Now the veracity of elected officials, especially those in Congress, has reached an all-time low. It is the general feeling that all incumbents, of either Party, lie, cheat and represent only themselves, not us. Everything they do is partisan and bluntly, if their lips are moving, they are lying. They seem to talk only in newspeak.

“Newspeak” is the word coined by George Orwell in his book 1984, warning us in his 1948 novel about what Big Brother could and will do to us. Using newspeak, a word or phrase means exactly the opposite of what you think it means. Bad is good. Black is white. Reforming healthcare makes it worse.

President Obama raised the issue of healthcare to national prominence by emphasizing its unsupportable cost spiral. His “Reform” Act, H.R. 3590 or the PPAHCA, spends over $1 trillion. This is classic newspeak. You call something “reform”–making things better, i.e., reducing costs–while you actually increase spending.

Consider the title of the PPAHCA: Patient Protection and Affordable Health Care Act of 2010. This is another demonstration of Congressional mendacity or disingenuousness. It is a WMDc (weapon of mass deception). It is classic newspeak.

“Patient Protection…”
Does PPAHCA protect patients? In fact, it creates the infamous Death Panels the Republicans tried to scare us with in 2009. The Act creates cost/effectiveness Commissions similar to what Great Britain calls the National Institutes For Clinical Excellence. These decide what is “cost/effective” for the national population, not the individual. If a treatment is deemed not cost/effective, it is not funded and therefore not available. In simple terms, if you need an unusual treatment or something that is very expensive, it is denied, you don’t get the care you need, and…guess what happens. That is a strange way to “protect” patients.

“…Affordable…”
“Affordable” for whom? Certainly not for our nation. The minimum cost estimate is $690 billion and the maximum I have read so far is $2.7 trillion. The fact that no one knows should itself scare you. Would you give a blank check to an inveterate overspender? You just did!

Worse, every entitlement program ever enacted has cost much more than projected. By 1990, Medicare had cost 854% over the original 1964 estimate and will be bankrupt in less than seven years.

Testifying before the Senate Budget Committee, the Director of the CBO (Congressional Budget Office) said that PPAHCA will accelerate not dampen the healthcare cost spiral. Recall that the President started the healthcare ‘reform’ movement because the upward cost spiral was unsupportable. The only way that accelerating the spiral would be considered “reform” is using newspeak.

No one in their right mind calls something affordable when you have to borrow the money to spend, then print dollars, and add to the national deficit.

Finally, where does all that money go? Did you know that before the PPAHCA almost forty percent (!) of all healthcare spending went to the Government? I termed this the “waste of the middle.” After this “Affordable” Act, close to 50% will go to the bureaucrats and not to hospitals, doctors and nurses, pharmaceutical companies, or wheelchair makers.

“…Health…”
Always bear in mind that “Healthcare” is a sickness treatment system. It does not reward health or wellness. Neither the Government nor the providers can deliver ‘health’ to the Public. This is particularly true when Cost/Effectiveness Commissions will prevent you from getting the care you need. Read Daniel Putkowski’s (temporarily fictional) novel “Universal Coverage” to see what it will be like for the average citizen under PPAHCA.

“…Care”
PPAHCA implicitly promises you health CARE but offers health insurance. They let you believe that having insurance automatically gets you care. This is probably the cruelest lie built in to the PPAHCA. Here is a dose of reality.

We currently have a shortage of nurses and doctors: we do not have enough providers to deliver the care needed right now. Further, our provider shortage has been getting worse. What will happen when 30 million additional Americans acquire health insurance and start demanding care? Where will they find doctors, especially since PPAHCA reduced Medicare payments? And while PPAHCA is hiring thousands of new bureaucrats, there is not one single dollar in PPAHCA for a new nurse or doctor.

If you think that I exaggerate, please check my facts and assertions. Unfortunately, you will find they hold up. It is just as bad as I describe.

PPAHCA or Obamacare is a superb example of newspeak.
It exacerbates healthcare rather than reforming it.
Good medicine for healthcare starts with the repeal of PPAHCA.

System MD

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Hopefully, you knew those were rhetorical questions with answers: YES and NO!

HR 3590, also known as the Patient Protection and Affordable Health Care Act (PPAHCA) or colloquially and derisively called Obamacare, is moving the Democrat Party agenda forward but not the welfare of our nation and its citizens. It will exacerbate, not “Reform,” our healthcare system.

