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Columns

Trump Needs to Drain the “Healthcare” Swamp

March 8, 2017 - 6:00am

In his Feb 28 address to the Joint Session of Congress, President Trump called the Affordable Care Act (ACA, or “Obamacare”) an “imploding disaster.”

His references to soaring premiums, contracting choices, and market collapse are all spot on. And, of course, everybody wants “reforms that expand choice, increase access, lower costs, and at the same time, provide better healthcare.” Trump wants Americans to be able to choose “the plan they want, not the plan forced on them by the government.”

But what must we do “first” and “second”? From a physician’s perspective, “first” is to make the diagnosis. “Second” is to remove the cause of the ailment if possible. And that means to drain the swamp.

Unfortunately, Trump’s “first” is to “ensure that Americans with pre-existing conditions have access to coverage” and “second” to “help Americans purchase their own coverage, through the use of tax credits….”

These “popular” ideas emanate from the swamp, percolating up through lobbyists, think tanks, and congressional “leadership.” Correctly translated, these mean to abolish true insurance—and the only reason for buying it when healthy—and to force healthy or higher-income people to pay more than their fair share. A “refundable tax credit” is a disguised subsidy, courtesy of present and future taxpayers.

And who are the swamp dwellers? They are the ones who siphon off a huge portion of $3 trillion “healthcare” dollars—perhaps 50 percent or more—before it goes to anything recognizable as a medical good or service received by an actual patient. They are part of the vast growth in the number of administrators compared with physicians. They include the “nonprofit” hospitals that charge up to ten times as much for a surgical procedure as the Surgery Center of Oklahoma does. They include brokers who “re-price” medical bills—getting a 30 percent “discount” from a bill that is overpriced by a factor of two or more and pocketing a cut of the “savings.” And they include the code writers, the regulation writers and auditors, the software and hardware vendors, and the data aggregators who are selling your medical record for profit.

Denizens of the swamp are self-identifying, as in a Jan 25 letter to President Trump and Vice President Pence offering to help implement “value-based” care. The more-than-120 signatories include the American Medical Association (whose main cash cow is the CPT procedure codes that doctors must purchase), numerous other medical trade associations (who help doctors learn how to comply with ever-changing rules), insurers, giant hospital systems, pharmaceutical companies, and self-certified “quality” agencies.

The “resources” they plan to save come from care denied to patients, and especially from the 19 percent of medical spending that goes to physicians’ practices. Instead of paying doctors more if they work more (“fee for service”) the system will pay for data collection and protocol compliance, and punish doctors if they order more tests or treatments for patients. And of course, all those involved in determining “value” get paid first.

The healthcare planners’ bane is the 10 percent of medical spending that goes directly from the person getting the service to the person providing it. None of this leaks into the swamp, and the value is determined by patients, who are presumably too ignorant to make complex judgments.

Swamp dwellers generate reams of studies about the resources that go to actual medical care—some of which would be exposed as being of limited value if patients had to pay out of pocket for them voluntarily. But such studies avoid mention of the enormous resources that go to “planning,” “certifying,” “evaluating,” “reviewing,” etc.—which vanish without a trace into the bureaucracy. Of course, these agencies like to conflate “care” with “coverage”: care is a loss, not a profit center. Even if ACA demands a “medical loss ratio” of 85 percent, that means at least 15 percent is diverted from actual care, and 15 percent of $3 trillion is a huge amount of money. If coverage is “comprehensive,” third-party managers have access to much more than they would if insurance covered only unpredictable catastrophes.

Trump needs to see through the subterfuge, and drain the third-party (“insurance”) swamp before it drains the life out of American medicine—into activities that patients would probably find to be of zero value.

 Jane M. Orient, M.D.obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine and a staff physician at the Tucson Veterans Administration Hospital. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is currently president of Doctors for Disaster Preparedness. Since 1988, she has been chairman of the Public Health Committee of the Pima County (Arizona) Medical Society. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, and the second through fourth editions of Sapira's Art and Science of Bedside Diagnosis published by Lippincott, Williams & Wilkins. She authored books for schoolchildren, Professor Klugimkopf’s Old-Fashioned English Grammar and Professor Klugimkopf’s Spelling Method, published by Robinson Books, and coauthored two novels published as Kindle books, Neomorts and Moonshine. More than 100 of her papers have been published in the scientific and popular literature on a variety of subjects including risk assessment, natural and technological hazards and nonhazards, and medical economics and ethics. She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of the Journal of American Physicians and Surgeons.

Comments

Use the judicial branch instead to decide case by case how much a patient should pay and how, post-treatment. Instead of insurance pre-treatment contracts we do not know ahead of time if they're satisfactory.

PRESIDENT TRUMP: CUT AN "EXECUTIVE ORDER" PLACING ALL CONGRESSIONAL REPRESENTATIVE AND SENATORS, (AS WELL AS THEIR FAMILIES, STAFF MEMBERS, AND OTHER "PROTECTED BUREAUCRATS) ON "OBAMACARE"....UNTIL IT IS REPEALED !!!! PROBLEM SOLVED!!!! "COOPERATION WILL ABOUND"!!!!!!!

Finally, someone on the right track! Let's also require that the same people be covered under whatever new system is adopted. While we're at it let's throw in The President, his family and all other members of the executive and judicial branches of government excuding only members of the uniformed military. Now we'll have a good healthcare system or we'll all go down together.

If we have not understood by now, we will never understand that the problem with our healthcare system is the rising costs of all kinds due to obsolescence of our healthcare delivery system. We need to change that by building efficient, productivity-inducing and cost-cutting Super-Clinics. Economic problems can only be solved with sound and prudent economic measures. I am talking about this issue since 1990, when I first published my book: VULTURES - Doctors, Lawyers, Hospitals and the Insurance Companies, What's Wrong and What to do about it. With Super-Clinics, we could provide top quality healthcare to ALL Americans and yet save over 30% -50% of the current healthcare cost.

Face facts; Obama and his democrats stole our once envy of the World super wonderful healthcare the private sector. Only reason no one ever mentioned was because of medicaid and those that would not pay for healthcare services rendered. Obamacare added over 15 million to medicaid and we the working have to pay for these peoples healthcare. He's something no one mentions........Why isn't it discouraged to use the emergency room for none emergency healthcare....The emergency is the most expensive healthcare. Repeal Obamacare and leave the government out of healthcare. Allow government to regulate and negotiate with healthcare insurance companies for more affordable healthcare costs and insurance like employers do. You pay for government data basing your medical records and that cost from the Doctor to the government, expensive.

Your premise is just not factual. I've been buying my own healthcare insurance for over 20 years, the ACA or your Obamacare did not cause this. And that is a dact.

Obama Care isn't the reason for high insurance coast. The problem is, to many people miss-use the Health Care System. People, not all people use the ER Services as a routine visit to a M.D.'s office and this elevates Health Cost unnecessarily high.

Edit: Healthcare "from" the private sector. "Here's" something no one mentions. The emergency "room" is the most expensive healthcare.

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