Sunday, May 31, 2009

DEMOCRATS SPEARHEADING HEALTH BILL ARE SPLIT

I wrote this letter to the editor because I'm frustrated by how our legislators favor those who fill their financial coffers. It's clearly evident to me that this Country needs a single-payer health care system. There are 45 to 47 million people in the U.S. who have no health insurance. If everyone was covered we would have a healthier nation. Even though we may have the most advanced medical system in the world, we are ranked 37th in the world for health outcomes. Nay-sayers complain that a single-payer system would "break the bank." It would not! What would break the bank is providing for-profit healthcare insurance for everybody in the Country. The tax credits and funds to provide this service would be overwhelming. The nay-sayers call single-payer socialized medicine. It is not! The same private health care system that we have now would continue to provide the care. In a socialized system, all of the hospitals and all of the caregivers would be on a fixed salary paid by the government. The Veterans Administration's medical care system is socialized medicine, yet it serves our veterans well.

LETTER TO THE EDITOR
N. Y. Times May 30 article: “2 Democrats Spearheading Health Bill Are Split,” compares Senator Kennedy’s preference for a national health plan that looks like Medicare to Senator Baucus’ choice of a bipartisan bill that would include the private, for-profit, health insurance companies.
Senior Republican, Charles Grassley of Iowa, opposes a new government program and declares “we cannot afford the public health plan we have already.” (Medicare)
As a senior, and a physician with 47 years of family practice experience, I’m well aware of why Medicare spends so much. The seniors are the sickest and require the most medical care as a group. Patients too young to qualify for Medicare coverage, use doctors, hospitals and other medical services in far less volume and frequency than the seniors do.
It doesn’t take a mathematician to figure out that a single-payer health care system would cost less or, at worst, no more than a system that included the private, for-profit insurance companies.
Over half of our people and healthcare providers are in favor of single–payer, but the pharmaceutical industry and the for-profit insurance companies have bought our legislators with campaign money and other financial benefits.
No wonder the single-payer plan is “off the table.”

Melvin H Kirschner MPH MD

Friday, May 29, 2009

WHAT IS THE FUTURE OF MEDICAL INSURANCE IN THE U.S.?

Dr. Gawande is a surgeon with an impressive educational background. He also is a prolific author. His long article in the New Yorker goes into great detail, but is well worth reading. I may have misinterpreted his conclusions, but the article is worth reading.

MEDICINE'S COST CONUNDRUM

Dr, Gawande’s June 1 article in the New Yorker, “The Cost Conundrum” views the reasons the cost of medical care in the U. S. varies so much even though the outcomes are relatively similar. As a family physician I agree with most of what he says. I sense that a system based on the socialized medicine model is what he prefers.
Socialized medicine would be administered and paid for by the government. There would be a fixed set of rules and standards for providers. The doctors would be on fixed salaries and essentially working for the government. The government would pay for other services as Medicare does now.
Many countries already have such a system, but I don’t believe that the people of the U. S. are ready for socialized medicine. All for-profit health care insurance companies are opposed to it, as are many providers. However, I believe that our people are ready to accept single-payer. A government funded single-payer system would have one set of rules to follow and one schedule of payments, but providers would not be government employees and not be on a fixed salary.
A single-payer system would be a health insurance program that would cover health care for every resident of our country. The for-profit insurance companies now leave 45 to 47 million people without health care coverage. In order to survive, the private for-profit insurance industry would have to provide coverage that the national single-payer did not include. There is no question that their covered population and income would drop precipitously

Many who do not want a single-payer, label it “socialized medicine.” As I described it above, socialized medicine is more than single-payer, it’s single provider.
I don’t believe that our country is ready for that.

