Today was a busy day. I wrote three letters about health care, to the editors today. In the days before the health plan option debate, I probably wrote one letter to the editor a week. The issue is evident. If a government health care option passes, not only would all of the uninsured people (46 million of them) join it, a lot of the privately insured people would choose to switch to it. The private insurers would only attract people who want more extensive coverage than the public choice provides. The insurers would probably continue their "prior condition denial practices," so those patients would have no choice but to join the public health care option. It hasn't a retroactive denial rule.
New York Times June 5th OP-Ed “Keeping Them Honest” gives us two pieces of advice:
1) Don’t trust the insurance industry.
2) Don’t trust the insurance industry.
The issue is, will there be new regulation that allows any American to choose a public plan as an alternative to private insurance. President Obama believes that this would give Americans “a better range of choices, make the health care market more competitive, and keep the insurance companies honest.”
The health insurance companies are promising to deliver major cost savings so that patients will not choose the pubic option. Fifteen years ago they made the same promise, but it never happened. They will do everything in their power to prevent public choice health legislation.
They could bribe the legislators with “campaign money.” That usually works!
Melvin H Kirschner, MPH, MD
Friday, June 5, 2009
PHARMACY STORE CLINICS
I wrote this letter to the editor not because I consider nurse practitioners in financial competition with me, but because I am concerned about patient safety. I have a high regard for nurse practitioners, but they have limits. Doctors have limits; that's why there are so many specialists. It's not about money, I refer patients to specialists frequently. I tell the patients that specialists know everything about nothing and generalists know nothing about everything. I'm concerned that nurses may know a little about something and maybe a little about many things; but does she know when to do nothing or what to refer to a doctor. And what backup does she have if the patient has a reaction? Maybe she sends them to the nearest emergency room. It rarely happens, and that's what I would do.
The June 5th L. A. Times Business Section story, “Walgreen, CVS add to clinic services,” worries me as a physician. There are some excellent, well-trained nurse practitioners, who are capable of diagnosing and treating specific problems, but are they capable of handling an unexpected side reaction? Are they equipped to do necessary diagnostic tests when the etiology of the illness is unclear. The article admits that there is usually not a doctor on the premises when the nurse holds clinic.
I agree with Dr. James Milam who the article quotes. He says, “When my nurse gives an injection, I am here.” The patient needs a regular doctor who has their history, family history and allergy history.
A Wal-Mart spokeswoman commented that the company is “always looking for ways to better serve our customers.” Does she mean better services, or more profits.
Melvin H Kirschner, MPH, MD
The June 5th L. A. Times Business Section story, “Walgreen, CVS add to clinic services,” worries me as a physician. There are some excellent, well-trained nurse practitioners, who are capable of diagnosing and treating specific problems, but are they capable of handling an unexpected side reaction? Are they equipped to do necessary diagnostic tests when the etiology of the illness is unclear. The article admits that there is usually not a doctor on the premises when the nurse holds clinic.
I agree with Dr. James Milam who the article quotes. He says, “When my nurse gives an injection, I am here.” The patient needs a regular doctor who has their history, family history and allergy history.
A Wal-Mart spokeswoman commented that the company is “always looking for ways to better serve our customers.” Does she mean better services, or more profits.
Melvin H Kirschner, MPH, MD
REPUBLICANS COMPLAIN ABOUT PLAN FOR INSURANCE
I wrote this letter in response to the noise our legislators are making about the proposed universal health care plan. They have already announced that single-payer is "off the table." It's likely that eventually a public health insurance option operating along side of the private plans will be adopted. It's not what we really need, but it's a step forward. If such a plan is passed, I believe that private health insurance will gradually experience a loss of most of its' business to the governmental plan. This would eventually create the single payer system that we'd like to have now, but it will take time and work. Just keep the faith.
The New York Times 6/5 National section article “Republicans Complain About Plan For Insurance” described their disagreement with the size, shape and cost of the emerging health care proposal.
Creation of a new government health insurance plan remains the most contentious issue in the debate. Opponents of a public plan are concerned that it would be unfair competition with the private plans and would make health care insurance much more expensive.
The truth is that 46 million people have no insurance, many because they can’t afford it. A universal health care insurance plan would cover everyone. President Obama favors “a public health insurance option operating alongside private plans.” The nay-sayers realized that private insurance providers could not compete with a public plan and still be profitable. Soon we would have a single payer health care system with everyone covered by government insurance.
The most expensive patients to care for are age 65 and over, They are already covered by Medicare. The public option would cover everyone else for no more than private insurance covers only a part of that population now.