While the Public experiences nothing good and hears little, the healthcare bureaucracy is massively expanding. HR 3590 creates 68 new grant Programs, 47 bureaucratic entities, 29 demonstration projects, six whole new regulatory agencies, six compliance standards, two new entitlements and a very large expansion of the IRS. All this reputedly to solve the healthcare [fiscal] crisis and provide care for uninsured Americans.

The Public has been sold a bill of goods, a basket of goodies that delivers exactly the opposite of what was advertised. This is also known as bait-and-switch. Four months ago, I asked, “Is ‘Credible Congress’ an oxymoron?” I think you will have to agree that the answer is a resounding YES!

Every fact reported below has quantified, documented proof.

Advertised: ‘We must reduce the unsupportable cost of U.S. healthcare.’ (President Obama, January 20, 2009)
Fact: Originally estimated by the GAO to cost only $1 trillion, HR 3590 will spend over $2.7 trillion dollars according to the Society of Financial Service Professionals. That is money we do not have and must borrow. The largest portion of these trillions goes to the government itself.

Advertised: ‘The PPAHCA will provide care for 30 million uninsured Americans.’ (Nancy Pelosi on Charlie Rose)
Fact #1: In January 2010, the GAO reported there were over 45 million uninsured Americans: roughly 12-15 million were illegal residents. Note how the number of uninsured touted by the White House and Congress dis-includes illegal residents. The Federal Government is silent, ambiguous, or self-contradictory on whether or not illegal residents will be covered under HR 3590. They know this is political plutonium.
The Government also ‘forgot’ to tell the Public that 25% of the 45 million “uninsured” Americans qualified for aid Programs that existed before PPAHCA was passed, and refused to apply.
Fact #2: Neither Congress nor any legislation can provide “care” (the “C” in PPAHCA stands for care). Only people called providers can do that.
Fact #3: We do not have enough providers to care for patients right now. Where will 30 million additional newly insured people get care in the face of nurse and doctor shortages?
Even before Healthcare Exacerbation of 2010, these shortages were getting worse. Since 1995, applications to U.S. medical schools have decreased by 20%. Professional satisfaction was 95% in 1972, and in 2004, it was 26%. Forty percent of doctors over age 50 are considering early retirement. Over 500,000 nursing positions are currently unfilled. Who is going to provide the care guaranteed by Congress?

Advertised: ‘If you like your doctor, you can keep him or her.’ (President Obama, multiple times)
Fact: The PPAHCA has cut already low Medicare reimbursements by an additional 21%. Physicians can no longer afford to accept Medicare patients. If you have Medicare (or any insurance plan that follows the Medicare reimbursement schedule), you will no longer have a doctor to “keep.”

Advertised: HR 3590 will determine what works and what does not work. The government will offer only what works. (Every official supporter of the Bill)
Fact: HR 3590 creates cost/effectiveness Commissions to decide what is “cost/effective” for the nation, not for the individual. That is what the British NHS does now and what Dr. Don Berwick, White House-designated Director of Medicare, wants to emulate here.
Treatments deemed to be “not cost/effective” would not be covered and therefore not available. If you are over 55 and need kidney dialysis, or have an atypical cancer and need an unusual drug, you cannot get the treatment. Guess what will happen to you? No one in government would dare name the Commissions as “Death Panels,” but that is what they are.

Advertised: ‘During this recession, HR 3590 will help business by cutting costs.’ (Nancy Pelosi on Charlie Rose)
Fact: Numerous large corporations have publicly shared their estimates of the effects of HR 3590 on their bottom lines. Their calculations showed cost increases just for 2010 as follows: Deere Farm Machinery ($150 million), Caterpillar ($400 million), and AT&T (over $1 billion). Medtronik, the world’s acknowledged leader in heart pacemakers, has already begun to do what the others say they must do: lay off workers to compensate for their increased costs. These costs are generated by a Bill that was advertised to reduce costs.

