medical equipment, the most break-through and life-saving
procedures particularly in the treatment of cancer?
Should
U.S. follow in the footsteps of France that recommends the legalization of “accelerated
deaths” based on three sets of circumstances? (http://www.france24.com/en/20121218-report-recommends-france-legalize-accelerated-deaths)
Porter
says that we can improve the delivery of health care and pensions “simply by
removing the profit motive from the equation.” Everything the federal
government is involved in, with the exception of the military, the delivery of
services is slow, the paperwork is daunting, and costs are bloated.
Profit
was a dirty word for communists, it was called surplus, which was supposed to
be equally shared with the proletariat. The problem was that, in the “socialist
workers’ paradise,” the proletariat never saw the “surplus,” neither did they
get proper and qualified medical care, abundant services, and the medicines
they needed. Shortages and rationing always came into play. Those who truly
benefited were the ruling communist elites for whom nothing but the best was
provided.
Rush
Limbaugh argued that nonprofits have huge pools of unspent money that keep
growing with profit from wise investments. Harvard has an endowment of $40
billion which makes about $10 billion in profit every year and they don’t pay a
penny in taxes – it’s saved for a rainy day but they never spend it if that day
comes. They keep asking for more donations. People who work for nonprofits are well
remunerated, they are not suffering or sacrificing their standard of living for
the “social justice” they advocate. (Rush Limbaugh show, January 9, 2012)
Colleges
in general are awash in money and donations that they spend generously on
sports and building stadiums and academic buildings. Professors are paid lavishly
and nobody questions the profit motive in academia because it is the fiefdom of
the left who indoctrinate our youth.
Nonprofits
are supposed to be morally superior because they do not exploit people like the
immoral profiteering hospitals. Profit must be an evil entity that kills
innocent and hapless victims. At the end of the year many for-profit hospitals
show a tremendous loss. Both for-profit and non-profit hospitals are bound by
the same laws to provide the same care to any person entering their ER and
doctors have sworn the same Hippocratic Oath.
Why
should pension funds not run on profit? How would pension funds be insulated
from bad times when there are not enough people working to replenish the stock in
order to pay the retirement of those who live longer and healthier lives? Why
rely on the government for pensions, the very government that can take away
benefits just as easily as it doles them out?
Suzanne
M. Kirchhoff, analyst in healthcare financing, prepared a 27-page report
released on January 2, 2013 for members and committees of Congress, “Physician
Practices: Background, Organization, and Market Consolidation.”(http://www.fas.org/sgp/crs/misc/R42880.pdf)
The
report addresses the growing number of U.S. physicians who are “combining
practices, affiliating with hospitals, insurance companies, and specialty
management firms, or going to work directly for such organizations.” (p. 2)
The
reasons given were multifold:
-
Desire
to have a set schedule and salary
-
Private
practices are too complex to manage
-
Physician
compensation and reimbursement by insurance, including Medicaid and Medicare, declined
-
Larger
practices control costs
-
Larger
practices can negotiate higher reimbursement with insurers
A
smaller group of doctors are creating “concierge” practices where they see a
limited number of patients per year who pay an annual retainer and a set fee
per visit.
Because
of these trends and the increased number of patients who will be insured
through exchanges, many studies warned of shortage of doctors, particularly
primary care physicians.
The
deceptively named 2010 Patient Protection and Affordable Care Act caused the
creation of a system called Accountable Care Organizations (ACO). Under this
system, the providers make contracts to oversee a patient’s total course of
care in order to manage costs and “improve quality.”
Physicians,
insurers, and hospitals have formed associations in order to qualify for these
ACOs. These associations appear to be more beneficial to the providers rather
than the patient. Obamacare forces doctors to consolidate in order to “reduce
fragmentation and control government and private health spending.” Will this
consolidation have a negative effect on patient access, prices, and
competition? Mergers in the 1980s and 1990s had negative effects in terms of
patients being restricted or blocked from access to specialists and procedures.
Hospitals
and physicians are in a rush to hire more doctors to fill the increased demand
from the millions of new insured under Obamacare. My personal doctor has hired
a nurse practitioner and a physician aide. I am not particularly thrilled to
see someone young who is just now learning how to deal with patients and
diagnose them properly, cannot do surgery, or someone who does not have a
medical degree at all.
The
American Medical Association (AMA) calls the 972,376 doctors and residents who
work primarily from solo or smaller practices as a “cottage industry.”
