Category Archives: Politics

The Fourth Estate Is Out of Control…

 

One could argue the last truly independent and highly trusted news people were Walter Cronkite and Edward R. Morrow. People listened and trusted them.

Media changed everything. Ratings are king and trusted sources be- damned unless the ratings are present to support them.

It was never more evident than Rachel Maddow’s breathless revelation of the totally unremarkable tax returns of President Trump. She opened with thirty minutes of rumors and innuendo and culminated her rambling in a “revelation” that revealed absolutely nothing. It was, frankly, embarrassing.

How can we return to the days when we trusted Cronkite, Morrow, and yes, Senators Everett Dirksen and Patrick Moynihan? Can we ever return?

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Filed under Governance of the Government, Politics

Racism, Bigotry or Extreme Political Correctne

 

Perhaps one needs to be older to properly grasp the nuances of what is politically correct and what is racist or bigoted.  Vocabularies change over the years as do their connotations as the younger generations accept/promote different interpretations and meaning.

Like many, the recent few years have offered me several head scratching moments where I was left thinking, “how could they possibly believe that comment was racist or bigoted”.

My hat is off to a young lady at Columbia University who seemed to get a good grip on the situation and did a good job of articulating it.   I only hope she doesn’t get any blowback on her opinion.

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Filed under Diversity, Education, New York City, Politics

The Challenges facing Obama Care Increase!

Many of us breathed a sigh of relief with last week’s Supreme Court decision.  The consensus opinion was the challenges were over and we can now smooth out the edges of the ACA and enjoy the benefits of health care for all.  In a word….Hardly!

The universal plan was needed, but designed by committee in order to get it passed.  And yes, we need Congress to clean up the rough edges, but there are more extraordinary issues that will be apparent soon enough that will call for more dramatic action.  For example:

  • The individual deductibles are at draconian levels.  Often $2500, $5000 or even $10,000 per year.  The good news ..you have health insurance and it will be affordable.   The bad news is in the absence of a serious illness or hospitalization; it won’t be of much use.  We need to get the deductibles down and that will cost money, lots of money;
  • The outrage of employers has not yet been felt. It will be and it will be loud.  An employers requirement to provide coverage will undoubtedly be paid for by deferring employee raises, or new hiring and probably both;
  • The hidden federal cost covering insurance company losses will come home to roost.  This first payment is $7.9 billion that Uncle Sam will reimburse insurance companies for their losses when underwriting the ACA.  There is much more to come;
  • Finally, insurers are already announcing some enormous rate increases that recognize their losses and the fact that government back reimbursements are not forever.

So what needs to happen?  First Congress must act to smooth out the inconsistencies and make structural changes so implementation can work smoother, better, cheaper.  Secondly, government must understand that cost savings or cost containment, whatever they want to call it does not mean simple ratcheting down the providers reimbursement rate.  They are already embarrassingly low and more and more providers are refusing to accept Medicare and the networks for the ACA are tiny and difficult to access.  And finally, allow the free market to react and innovate some workable affordable solutions for high deductibles, affordable plan changes, etc.

 

Our conclusion is there will be more pain before we have a viable and affordable structure for all of America.

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Filed under Healthcare, Politics

Congressional Dysfunction Threatens Seniors Health Care…..Yet Again

Most seniors have never heard of the acronym SGR that in healthcare parlance means Sustainable Growth Rate.

The wisdom of congress passed this particular piece of legislation in 1997.  Its purpose was to control the cost of Medicare through a complex formula that controlled escalating costs.

The problem is simple; it doesn’t work and has really never worked.  Congress however, has never been able to come to grips with it and continues to pass “kick the can down the road” legislation rather than fixing it.  In 2010 alone, the proverbial can was kicked five times.

We now find ourselves staring down the barrel of a gun once again.  If congress doesn’t act by the end of March, Medicare reimbursements to doctors will be cut by 21%.

What does this mean?  Docs won’t be happy, in fact they have about had it with Medicare as evidenced by a growing group of them who will no longer accept Medicare.

A colleague of ours voiced his thoughts recently.  It went something like this….”I began to accept Medicare even though I felt their reimbursement rate was low and didn’t properly compensate me for my time and expenses.  However, they paid promptly and didn’t harass me with a million questions about why I used one treatment versus another” He has since changed his mind.  His comments now complain that reimbursement, which was never fair, has been reduced.  He now receives letters from Medicare questioning his judgment, and he is facing not just another cut, but a long delay in receiving anything.  He has had it and will not longer accept Medicare patients.

If congress fails to act (again) by March 31st, doctor’s treating Medicare patients will face a 21% reduction in their reimbursement rate.  Could you afford a 21% pay cut.

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Filed under Governance of the Government, Healthcare, Politics

Is the ACA (Obamacare) working….yes, a little.

This blog has previously indicated the ACA will not solve the decades old problem of the 30 to 50 million uninsured Americans…and I maintain that position. However, it has made some inroads and offers a glimmer of hope.

Data is still extremely elusive with this White House and we generally get the cherry picked good news pieces rather than the full Monty. These selective data releases would indicate a modest inroad into the uninsured base of perhaps 15%…that’s a start. My question is at what cost? And no, I’m not talking money.

If there is any such person as a typical uninsured, he or she would probably be a low income individual who has a low paying or part time job which doesn’t offer insurance. This class will also include the previously employed, but now displaced workers. This allows them to enroll in an ACA plan and perhaps receive a substantial subsidy from the government to reduce the premium. Stories abound with monthly premiums of $100 or so per month for “full coverage”. The problem is defining “full coverage” or any coverage at all.