Have you heard about any of this? I think not. The quiet is unnerving. Actually, it is terrifying. The quiet on the surface is deceptive. Under the radar, there is tremendous activity, all at our expense and NOT to our benefit.
• The governmental bureaucracy is following its own mandate–to expand infinitely.
• Costs are skyrocketing instead of decreasing.
• The deficit is exploding.
• Business is being shackled even further.
• Providers are giving up, making shortages even worse. Meanwhile,
• We are told ‘they know best,’ just keep quiet, accept what they are giving us, while our grandchildren will have to pay the bill for the Bill.

System MD

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Health care as a right means that people are entitled to medical care services just like free speech and the right to assembly. We do not have to do anything to get them. They are ours by right and they are free. We have no responsibility and therefore no personal control and or need to make decisions.

In all societies without exception, supply must equal demand. This may be done by nature as in hunter-gatherer societies, by the free market in capitalist nations, or by the government in socialist or communist countries. But someone or something must balance the two. Another word for balancing supply and demand is rationing.

Ration comes from latin ratio (to reason or think) and can be defined as “allowing an individual a fixed amount of a commodity.” If health care is a right, the “allower” or balancer of supply and demand is the government, which must and will ration health care. That is what occurs in all ‘universal health care’ countries including France, Germany, Scandinavian nations, Taiwan, and Japan. Consider Great Britain with its National Health Service (NHS).

Because Great Britain cannot afford its current level of demand for health care, the NHS is cutting services. Services already deleted or to be cut include: heart surgery over the age of 65; kidney dialysis over 55; much hospice care; many cancer treatments; and most nursing homes.

The NHS has a Commission (Department) called NICE, the National Institute for Health and Clinical Excellence. As an aside, note that the President’s choice for Director of Medicare, Dr. Don Berwick, is an admirer of the NICE and wants to import to the U.S.A.

The responsibility of NICE is to determine which medical treatments have the best cost/benefit ratios for the nation, to approve payment for those, and to deny payment for all others. Note what the underlined words mean (to them). Cost considers only the immediate outlay and does not calculate avoided costs or productivity gains or losses. The benefit is national: based on the entire population and not the individual’s best interest. If a specific patient needs something that does not work in the majority, the specific patient doesn’t get it.

The non-payment for specific treatments either because of age or based on NICE criteria (talk about a acronym that means its opposite!) is effectively a Death Panel. Remember the fierce denial of the Democrats that Obamacare (HR 3590 or PPAHCA) would have any such thing? Read the Patient Protection and Affordable Health Care Act: it assigns $650 million for cost/benefit analyses. What happens when the answer is negative? Answer: no payment for that care and therefore, NO care, just like Great Britain.

Nations with ‘universal health care’ have a dirty little secret that is highly relevant to those in the USA who want to import their systems: they are not ‘universal.’ Non-citizens are excluded. If you are an illegal resident, you are not part of the ‘universal care’ and have No right to health care. Recall that the White House said that ALL Americans were entitled to health care and that HR 3590 will cover the “30 million uninsured Americans.” The quote is another WMDc (weapon of mass deception).

Check out the GAO report from January 2010 that clearly and publicly shows there are over 45 million uninsured people in the USA, 12-15 million of whom are illegal residents. Should they be included in the “health coverage for all Americans” or not? Note how smoothly the President sidestepped this political third rail by cutting their millions out of the number of “uninsured Americans.” The issue of health care for non-residents remains our dirty little unresolved secret.

The conclusion is clear and inescapable: health care as a right leads to government rationing of health care. If that is what you want, fine. But do not be fooled by snake oil salesmen in Congress or the White House who says otherwise. If you believe that health care is a right, you cannot and will not have the care you want or need.

Finally, what happens to your right to health care–rationed or without limit–if there are no doctors or nurses? Since 1995, applications to U.S. medical have fallen off 20%. At present, over 500,000 nursing positions are unfilled. A right to health care is meaningless if no one chooses to be or stay a care provider.

DO YOU STILL WANT HEALTH CARE AS A RIGHT?

System MD

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A recent newspaper article reported that, instead of reducing Emergency Room visits, the self-styled Healthcare ‘Reform’ Act (HR 3590), will increase visits to these already over-burdened facilities. Washington’s prediction of reduced ER visits was another demonstration of magical thinking.

Small children are magical thinkers. Ask any psychologist, pediatrician or parent. Magical thinkers believe that because they want it or can conceive of it, “it” is so or will be so. The magically thinking child ties a cape on his back and KNOWS he can fly. When he jumps off the roof, he will of course fall, not soar like Superman.