Melvin H Kirschner, MPH, MD
I COULDN'T RESIST WRITING THIS LETTER
It's seldom that I see two stories about health insurance rescisions in the same paper, let alone the same section. I was at a meeting about single payer last night. Everyone in the room indicated that they favored a single payer health care system--not only in California, but in the entire nation. Our people are tired of the games that the private, for-profit health care insurance companies play. The fire department, the police department, the Veterans Administration are all single-payer agencies. Would you have them all privatized, for profit and available only to people who can afford to buy their services? I doubt it. Unlike these agencies, the single payer health care system would continue to pay for the doctor, dentist, hospital or other private, for profit services that the patient uses now. The government would be the funding agency as health insurance is now. The difference is that there would be one set of rules and one payer instead of the hundreds of plans we have now. If anybody wants coverage that the single payer doesn't offer, thay could purchase additional coverage from one of the private insuranse companies.

TWO STORIES ABOUT HEALTH CARE RECISSIONS

The May 29 Business Section of the L. A. Times printed two stories regarding rescissions of payments by health care insurers.

One article reported that Blue Shield successfully rescinded coverage and payments for services billed, because the patient “failed to disclose preexisting conditions, including hypertension.”
The other article, in the same Times Business Section, reported that Health Net “agreed to pay California hospitals at least $1.95 million for care delivered to patients whom the insurer later dropped.”
These two stories are good examples of why we should have single payer medical care coverage in California. A single payer insurance program would insure every California resident regardless of prior existing medical history. S, B. 840 was such a bill, but was vetoed by Governor Schwarzenegger twice. It had one set of rules. All California residents would be covered. All doctors, dentists, hospitals, laboratories and other medical care providers would be paid for their services as long as they followed those rules.
That bill is back as S.B. 810 (Leno), with the prospects that the next governor will pass it. The insurance companies are fighting it vigorously. They realize that single payer will be less expensive than their insurance and hugely cut their patient base and their outrageous profits.
If it passes, California will be the first in the nation. It could lead to passage of a national single payer health care program such as S, B, 676 (Conyers).
Melvin H Kirschner, MPH, MD

Wednesday, May 27, 2009

DYSFUNTIONAL HEATHCARE SYSTEM

Candian vs. U.S. Health Care

The L. A. Times May 27 Business section: “Canada’s healthcare saved her. Ours won’t touch her.” relates a poignant example of how dysfunctional the U. S. healthcare system is.
The article discusses the plight of a Canadian woman who was in a car accident in Nova Scotia. She suffered a brain injury and thirteen broken bones. She spent three months in a Halifax hospital. The Canadian government paid the entire bill.
She recovered from that accident, married an American and now lives in San Diego County. She applied for healthcare insurance, but was rejected by two major health insurance companies. The decision was based on her 2007 hospitalization, even though she has recovered.
The lesson to be learned is that our healthcare insurers put profit ahead of patient needs. This country needs a single-payer health care system, similar to the Canadian system, but the private insurers are lobbying aggressively to prevent that from happening.
Most Americans, including nurses and doctors, want a single-payer healthcare system, but our legislators declare that the issue is “off the table.” They are supposed to be legislating in the best interests of the public, but the for-profit health insurance industry puts lots of money in their coffers, and money talks.

Melvin H Kirschner, MPH, MD
As a family physician in the San Fernando Valley for 47 years I've watched the health care system mutate from a mostly not-for-profit patient service, to a monster that maximizes profits and minimizes patient care. The L.A. Times article validates that statement.
Our people, including a majority of doctors and a large majority of nurses have concluded that we must have a single payer health-care system, with a single set of rules for everyone. This will not be socialized medicine and it will not cost more than the private, for-profit insurance system that we now have. What we have now leaves 47 million people without health insurance coverage and millions more with inadequate coverage.
The government funded system would be a form of Medicare. It would be not-for-profit, paid for by taxes, have one set of rules and use the health providers that we now use. If anyone wants coverage beyond what the Medicare-for-All provides, they would be free to buy additional insurance elsewhere. But the Medicare system would cover all essential needs as it does now for seniors.
I'm convinced that the Medicare-for-All would cost no more than the patchwork of private for-profit insurance companies spend now for only a portion of our population. Medicare-for-All would probably cost less.
Melvin H Kirschner, MPH, MD