Over 50% off our population want universal, single payer health insurance. They probably will not get it. After all, they are not putting huge amounts of money in their legislator’s reelection coffers.
Melvin H Kirschner, MPH, MD
I wrote this letter in response to the noise our legislators are making about the proposed universal health care plan. They have already announced that single-payer is "off the table." It's likely that eventually a public health insurance option operating along side of the private plans will be adopted. It's not what we really need, but it's a step forward. If such a plan is passed, I believe that private health insurance will gradually experience a loss of most of its' business to the governmental plan. This would eventually create the single payer system that we'd like to have now, but it will take time and work. Just keep the faith.
The New York Times 6/5 National section article “Republicans Complain About Plan For Insurance” described their disagreement with the size, shape and cost of the emerging health care proposal.
Creation of a new government health insurance plan remains the most contentious issue in the debate. Opponents of a public plan are concerned that it would be unfair competition with the private plans and would make health care insurance much more expensive.
The truth is that 46 million people have no insurance, many because they can’t afford it. A universal health care insurance plan would cover everyone. President Obama favors “a public health insurance option operating alongside private plans.” The nay-sayers realized that private insurance providers could not compete with a public plan and still be profitable. Soon we would have a single payer health care system with everyone covered by government insurance.
The most expensive patients to care for are age 65 and over, They are already covered by Medicare. The public option would cover everyone else for no more than private insurance covers only a part of that population now.
Over 50% off our population want universal, single payer health insurance. They probably will not get it. After all, they are not putting huge amounts of money in their legislator’s reelection coffers.
Melvin H Kirschner, MPH, MD
Thursday, June 4, 2009
LETTER TO THE EDITOR IN RESPONSE TO THE TIMES ARTICLE
This letter illustrates why private, for-profit health care insurance should not be part of a universal health care system. A universal Medicare system provides care for everyone equally, under one set of rules. If a patient wants more coverage than the Medicare system provides, they may choose to purchase a supplementary plan from a private insurer. The backers of a combined system realize that private insurers cannot compete with a "Medicare for all" system and still advertise and make profits. Even though more than 50% of Americans want universal single payer, the private insurers will make every effort to scuttle it. Their only option is to buy off the legislators, and so far they seem to be successful at doing just that.
MEDICAL BILLS
The L.A. Times May 4th Business Section Article “Medical bills tied to more bankruptcies,” cited a study showing that “healthcare costs play a role in 62% of bankruptcies.”
To solve this problem, Senators Kennedy (D. Mass) and Baucus (D. Montana) are leading efforts to develop universal heath care legislation. Mr. Kennedy advocates a single payer, government funded system. Baucus advocates a combined health care program where the private, for profit insurance companies also have a role.
The study cited, showed that “private insurers have failed to protect consumers from financial ruin in the event of a medical crisis.”
There is no doubt that we need universal health care coverage; but the private insurers have already demonstrated that they don’t protect people from financial ruin due to medically related expenses.
We need universal, single-payer health care, such as Medicare. Everyone will have coverage and nobody will suffer bankruptcy due to medical bills. It will not cost more than is spent per patient now, because the most expensive group of patients are seniors over age 65, and they’re already covered by Medicare.
Melvin H Kirschner, MPH, MD
This letter illustrates why private, for-profit health care insurance should not be part of a universal health care system. A universal Medicare system provides care for everyone equally, under one set of rules. If a patient wants more coverage than the Medicare system provides, they may choose to purchase a supplementary plan from a private insurer. The backers of a combined system realize that private insurers cannot compete with a "Medicare for all" system and still advertise and make profits. Even though more than 50% of Americans want universal single payer, the private insurers will make every effort to scuttle it. Their only option is to buy off the legislators, and so far they seem to be successful at doing just that.
MEDICAL BILLS
The L.A. Times May 4th Business Section Article “Medical bills tied to more bankruptcies,” cited a study showing that “healthcare costs play a role in 62% of bankruptcies.”
To solve this problem, Senators Kennedy (D. Mass) and Baucus (D. Montana) are leading efforts to develop universal heath care legislation. Mr. Kennedy advocates a single payer, government funded system. Baucus advocates a combined health care program where the private, for profit insurance companies also have a role.
The study cited, showed that “private insurers have failed to protect consumers from financial ruin in the event of a medical crisis.”
There is no doubt that we need universal health care coverage; but the private insurers have already demonstrated that they don’t protect people from financial ruin due to medically related expenses.
We need universal, single-payer health care, such as Medicare. Everyone will have coverage and nobody will suffer bankruptcy due to medical bills. It will not cost more than is spent per patient now, because the most expensive group of patients are seniors over age 65, and they’re already covered by Medicare.