Those in Washington – both Congressional leaders and the White House – are magical thinkers. Because they say it, “it” will be. If House Speaker Pelosi says that HR 3590 will save money, it must save money. If President Obama says that the Bill will increase care, reduce errors and improve quality, it will happen (because he said so).

The reason most adults do not don capes and jump off roofs is evidence. They may have tried it as a child and have the painful evidence in memory of a broken leg. They may read in the newspaper or see on TV the evidence of what happened to a child who tried it. They may simply consider the centuries old evidence about gravity and deceleration injury.

Is there evidence about healthcare, evidence that Washington ignored? Absolutely!

“HR 3590 will save money.” Every entitlement Program ever enacted has: a) cost more than projected, and b) spent money we did not have or do not have. No entitlement Program EVER saved money. There is overwhelming evidence to prove this.

“HR 3590 will provide care for 30 million uninsured Americans.” Is there evidence to confirm or refute this? Again, yes. Take the experience with Medicare, Medicaid and all other government health insurance programs.

If Medicare pays less than the doctor’s cost-of-staying-in-business (which it does), then the doctor CAN NOT (this is not a question of will not) accept a Medicare patient. If having Medicare insurance guarantees the doctor will not see you, then having government insurance guarantees that you will NOT GET CARE: the opposite of what was promised. Unfortunately, things are even worse than that.

Having any kind of insurance – government or private – may not guarantee getting care. Evidence shows a 20% fall-off in applications to U.S. medical schools. Forty percent of physicians in their prime are considering early retirement. There is hard evidence about our nursing shortage: over 500,000 positions are presently unfilled. So even if you had insurance and even if it paid well, you cannot get care if there are no nurses or doctors. Having insurance does not equal receiving care, and magical thinking will not make it so.

“HR 3590 will reduce errors and improve quality.” This is more magical thinking or worse, a WMDc (weapon of mass deception). To do either – reduce errors or improve quality – providers must learn. That means taking risks and easy access to lots of data, including bad outcomes. Evidence shows that the tort system, the security tightening of HR 3590, and FDA draconian regulations are killing healthcare’s ability to try new things and learn.

Magical thinking by children can harm them. Magical thinking by Washington can kill us. Those with power in Washington are not children, but they think like children, magically, and ignore the evidence.

We tolerate magical thinking by children: that is part of childhood.
Why do we tolerate such behavior in our ‘Representatives?’

System MD

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Healthcare has a tapeworm but it won’t let go. It keeps growing as the host consumes more but gets less nourishment. The worm’s full technical name is Bureaucrator defensis uber alles (BDUA) or bureaucracy for short. Because it won’t let go, the host called Healthcare is starving to death.

According to Darwin (“On the Origin of Species,” 1859), biological organisms survive in order to procreate. BDUA is different. It survives and defends itself solely for the purpose of expanding or enlarging and does so at the expense of everything, including its host.

Host healthcare is gorging itself…on money. The U.S. consumes more healthcare dollars per capita than any other nation. Since money is the energy source by which systems do whatever they do, one expects that the system that uses the most energy (consumes the most money) gets the most benefit. Not so!

The U.S. spends more of its gross domestic product on healthcare than Canada (50% more in USA), Japan (48%), United Kingdom (46%), Germany (35%) and Switzerland (24%). The U.S. ranks behind every one of them in how long we live and infant mortality.

To paraphrase a beer commercial, we are spending more and getting less. Plagiarizing Peter, Paul & Mary, “Where has all the money gone?” Answer: the “waste of the middle,” consumed by BDUA. Roughly 40% of all the dollars that go in to the U.S. healthcare system never come out. When you are talking about $2.5 trillion, even Senator (deceased) Everett Dirkson would call $1 trillion [40% of 2.5 trillion] some “real money.”

Imagine what the nurses and doctors could do for us if they had a $1 trillion more than what is available now!

There is one huge difference between BDUA and the more common human tapeworms (Cestoda). When an individual human is infected with Cestoda, the person cannot decide what the tapeworm eats versus what goes to the host.

For BDUA, we can say how much [money] goes to it and how much goes to us [patients]. By requiring cost/benefit analysis for all food [money] going to the bureaucracy (BDUA), we can reduce its obscene, life-threatening eating habits and have more health care for people.

