Please Cut the Crap!: Deconstructing the Right Wing Lies on the Health Insurance Bill#more#more

Please Cut the Crap!: Deconstructing the Right Wing Lies on the Health Insurance Bill#more#more:

The right's lies about the current health insurance proposals before Congress have rarely been compiled in such concise form before.

What follows is an article from the Right Wing blog ChronWatch:

Page After Page of Reasons to Hate ObamaCare
By Alan Caruba

The problem is, there's something missing, such as context. See, the writer is expecting the reader to take everything as gospel, and agree that it's bad, without any sort of explanation. It's a list of all of the things that are wrong with the current state of the health care reform bill before Congress. If you'd like to follow along, feel free to click here to go to the bill itself. In fact, I would encourage you to look at it for yourself; it's an easy way to learn what's actually in it, without having to read through all of the legalese.

We're not called Please Cut the Crap for no reason. Below each item the right wing assures readers we're supposed to hate, I've inserted context, and explained why you really shouldn't hate it. Unless you should. All of my responses are italicized and printed in red, so that you can tell whose words are whose.

I'll warn you, this is a long one, but it's an important one, so get a glass of tea, print this out, and read it to everyone who spews one of these talking points, because this really does touch on pretty much all of the right's talking points. And now you'll be able to refute them. Isn't that cool?"

Follow the link to read it all.

A friend sent me this email from a right wing relative, and it was just too full of crap to spend the time debunking, but fortunately the good people at "Please Cut the Crap" did it for me!

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Doctor Self-Referrals Part of Health-Care Cost Trend - washingtonpost.com

Doctor Self-Referrals Part of Health-Care Cost Trend - washingtonpost.com:

"In August 2005, doctors at Urological Associates, a medical practice on the Iowa-Illinois border, ordered nine CT scans for patients covered by Wellmark Blue Cross and Blue Shield insurance. In September that year, they ordered eight. But then the numbers rose steeply. The urologists ordered 35 scans in October, 41 in November and 55 in December. Within seven months, they were ordering scans at a rate that had climbed more than 700 percent.

"The increase came in the months after the urologists bought their own CT scanner, according to documents obtained by The Washington Post. Instead of referring patients to radiologists, the doctors started conducting their own imaging -- and drawing insurance reimbursements for each of those patients."

It is clear some oxen have to be gored, or at least hobbled, to "bend the curve." Let's start being explicit about where to do this. Private insurers, over-utilizing physicians, drug and equipment manufacturers and suppliers. Let's start the hard discussions, please.

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What the Mayo Clinic knows | Freep.com | Detroit Free Press

What the Mayo Clinic knows Freep.com Detroit Free Press:

Three goals underscore our nation's ongoing healthcare reform debate: 1) insurance for the uninsured, 2) improved quality, and 3) reduced cost. Mayo Clinic serves as a model for higher quality healthcare at a lower cost.

President Barack Obama, after referencing Mayo Clinic and Cleveland Clinic, advised: 'We should learn from their successes and promote the best practices, not the most expensive ones.' Atul Gawande writes in the New Yorker, 'Rochester, Minn., where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest 15% of the country -- $6,688 per enrollee in 2006.

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Rationing? Say it ain't so!

Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times:

But documents obtained by the House Committee on Energy and Commerce and released today show that the company's employee performance evaluation program did include a review of rescission activity.

The documents show, for instance, that one Blue Cross employee earned a perfect score of '5' for 'exceptional performance' on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

'When times are good, the insurance company is happy to sign you up and take your money in the form of premiums,' Stupak said. 'But when times are bad, and you are afflicted with cancer or some other life-threatening disease, it is supposed to honor its commitments and stand by you in your time of need.

'Instead, some insurance companies use a technicality to justify breaking its promise, at a time when most patients are too weak to fight back,' he said.

Lawmakers -- Republicans and Democrats alike -- decried the practice of canceling policies of ill policyholders and grilled insurance executives about it.