DYSFUNCTIONAL U. S. HEALTH INSURANCE SYSTEM

The L. A. Times May 27 Business section: “Canada’s healthcare saved her. Ours won’t touch her.” relates a poignant example of how dysfunctional the U. S. healthcare system is.
The article discusses the plight of a Canadian woman who was in a car accident in Nova Scotia. She suffered a brain injury and thirteen broken bones. She spent three months in a Halifax hospital. The Canadian government paid the entire bill.
She recovered from that accident, married an American and now lives in San Diego County. She applied for healthcare insurance, but was rejected by two major health insurance companies. The decision was based on her 2007 hospitalization, even though she has recovered.
The lesson to be learned is that our healthcare insurers put profit ahead of patient needs. This country needs a single-payer health care system, similar to the Canadian system, but the private insurers are lobbying aggressively to prevent that from happening.
Most Americans, including nurses and doctors, want a single-payer healthcare system, but our legislators declare that the issue is “off the table.” They are supposed to be legislating in the best interests of the public, but the for-profit health insurance industry puts lots of money in their coffers, and money talks.

Melvin H Kirschner, MPH, MD

Dysfunctional U. S. healthcare syste

The L. A. Times May 27 Business section: “Canada’s healthcare saved her. Ours won’t touch her.” relates a poignant example of how dysfunctional the U. S. healthcare insurance system is.
The article discusses the plight of a Canadian woman who was in a car accident in Nova Scotia. She suffered a brain injury and thirteen broken bones. She spent three months in a Halifax hospital. The Canadian government paid the entire bill.
She recovered from that accident, married an American and now lives in San Diego County. She applied for healthcare insurance, but was rejected by two major health insurance companies. The decision was based on her 2007 hospitalization, even though she has recovered.
The lesson to be learned is that our healthcare insurers put profit ahead of patient needs. This country needs a single-payer health care system, similar to the Canadian system, but the private insurers are lobbying aggressively to prevent that from happening.
Most Americans, including nurses and doctors, want a single-payer healthcare system, but our legislators declare that the issue is “off the table.” They are supposed to be legislating in the best interests of the public, but the for-profit health insurance industry puts lots of money in their coffers, and money talks.

Melvin H Kirschner, MPH, MD

Friday, May 22, 2009

Blue Double Cross

I read Paul Krugman's May 22 column in the N. Y. Times and entirely agree with his view of the for-profit health care insurance companies. In the 47 years that I've been a family physician, I've seen these insurance companies evolve from not-for-profit patient orientated providers to the rapacious gang they are today. As a young doctor, I could rely on the insurance providers to see to it that my insured patient's medical necessities were promptly covered within the clearly descibed limits of their policy.
There were many people who had no health care insurance. The government partially reduced the size of the uninsured population by legislating single-payer plans for the indigent and those people age 65 and over, (Medicaid and Medicare.) Those programs exist today and cover almost one third of our population. They limit the amount they pay for services, but the guidelines clearly state what is covered and the remuneration for each service.
The Medicaid and Medicare programs are not "socialized medicine," as the opponants to single-payer lead the public to believe. They do not directly employ care-givers and other providers, or own the hospitals or laboratories. The Veteran's Administration program is an example of a government owned single-payer system. Everyone working for them is on a fixed salary and the hospitals and clinics belong to the government. Yet it's considered one of the best health-care providers in the Country.
The private for-profit health insurance companies are actually more expensive than the government plans, because of their need to make profits. Insurance company profits do not pay for patient care. The patch work nature of the industry also costs the patient-care providers more time and money.
My letter to the Times is a brief response to Krugman' excellent column.
Melvin H Kirschner, MPH, MD, Family physician