I often repeat Dennis Miller’s famous closing line, “That’s just my opinion. I could be wrong.” Not this time – I know I am right. In a choice between our welfare and the tapeworm, we must choose us.

System MD

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As Americans, we are all guilty of imitating the ostrich. We hide our heads in the sand to avoid confronting painful, difficult questions like: Do we want to have capitalism in healthcare?

“Capitalism” above refers to the free market, financial incentives, money as reward.

DO WE WANT FINANCIAL INCENTIVES IN HEALTHCARE?
If the answer is no, then we solve healthcare problems using a centrally controlled, government regulated system unaffected by capitalism and market forces.
If the answer is yes, should financial incentives govern ALL goods & services? If financial incentives apply only to some parts of healthcare, which ones should be market-driven and which ones should be entitlements?

As long as the Public ignores this crucial question, our healthcare system will continue to be structured according to the ideology of whichever Party is in power, focusing solely on their immediate political advantage and NOT on our long-term welfare.

Why does capitalism fail in healthcare?
Capitalism–a free market that balances demand with supply–works by using money to connect consumer wants and needs (demand) with the production and distribution of goods and services (supply). We have cheaper and better computers because consumers forced the suppliers to compete. The same thing happened to Lasik eye surgery. The key is the connection between demander/consumer and the supplier/producer. In healthcare, supply and demand are disconnected.

For capitalism to function, the consumer must have control of spending and enough information to be a wise shopper in his or her own self-interest. In U.S. healthcare, the consumer/patient has virtually no control over who will provide service or what service will be provided. The consumer/patient who needs a hernia repair has none of the usual information available when buying a car or hiring a lawyer. The consumer/patient does not pay for what he or she is consuming, at least directly. Under these conditions, how can any patient be the rational consumer on which capitalism depends?

Contradictory incentives
HR 3590–Patient Protection and Affordable Health Care Act of 2010–makes our system even more confusing and contradictory than it was. Consider the insurance conundrum described below (that HR 3590 expands).

Another example of contradictory incentives can be found in HR 3590’s elimination of physician-owned investments. The theory is that when doctors own hospitals or test equipment, they will order unnecessary (and expensive) tests and procedures because doing MORE makes them more money. There is evidence to support this theory.

There is also evidence of the converse. When doctors are paid a fixed sum of money, they will defer doing necessary medical activities because in a managed care system NOT doing tests and procedures is how they make money.

Either way, financial incentives can encourage doctors to behave in ways that are counter to the patient’s welfare. Our present healthcare financing places the patient’s best medical interest in direct conflict with the physician’s best financial interest.

Insurance Industry
What does the medical insurance industry actually do? Underwriters calculate predicted risk and potential payouts. Private insurers maximize profits by spending as little as possible of their collected premiums. Government insurers also seek to spend as little as possible in order to stay within budget. “Spend as little as possible” translates to paying for the least care they can get away with.

The medical insurance industry suffers from the contradictory incentives built into our current healthcare system. Patients want their insurers to pay for whatever medical care they need or want. Shareholders want insurers to pay out as little as they can in order to maximize profits. Taxpayers want government insurers to pay out as little as possible to avoid tax increases. Incentives discourage providing care.

U.S. Pharmaceutical Industry
Using any metric you like–number of patents, drugs in use, volume of research–the USA creates more and better pharmaceuticals and medical devices than the entire rest of the world put together. Why is that? Answer: the U.S. has a powerful financial incentive system that encourages such development.

Try a simple calculation. Flomax is a drug that relieves obstruction to urination in men caused by an enlarged prostate gland. Say Flomax costs $1/pill and you take one per day (=$365/year). Say Flomax prevents the need for surgery on your prostate (estimated cost ?$20,000). It would take 54 years of Flomax to equal the cost of one operation, without even considering the risks, discomfort, and loss of productivity associated with surgery. Which is better? Do you still think $1/pill is exorbitant?

What about Lipitor at $2/pill if it staves off $100,000 heart surgery? The answers come from long term cost/benefit analysis but no one does this calculation. Currently the only, and I do mean only, factor considered is immediate cost. No one talks about cost/benefit.