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Doctors Oppose Giving Commission Power Over Medicare Payments - WSJ.com

Doctors Oppose Giving Commission Power Over Medicare Payments - WSJ.com:

But doctors are objecting to proposals that would allow a federal commission to set the size of Medicare payments to doctors, hospitals and other health-care providers. Under a proposal from White House budget director Peter Orszag, if the president accepted the commission's recommendations, they would automatically take effect unless Congress acted to block them.
Doctors' objections to the commission idea highlight the difficulty of maintaining the support of different health-care constituencies when the focus turns to controlling costs.
Surgeons would 'vigorously oppose' legislation that gave an unelected executive agency power to set Medicare rates, said the American College of Surgeons, which claims more than 74,000 members, in a letter to House Speaker Nancy Pelosi last week. Several surgical-specialty societies also signed the letter.
The AMA, which claims 250,000 members, said a commission shouldn't be authorized to set Medicare payment rates for physicians. 'If the solution is we're just going to have a big board that will make draconian slashes, that's not getting at the root cause of what the problem is,' said AMA President J. James Rohack.

This is interesting. First, reimbursements are virtually set now by an unelected board, the RUC, made up largely of the highly paid, procedure based specialists.

Second, I just heard Chuck Grassley on NPR this morning saying the House and Kennedy Bills did nothing to bend the curve. This is what is required to bend the curve. Put up or shut up. Bending the curve isn't some magical thing where everyone gets to keep making as much money, on the same trajectory as they do now.

And it's worth pushing back on the AMA in particular. They've been talking a good game about what needs to be done to improve health care, reluctantly (because of fear of retribution, I suspect) pointing out whose oxen to gore, but they've been very silent about what physicians will be required to give up in all of this.

I frankly don't expect to have to give up much, (I'm 49) and what I do give up will occur over ten to twenty years and so accommodation will be made by the "youngsters," those going into and coming out of medical school and residencies now). They are the the physicians who will actually be affected by this. The old guys pissing and moaning are ready to retire soon, so shouldn't be holding the country hostage to their reactionary, out dated ideas of what medicine should be about.

UPDATE: I was researching Medcare for a talk on the 44th anniversary of the program, and it is worth mentioning that one of the things LBJ had to do to pass Medicare was to cave to the American Medical Association and American Hospital Association, essentially giving them whatever was required to stop opposing the legislation. This had good and bad effects: lots of hospital construction, advances in medicine, and huge revenue boosts for hospitals and doctors.

On principle, we should not cave to get reform, but on a pragmatic level, fear works and the erosion in support for reform is evidence of that. But let's call BS, at least, on Grassley and the other reborn deficit hawks: If you want to bend the curve, then you have to make some tough choices.

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Health Affairs - 2 articles on the cost of private insurers to the system

Two articles from Health Affairs regarding the cost of Private Health Insurers, for profit and not for profit, to physicians' practices, bottom lines, time and aggravation.

Peering Into The Black Box: Billing And Insurance Activities In A Medical Group -- Sakowski et al. 28 (4): w544 -- Health Affairs:

"Billing and insurance–related functions have been reported to consume 14 percent of medical group revenue, but little is known about the costs associated with performing specific activities. We conducted semistructured interviews, observed work flows, analyzed department budgets, and surveyed clinicians to evaluate these activities at a large multispecialty medical group. We identified 0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician. In addition, clinicians spent more than thirty-five minutes per day performing these tasks. The cost to medical groups, including clinicians’ time, was at least $85,276 per FTE physician (10 percent of revenue)."


What Does It Cost Physician Practices To Interact With Health Insurance Plans? -- Casalino et al. 28 (4): w533 -- Health Affairs: "Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. However, little information exists about the extent of these interactions. We conducted a national survey on this subject of physicians and practice administrators. Physicians reported spending three hours weekly interacting with plans; nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that the national time cost to practices of interactions with plans is at least $23 billion to $31 billion each year."

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Medicare's 'No' on Virtual Colonoscopy Stirs Expert Debate - Forbes.com

Medicare's 'No' on Virtual Colonoscopy Stirs Expert Debate - Forbes.com

Just a marker for when the topic comes up. basically Medicare, for the first time, has indicated that the evidence for virtual colonoscopy is not yet adequate to warrant reimbursement at this time. This will be reconsidered if new evidence accumulates.

It's worth saying that this is how medicine should work, but it has become a favorite piece of evidence for Sen. Tom Coburn that the world of American Medical Paradise is coming to a totalitarian halt.

Researchers do studies to evaluate treatments, medications, etc., and when a significant amount of evidence accumulates, the treatment enters general use.

Sad part is, this works exceptionally well when procedures are involved because of the fee basis for physician reimbursement and the lopsided reimbursement that hospitals and surgery centers receive for procedures.

It doesn't work so well getting new methods of medically managing patients out into standard practice. This is what Comparative Effectiveness Research should help. Finding out wht works and what doesn't and developing new standards and ways for physicians to implement them to the bedside or office.

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