To the N. Y. Times:

As a family physician for 47 years, I totally agree with Paul Krugman’s May 22 column “Blue Double Cross. Healthcare insurers are “more bureaucratic than any government agency. They deny choice of doctor, and sometimes refuse to pay for care.”
My experience with the government programs, Medicare and Medicaid, is that the reimbursement for services are low, but there is one uniform set of rules to follow.
Each healthcare insurer has a different set of rules. The reimbursement for services varies widely and the doctor sometimes doesn’t know where to send the patient for laboratory or other tests. Furthermore, the physician often doesn’t know whether the prescriptions they write will be covered.
As Mr. Krugman reports, “Insurance companies are still bad for your health.”

Melvin H Kirschner, MPH, MD

Saturday, May 16, 2009

I wrote this letter because I was incensed by Senator Max Baucus' total disregard of the people's role, their testimony and their best interests. We need term limits, publically funded election campaigns and no lobbying money permitted. That is the only way that the true voice of the public can be heard.
I read the NY Times 5/16 article “HEALTH PLANS WOULD ADD TO CONTROLS ON INSURES” with some disbelief and much disgust.

The reason politicians have not resolved the “explosive question of whether to create a public insurance program, to compete with private insurers,” is because that would cut off a substantial portion of their re-election money.
A public health insurance plan would surely scuttle the private for profit health care insurance industry. Except for supplementary policies, what percent of Medicare eligible seniors buy private insurance as their primary policy?
It’s interesting that no advocates of a single payer system were allowed on the committee. In fact those who tried were arrested, including three physicians.
Ours is not a country “of the people, by the people and for the people.” Our legislators sell themselves to the highest bidder. Until we get legislative term limits and restriction against accepting lobbying money, the pubic will never have true representation.

Melvin H Kirschner, MPH, MD

Thursday, May 14, 2009

Letter to NY Times re health care for all.

I was reading an article in the NY Times this morning, and became offended by the lack of truth in what the Republicans said about the health care for all proposal. According to the paper, Mr. Frank I. Luntz. an expert on the language of politics and an adviser to the Republican party had criticized the Democrat's health care for all plan. Here is the letter I wrote to the Times:

The N.Y. Times 5/14 article “Democrats To Develop Plan to Sell Health Care” should have been titled “Republicans Develop Plan to Scuttle Health Care for All.” The Republican message is that “the Democrats want to put Washington politicians in charge of your health care” and that their plan would “deny people treatments they need and make them wait to get the treatments they are allowed to receive.”
The first statement is simply untrue and the second describes what happens now in our current for profit health care insurance system. The proposed Democratic health care system would cover everyone—health care for all. A patient would be able to choose any plan they want. The big “for profit” health care insurance companies realize that they would lose patients and profits in such a system. They have bought our legislators so that they will oppose the Democrat plan.

I wrote this letter to make the point that under the current for profit health care system, all of the issues around not getting proper and timely care already exist. Mr. Luntz and advised the Republicans to make statements that would imply that these issues don't occur under the current system, and would only happen once the Democrat's plan was enacted. As a biomedical ethicist and a physician, I feel it continues to be my duty to clear the rhetoric from the situation rather than add more to it. To that end, I'm going to an ethics meeting tonight! More as this continues to develop...

Monday, May 11, 2009

Welcome to my Healthcare Blog

Hello. I am Dr. Melvin H. Kirschner, MPH, MD. Welcome to my new web log.

I have been a family physician for 47 years, and prior to that worked in the public health arena as a Public Health Inspector for several California State health departments. This blog will discuss issues related to the health care system in the US.
It is my hope that you will come to value my comments and opinions, and share your views and experiences with me.

It is also with great pride that I announce the launch of my new book, which this blog takes it's title from. "All Medicines are Poison!", due to be published during the Summer of 2009. I will be posting more information about when and where it will be available as it nears distribution.