Should We Have Financial Incentives in Healthcare?
What matters when answering this question is our collective decision and not Congressional wisdom, Presidential politics, or some expert’s branded solution. The Public needs to discuss financial incentives openly, come to some consensus, and transmit that consensus to the Federal government. Without that, the contradictory mess we currently have will persist.

There is in our country a “consensus of futility.” They believe that money-in-healthcare is too volatile, polarizing and fundamental for us ever to achieve a general consensus. I disagree and counter with civil rights. THAT was violently vitriolic, inciting riots and killings, yet we now have a general (not universal but getting there) consensus that people are people regardless of the color of their skin, religion or place of origin. If we can do that, we surely can come to some agreement about dollar flow in healthcare.

WHO should pay and for WHAT?
After the Public decides on incentive-based or flat rate payment, there remain two key questions. WHO should pay? WHAT should they pay for? Spending on healthcare should not be viewed as a simple cost item, money down the toilet. It is or should be an investment in our futures, both as individuals and as a nation. Investments should: a) have a positive cost/benefit ratio, and b) be paid for by those who benefit.

When people are healthy, both the individuals and the country as a whole benefit. WHO should pay? Answer: those who benefit–both individual and nation. What should they pay FOR? Answer: they should pay for those outcomes or results with positive long-term cost/benefit ratios: access and service, good medical outcomes, sustained health and productivity, longevity, as well as rules, regulations and laws that are worth what they cost.

If we can get those things using fixed payments, great! If we need incentives to get quicker access, better service, new drugs, longer lives, then we should use incentives–the free market–to get what we want and need.

System MD

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Those who advocate repeal of the self-styled Healthcare Reform Act–HR 3590–have been labeled as unfeeling, loony, anti-democratic, anti-Democratic [party], Those-who-only-know-No, and anarchists. The correct epithet is good Americans.

Repealers are American.
In contrast to the President’s exhortation to listen more attentively, Americans HAVE listened and more important, we have watched what Congress has done. Regardless of what demagogues claim, Repeal is not based on party affiliation. Democrats and Republicans alike understand that this is bad legislation, will make healthcare sicker, and put our nation deeper into a financial hole.

The partisan charge over this issue crystallizes a key problem: it polarizes a national, not a political party, concern. Fixing healthcare is not and cannot be a Party achievement. We must FIRST have national consensus and then build the fix–a new system–on that American consensus, not based on a Democratic or Republican platform or political compromise.

Eleven States in our Union are exploring a reversal process. Polls show that over half of our citizenry actively oppose self-styled Healthcare ‘Reform’ and the rest are doubtful it will work. Why are people rejecting what we are told will fix healthcare?

Repealers DO care.
The President promised that HR 3590 would expand service adding, “if you like your doctor, you can keep him [or her].” As part of the final ‘Reform’ package, the Senate voted to cut Medicare reimbursements by 21%. Cutting reimbursements has an iimmediate, direct effect: it reduces availability of doctors to see patients. As Medicare reimbursements are cut even further, physicians will be unable to afford to accept Medicare patients and still keep their offices open.

HR 3590 dramatically increases the size of bureaucracy while simultaneously reducing the availability of providers. Repeal would do the opposite. Which group–bureaucrats or doctors–delivers care to patients? Now, ask yourself who cares about patients?

Repealers understand inconsistency.
The President started his push to reform’ healthcare claiming (rightly) that, “The system is broken.” HR 3590 does nothing to fix the system. In fact, it makes the system sicker: unsupportably expensive; more regulated and therefore less able to learn; while reducing availability of care. The Act is exacerbation, the opposite of reform.

If what you are doing is making things worse, don’t you stop?
Repeal is the sane, logical and appropriate response to HR 3590.

System MD

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Today’s diatribe was stimulated by an event that happens every day to every U.S. doctor.

Case
One month ago, a seven year-old child was seen for a possible rhtyhm problem of the heart. The child was eligible for Medicaid but the mother had not applied. Considered urgent, I saw the child and did preliminary tests but could not bill anyone because there was no funding source. An exercise stress test was scheduled for the following month. Mother promised to apply for Medicaid in advance.

Yesterday was the day for the stress test. The family failed to keep their appointment. When our office contacted the home, mother responded that the child was sick with strep. She wanted to reschedule the stress test for when the child was well. Mother still had not applied for Medicaid.