Melvin H Kirschner, MPH, MD
Wednesday, June 3, 2009
Gaps in Health Insurance
The excellent June 3th editorial in the Daily News had a couple of "gaps in details." I detailed the points they made and added a couple of of my own. We all have a tendency to call the health care we need "universal care." That's true but misleading. The for-profit insurance/Medicare plan is universal; but it's not single-payer, which is actually what we need. The patients over age 65 now covered by Medicare are our sickest population and the most likely to use health care services. The rest of our population as a whole require much less care. Medicare-for-all will do two things that will reduce costs; yet cover everyone. An illness prevention program will be available to all; the under age 65 people will cost less than the sicker seniors. Seniors are at much greater risk of hospitalization, end-stage illness and death. Do the math!
Next time you mention universal health care for all, be sure that you use the expression "single payer."
Americans pay for gaps in insurance
The excellent June 3rd Daily News editorial, “Americans pay for gaps in insurance,” almost says it all. However, as a family physician I’m compelled to submit a short resume with a couple of personal observations.
I agree that insured Americans subsidize care for the uninsured. I’m well aware that “emergency room care remains one of the most expensive and least efficient ways to treat routine illness.” Everyone who walks into an emergency room must be evaluated and receive care, unless they can be safely sent home or transferred to a public facility.
A report by Families USA advocates universal health care. Congress has been considering “making sure Americans have a choice of doctors and health plans through a mix of affordable private and public offerings.”
That process will result in universal health care, but not what we really need. Medicare is a single-payer plan. Every Medicare senior is covered for life. There is one set of rules. No “pre-existing” condition can disqualify them for coverage. The for-profit health insurance companies each have different rules about what they will or will not cover, or which doctor or hospital the patient may go to. This nightmare increases confusion and expenses for doctors and the cost of taking care of patients.
We need a “universal, single-payer” system—Medicare for everyone. Everyone will have coverage at a cost less than the “For-profit/Medicare choice plan. And without the 46 million people now not covered at all, we will be a healthier country.
Melvin H Kirschner, MPH, MD
Next time you mention universal health care for all, be sure that you use the expression "single payer."
Americans pay for gaps in insurance
The excellent June 3rd Daily News editorial, “Americans pay for gaps in insurance,” almost says it all. However, as a family physician I’m compelled to submit a short resume with a couple of personal observations.
I agree that insured Americans subsidize care for the uninsured. I’m well aware that “emergency room care remains one of the most expensive and least efficient ways to treat routine illness.” Everyone who walks into an emergency room must be evaluated and receive care, unless they can be safely sent home or transferred to a public facility.
A report by Families USA advocates universal health care. Congress has been considering “making sure Americans have a choice of doctors and health plans through a mix of affordable private and public offerings.”
That process will result in universal health care, but not what we really need. Medicare is a single-payer plan. Every Medicare senior is covered for life. There is one set of rules. No “pre-existing” condition can disqualify them for coverage. The for-profit health insurance companies each have different rules about what they will or will not cover, or which doctor or hospital the patient may go to. This nightmare increases confusion and expenses for doctors and the cost of taking care of patients.
We need a “universal, single-payer” system—Medicare for everyone. Everyone will have coverage at a cost less than the “For-profit/Medicare choice plan. And without the 46 million people now not covered at all, we will be a healthier country.
Melvin H Kirschner, MPH, MD
Tobacco
TOBACCO LEGISLATION
I've seen many of my patients suffer and die because they couldn't stop using tobacco. In my soon to be published book, "All Medicines Are Poison," I tell some of these stories. I was glad to hear the tobacco regulation was going to be under FDA control. But when I read that the tobacco industry had a hand in crafting this law, I realized that the FDA would be unable to do much of value to control the use of tobacco and its dangers. Americans will continue to suffer and die until effective legislation is passed, free of the tobacco industry's influence.
LA Times June 3th article “Blowing smoke with legislation” sure corrected my opinion that putting tobacco under FDA supervision is a good thing.
The article indicates that the Philip Morris Company helped in the crafting of the legislation. The author is a Boston University professor who specializes in tobacco policy analysis. If what he reports is true, and I believe it is, this legislation has actually given no genuine ways to make tobacco smoking safer.
I practiced as a family doctor for 47 years and can validate the many deaths and much illness that can be attributed to tobacco. It’s very addictive and most of my patients could not stop using it even though they were well aware of the damage it was causing to their lungs and other organs.
We need legislation that does not include the tobacco industry’s input. There are plenty of doctors and other experts who can attest to the extreme danger of using this substance.