Eighty-four percent of Americans’ visits to the doctor are to the primary care
physician. Twenty percent of physicians work for hospitals. (Congressional Report
Services, pp. 1-2)
Twenty
percent of medical spending goes to physician payment accounts. Physicians make
referrals, tests, hospital admissions, therapy, and other actions, accounting
for 90 percent of total health care spending. (CRS, p. 3)
Of
the 972,376 physicians and residents, 7% are osteopaths, one-third primary care
physicians, and two-thirds specialists. One fourth of U.S. doctors are
graduates from international medical schools. New England and Middle Atlantic
regions have the highest number of doctors per capita. Rural areas have the
lowest. The Association of American Medical Colleges predicted in 2008 that by
2025 there will be a shortage of 130,600 doctors. Nurse practitioners,
certified mid-wives, and physician assistants will have to make up the
shortage. The law varies from state to state as to what procedures and services
these individuals can perform. (CRS, pp. 4-6)
There
are 155,000 active nurse practitioners with graduate education beyond a
bachelor’s degree who are registered nurses. “They can take case histories,
perform basic exams, order lab work, prescribe some meds, and provide health
education and counseling.” (CRS, p. 6)
There
are 86,000 certified physician assistants with a bachelor’s degree, 27 months
of specialized training and 2,000 hours of clinical rotations. “They can take
patient medical histories, examine patients, treat minor injuries, order and
interpret lab tests, and make rounds in medical facilities.” (CRS, p. 6)
“The
consulting firm Accenture predicted that just a third of U.S. doctors would be
truly independent by 2013.” Medical
practices will be morphing into two types of business consolidation:
-
Horizontal
mergers (specialty practices merge for reasons of economies of scale, i.e.
lower overhead costs)
-
Vertical
mergers (hospitals buying physician practices or hiring physicians; physicians
partnering with insurers, and joint ventures forming Accountable Care
Organizations or ACOs) (CRS, pp. 8-9)
“Concierge”
medicine, seeing a limited number of patients for a set fee, already has
regional groups like MDVIP from Boca Raton, Florida, and Concierge Choice
Physicians in New York. At least 756-retainer based physicians charge average
fees from $600 to $5,400 – they see their patients for longer office visits,
more in-depth physicals, and preventive and continuous care. (CRS, p. 15)
There
are legal issues with medical mergers:
-
Compliance
with state and federal laws in regards to fair competition and transparency
-
Over-utilization
of services in the health care sector
-
Antitrust
(Sherman Act in re to monopolization, and Clayton Act in re to anti-merger)
-
anti-kickback
laws in Medicare and Medicaid
-
State
laws barring the corporate practice of medicine
-
Stark
law of 1989 that imposes limitations on physician self-referrals (CRS, p. 16)
Congress
might be interested in the following issues:
-
medical
spending (rising health care costs due to tight associations such as ACOs;
physician productivity based on volume)
-
access
(disparities; ACOs may not treat sicker, more expensive patients, resulting in
being more selective in their choice of patients; would patients have freedom
to see the doctor of their choice or a specialist; would rural areas be able to
attract physicians if there is too much consolidation; physician supply – would
“concierge” medicine take too many doctors out of general access)
-
coordinated
care/quality (physicians who handle their patients outside of hospitals by
using ambulatory settings such as imaging, surgery, chemotherapy vs. physicians
who use hospitals exclusively for their patients as is the case in Europe; in
both cases, primary care physicians are left out, including cases when many
patients seek first help in Emergency Rooms) (CRS, pp. 17-21)
Physician
income and practice costs can be affected by specialty, source of payment
(private vs. public), and productivity (volume or range of services offered).
Currently, “general practitioners and pediatricians make less than specialists
such as cardiologists and oncologists.” According to the Medical Group
Management Association, doctor compensation ranges from $189,402 for family
practice to $514,659 for orthopedic surgery. (CRS, p. 22)
Congress
created the Medicare Sustainable Growth Rate formula in 1997 to address annual
updates to the physician fee schedule. This may not be an issue as overtures
have been made towards the equal remuneration of all doctors, regardless of
specialty. (CRS, p. 24)
The
electronic health record (EHR) must replace the paper-based medical system. I
have already encountered the orange portable iPad style computer that patients
must fill out in order to expedite the electronic compliance. EHR incentives
offer $20,600 per physician although the cost of implementing the electronic
health record can be as much as $54,000 per doctor. Medicare pays up to $44,000
over five years plus an additional 10 percent if the physician practices
medicine in a “designated medically underserved area.” “The payments phase out
over time and are replaced by financial penalties” if the doctor is not
compliant. By 2015 a reduction in Medicare Part B reimbursement will occur if
the doctor is not a “meaningful user” of electronic health records. (CRS, p.
24)
Under
totalitarian regimes, doctors are still forced to practice medicine where they
are told because the state picks up the tab of their education. The state also
tells them how much compensation they are going to expect, the number of hours
they have to practice medicine six days a week, and the number of patients they
must see every day. The ratio of doctor to patient is usually very high due to
chronic shortages of doctors. Nobody wants to study medicine for 12 years and
receive the same remuneration as a person with a high school degree.
Rodney
Atkinson said, “Corporatism is the socialist form of capitalism and it rules in
most western ‘capitalist’ countries. The ultimate expression of corporatism is
the European Union.” Ruled by the leftist interests of corporatists (large
unions, big business, unelected non-governmental organizations with
supranational powers, lobbying groups, professional interest organizations,
main stream media) and run by the government, the United States’ tenth ranking
in the index of economic freedom does not even begin to explain how little
freedom we have left in America. And now our medical care will be fundamentally
changed as well.
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