Last week mother took the child to the pediatrician. Because the child was sick the pediatrician evaluated the child while knowing this would be ‘free’ care because mother refused to fill out the Medicaid application forms.

WHY IS THIS OKAY?
A-B-C-D below happens every day in thousands of variations across our country. Neither doctor nor hospital can “Just Say No,” both for moral as well as legal reasons.
A) The patient gets care.
B) The family pays nothing.
C) Without a funding source, the doctor and hospital are not paid.
D) Doctor and hospital must still pay their fixed costs.

Personally, I believe such rejection of personal responsibility is corollary of the belief that health care is a right. Whatever the reason, I ask again, why is this okay? What if everyone behaved like my patient’s mother?

Imagine a scenario where affordable health insurance is universally available such as promised by H.R. 3590 (PPAHCA). Suppose that someone chooses not to enroll. That person goes to a doctor because of a heart murmur. Should the doctor see the patient?

If you believe that the doctor should care for the above patient regardless, then there is no such thing as personal responsibility in healthcare.

What about other countries?
In universal health care countries, you must be “on the list” to get care. This means if you are a citizen, you will be enrolled in the government system: you cannot decline. In countries without universal health care, you must have private insurance or pay up front to get medical care. Without one of those two, you do not get care.

System MD

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The buggy whip, steam-powered cars, sail-powered ships and the Mustard operation* all ‘died’ through Schumpeter’s creative destruction. When no longer needed, they were replaced by superior value-adding objects or approaches: ones that had better cost/benefit ratios.

*The Mustard operation was used in the 1970s and early 1980s to repair a congenital heart condition. When a better approach was found, it “killed” the Mustard operation.

Healthcare is over- (and over-) regulated, possibly more so than any other industry. The rules, regulations and laws, very much including H.R. 3590, add huge useless costs while at the same time they reduce care – both access and quality. In other words, most of the healthcare bureaucracy has a negative cost/benefit ratio.

Cost and Effectiveness
Doctors are expected to understand the cost-to-the-patient (or risk) as well as the benefits and unintended adverse consequences to the patient. A doctor who either does not know these or fails to inform the patient falls below the standard.

In many medical circumstances, the cost/benefit ratio is not currently known, particularly of different approaches for the same condition. Should they use stents or surgery for blocked coronary arteries? Which program is better at preventing or treating asthma?

The rules set up by State and Federal governments affect my patients much more than I do. The bureaucracy determines when my patients get treatment, where and what type. Every doctor knows that both the insurance companies and governments ‘practice medicine’ more than providers, though bureaucrats would vehemently deny this.

Why are legislators and others in authority over healthcare not held to the same standard as doctors? Should they not know the cost/benefit ratio of the laws they enact before they pass them, especially because these laws impact every patient and every provider every day?

Note: H.R. 3590 (Patient Protection and Affordable Health Care Act of 2010) encourages cost/benefit research in the medical aspect of healthcare. There is no money in H.R. 3590 to support cost/benefit analyses of the healthcare bureaucracy.

Complexity [the Bureaucracy] Costs and Kills
What is by far the #1 consumer of healthcare dollars? Answer: it is not the doctors, hospitals, big pharma, or even insurance companies. No, the winner is…the “waste of the middle” also known as (aka) the bureaucracy.

What is the #1 cause of adverse medical outcomes? Answer: limitations in medical knowledge. What is #2? Answer: errors in practice and delays in treatment.

Errors are most often due to miscommunication. Who (what) actively prevents information sharing and learning? Answer: the rules and regulations created by the bureaucracy that are supposed to help and protect us. They actually hurt us.

What is the main reason for delays in care? Answer: the complex system established by the bureaucracy where delaying care is profitable!

You now see why I wrote “complexity costs and kills” in “Uproot U.S. Healthcare,” available (at discount) at www.uproothealthcare.com.

Cost-Cutting Commissions
H.R. 3590 provides for cost-cutting commissions (CCC). These new bureaucracies are advertised as safety features that will improve care for you and me, but this is more political mendacity. A CCC is effectively a Death Panel for people. It decides which treatments will be made available to Public and which treatments will not. If you need some therapy that the CCC deems not to be cost-effective, you do not get it. You know what then happens. By the way, that is how all ‘universal health care’ systems control their costs. That is what is coming to us via H.R. 3590.