Melvin H Kirschner, MPH, MD
I've seen many of my patients suffer and die because they couldn't stop using tobacco. In my soon to be published book, "All Medicines Are Poison," I tell some of these stories. I was glad to hear the tobacco regulation was going to be under FDA control. But when I read that the tobacco industry had a hand in crafting this law, I realized that the FDA would be unable to do much of value to control the use of tobacco and its dangers. Americans will continue to suffer and die until effective legislation is passed, free of the tobacco industry's influence.
LA Times June 3th article “Blowing smoke with legislation” sure corrected my opinion that putting tobacco under FDA supervision is a good thing.
The article indicates that the Philip Morris Company helped in the crafting of the legislation. The author is a Boston University professor who specializes in tobacco policy analysis. If what he reports is true, and I believe it is, this legislation has actually given no genuine ways to make tobacco smoking safer.
I practiced as a family doctor for 47 years and can validate the many deaths and much illness that can be attributed to tobacco. It’s very addictive and most of my patients could not stop using it even though they were well aware of the damage it was causing to their lungs and other organs.
We need legislation that does not include the tobacco industry’s input. There are plenty of doctors and other experts who can attest to the extreme danger of using this substance.
Melvin H Kirschner, MPH, MD
“Obama Urges Quick Action By Senators On Insurance.”
I wrote this response to the NY Times report because there are many ways that the for-profit insurers to try to scuttle a public plan for all. Their biggest argument is cost. Medicare already covers the sickest, most frequent users of the medical care system, the seniors. Not only will the people under 65 cost less to cover, they will all have coverage and preventive medical care. One set of rules will reduce the time and effort doctors' offices spend for billing, They will be well aware of what the single payer will or will not cover. The private insurance coverage is a hodgepodge of different rules and coverages. We are the only industrialized country in the world that doesn't have single payer health care and we are listed 37th in the health outcomes of our population.
N Y Times June 3 reports that “Obama Urges Quick Action By Senators On Insurance.”
In recent weeks I’ve been discouraged by the trend that universal health care proposals have taken. My sense was that the for-profit health care insurance companies were going to succeed with their plan to scuttle any government healthcare plan similar to Medicare that would cover patients under 65.
The private health insurance companies realize that not only the 46 million uninsured would be covered, but many people now covered by private health insurance would also switch to the public plan.
They paint a Medicare plan for under 65 year olds as a slow and inadequate provider that will be shunned by most doctors and make it easy for unscrupulous people to over utilize the system. As a physician who has been in practice since Medicare started, I realize that the scammers, with and without insurance, have always been there and will continue to be there whatever plan we finally adopt. Sadly, there are also a few doctors who scam the system, but most doctors try to provide services that are best for their patients.
The for-profit health insurance companies promise to change their ways, such as retroactive denials, rejection for a history of prior illnesses, etc. Those patients will be dumped into the public system.
What we need is a single payer, with one set of rules and coverage for all of us. Anyone who wants more coverage can buy it from the private providers.
Melvin H Kirschner, MPH, MD
I wrote this response to the NY Times report because there are many ways that the for-profit insurers to try to scuttle a public plan for all. Their biggest argument is cost. Medicare already covers the sickest, most frequent users of the medical care system, the seniors. Not only will the people under 65 cost less to cover, they will all have coverage and preventive medical care. One set of rules will reduce the time and effort doctors' offices spend for billing, They will be well aware of what the single payer will or will not cover. The private insurance coverage is a hodgepodge of different rules and coverages. We are the only industrialized country in the world that doesn't have single payer health care and we are listed 37th in the health outcomes of our population.
N Y Times June 3 reports that “Obama Urges Quick Action By Senators On Insurance.”
In recent weeks I’ve been discouraged by the trend that universal health care proposals have taken. My sense was that the for-profit health care insurance companies were going to succeed with their plan to scuttle any government healthcare plan similar to Medicare that would cover patients under 65.
The private health insurance companies realize that not only the 46 million uninsured would be covered, but many people now covered by private health insurance would also switch to the public plan.
They paint a Medicare plan for under 65 year olds as a slow and inadequate provider that will be shunned by most doctors and make it easy for unscrupulous people to over utilize the system. As a physician who has been in practice since Medicare started, I realize that the scammers, with and without insurance, have always been there and will continue to be there whatever plan we finally adopt. Sadly, there are also a few doctors who scam the system, but most doctors try to provide services that are best for their patients.
The for-profit health insurance companies promise to change their ways, such as retroactive denials, rejection for a history of prior illnesses, etc. Those patients will be dumped into the public system.
What we need is a single payer, with one set of rules and coverage for all of us. Anyone who wants more coverage can buy it from the private providers.
Melvin H Kirschner, MPH, MD
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