Wanted, Desperately: A Death Panel
No one wants a Death Panel for people. We do want and desperately need a Death Panel for rules, regulations and laws. To avoid the name stigma, let’s call it the Sunset Commission.

No one really likes Congressional military base-closing hearings but they perform a vital, cleansing function. Create a Sunset Commission as a healthcare analogue to base-closings. This Commission would say to any agency that oversees or controls healthcare: show us a positive long-term cost/long-term benefit analysis or say goodbye to your funding. This suggestion is part of the proposed cure for healthcare offered in “Uproot U.S. Healthcare,” available at discount at www.uproothealthcare.com.

During the past seven years, the U.S. has spent over $900 on the Iraq War. Last year alone, we uselessly spent 89% of that total amount on healthcare’s “waste of the middle.” Imagine if we could use some (most) of that money for patient care? The Sunset Commission could get that money for us and prove what a respected colleague testified publicly several years ago: “We already have enough money in healthcare. It is just badly distributed.”

System MD

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The Beltway folks would understand by watching the movie “Something’s Gotta Give.” In it, Jack Nicholson says, “I have always told you some version of the truth.” Diane Keaton responds, as most Americans would, “The truth doesn’t have versions.”

Congress thinks that the truth can be adjusted, that facts and evidence are malleable, and that ethics are situational. They are not.

FANCY FOOTWORK ON THE UNINSURED
In early 2009, every official estimate said there were over 45 million Americans without health insurance. The Obama administration repeatedly used this statistic to bolster its claim that U.S. healthcare was in crisis.

The fact then surfaced that 11-15 million of the 45 million were illegal residents. Suddenly, the number of uninsured in all government speeches was 30 million rather than 45, thereby side-stepping the contentious issue of medical care for illegals.

Now that H.R. 3590 has been passed, the White House is again talking about 45+ million uninsured Americans. Do our ‘Representatives’ think we missed their free-and-loose behavior with their facts? They adjusted the numbers to fit their political agenda. That is why their statements of “fact” and assertions of doing “what is in our best interests’ have little credibility with us.

CREATIVE COST ACCOUNTING
In January 2010, the CBO (Congressional Budget Office) estimated that H.R. 3590 would COST about $1 trillion. Two months later with no significant change in the Bill, the CBO said it would SAVE $1 trillion.

The details of their creative adjustments in accounting would make excellent fodder for forensic accountants. Most of us do not care how they did it. The point is that they did it. How can we believe any numbers they spout when the numbers are so…flexible? The simple answer is: we cannot.

The real and certain cost of H.R. 3590 is what small shred of credibility Washington might still have had. That is now gone.

SHAMEFUL CHICANERY
Americans are used to, some say we revel in, political differences. If one Representative strongly supports a position on principle and another opposes it on principle, we understand and often applaud. What we do not accept and unfortunately DO understand is vote buying. We do not trust Representatives who hang out a “For Sale” sign.

When Senators Ben Nelson (D – NE), Mary Landrieu (D – LA) and others sold their votes on H.R. 3590 we were all appalled. When Representative Bart Stupak (D – MI) used a transparent excuse to change his vote (under pressure from the White House), we watched with dismay.

Apparently, people in Congress can justify to themselves actions they take in pure self-interest as being in the public best interest. We know the difference between rationalization and reality, between reform and exacerbation. Most people of whatever political affiliation find such fast-and-loose behavior abhorrent and beneath what we expect from our Representatives.

Some supporters of H.R. 3590 can accept shameful political chicanery because “the end justifies means.” It does not. No matter how honorable the end might be, it does not justify dishonorable, unethical behavior.

BOTTOM LINE
Whether H.R. 3590 will be good for our country is not at issue here. (You will note that the phrase “healthcare spending reduction” – the reason for starting the national healthcare dialogue – does not appear in the name of the Act.)

The main concern is how Washington passed this Act, one that well over half of the country opposed. What opponents and supporters alike observed was a display of fancy footwork worthy of “Dancing with the Stars.” We experienced creative accounting that is in keeping with Bernie Madoff’s best. The lack of principle in our Representatives’ actions made most of us nauseous.

If those in Congress wonder why average Americans neither believe in them nor trust them, we say: Your actions are the reason we do not trust you. And to the President: let me assure you that we ARE listening attentively and we DO understand.

System MD

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