A look at a community I’m familiar with has approximately 250 doctors. I can only identify 8-10 primary care docs in this population who accept the predominate ACA plan in our area. The specialist community is even more restrictive, with no availability at all for some specialties and very little for others.

If we couple this extremely small network of physicians accepting the most prevalent plans, and the plans deductibles ranging from $500 to $7500 we have a problem….people with insurance coverage but none or few available doctors to treat them and deductibles that are not affordable, posing another roadblock to health care for them.

We need ACA amended, to make it more responsive to patients, insurance companies to be more responsible when dealing with physicians and more companies offering plans to foster competition. These changes will help reduce the vast number of uninsured Americans, a very noble and worthwhile undertaking, but will also give rise to a new issue…yet another tier of patient care…but that’s for another day.

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Filed under Healthcare, Politics

No Solutions for Uninsured Americans

We have predicted before that the ACA will not solve the problem of the 40 to 60 uninsured American’s.  In fact, it doesn’t even begin to address the problem.

It appears we have 6.0 million to 7.0 million now enrolled in ACA.  Many of these (a number unknown because no one seems to want to tell us) were already covered in a plan that was canceled, or were on Medicaid, etc.  Only a small portion of these insureds were uninsured before their enrollment.

Check out this blog:  http://healthpolicyandmarket.blogspot.com

This blogger is one of the better informed on the subject.

 

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Filed under Healthcare, Politics

Two Enemies of Good Government

Ideologues and Political Rhetoric without Action

Good governing only comes with compromise, and ideologues seem to lack the common sense that they can’t prevail at all times.  Simply stated they are incapable of compromise.  Rhetoric without action can be worse since nothing is there to be discussed, modified and ultimately agreed.  Great pronouncement speeches are soon forgotten without the requisite follow through of action.

We have all witnessed these two shortcomings in our politicians, and unfortunately our well-intended new Mayor of New York seems to embrace both.  His Pre-K stance on tax the rich as the only path to offering universal Pre K even though the state has offered to fund it, is an excellent example of an ideologue that refuses to compromise, even when he is getting most of what he wants. He then goes on to embrace the second failing of rhetoric without action by announcing multiple projects and trashing existing ones without any specific plans to launch or improve them.  Take your pick, a rejuvenated Sandy, a “reset” of mid-town zoning, specifics on Pre-K, etc.

I for one am also tired of hearing the new mayor was elected with a 73% mandate.  Let’s take a quick look at those pesky facts:  There are 4.6 million registered voters in New York City.  Only 1.02 million actually voted which is only 22.2 % of eligible voters.  Of this 22.2 percent he did receive 73% of the vote.  This translates, mathematically and factually into 16.3 % of the vote of New York City voters…hardly a mandate.

However, it was clearly a mandate by the unions of New York City.  If 75% of the 300,000 union members of NYC voted for DeBlasio and their partner/spouse also voted for him, along with one parent or parent-in-law, that group alone would have accounted for almost the entire vote he received.  And, let’s not forget, union members are democrats, they vote regularly, and the new Mayor was promising retroactive pay increases.  They totally supported him and if the truth were known, single handedly, elected him. This calculation would leave 3.0 million registered voters who did not cast a vote (shame on them) and gave the Mayor his often-stated “mandate”.

The mayor must start delivering.  Compromise on the Pre-K, and you’ll be lauded and known as the Mayor who gave everyone Pre-K not the Mayor who compromised away his tax increase.  Release specifics on projects and “resets” that make sense and then follow through.

And, a few more thoughts Mr. Mayor.  Those nasty one-percenters are at their desk in the financial district long before your first meeting is scheduled and they show up on time, each and every day.  They are not 40 to 60 minutes late for their scheduled meeting and certainly not for their first of the day.  You’d be surprised to see how active the “street” is at 6AM or 7AM each morning.  Try getting up one morning and checking it out.  You’ll find the “other city” you often refer to up and working very hard long before you’ve had your first cup of coffee.

And above all, don’t become the Mayor Ed Koch spoke of in his memorable words:  “The people have spoken…and now they must be punished”

Good Luck Mr. Mayor.  Everyone really does want you to succeed, as that would be best for the city we all love.  But, you’ll have to get up early, show up on time and avoid the two enemies of good government.

 

 

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Filed under Governance of the Government, New York City, Politics

Affordable Care Act… the Real Problem

 

We have estimated 40 to 60 million uninsured Americans for the last several decades.  The last available estimate in 2012 was 47.0 million.  It is commonly believed this group has not received routine health care, and has swarmed hospital emergency rooms and overwhelmed the system with acute health care needs.  This is all true… to a very small degree, and most importantly this main objective of the ACA remains unresolved.

 

The numbers coming in for the ACA enrollment clearly reflect a shift of previously insured parties to new insurance plans in the ACA.  This shift does nothing to resolve the uninsured problem; and won’t in the near or far term unless the plan is dramatically altered.

 

The almost accidental positives of ACA include no limit health care, removing pre-existing conditions, offering guaranteed issue to all, and extending coverage for aging dependent children.  The guaranteed issue comes with the cost of the myriad of extremely confusing state and federal plans.  There were far easier ways of accomplishing these offerings, none of which were used because of the administrations unilateral approach to the legislation.

 

The vast majority of participants in the new plans come from previous individual policy insured’s who were forced to change because their policy was canceled; or from Medicaid eligible individuals.  It is now clear the previous multi-millions of uninsured have not flocked to the new plans and probably will not do so.  Yes, the 47 million uninsured will be reduced, but probably only by a small percentage.  We will be left with some 30+ million uninsured and a revised health care financing system that will take years to sort out and modify in order to get it to run smoothly.

 

And, one of the dirty little truths is this large and hardly changed uninsured group will continue to visit ER’s but for an entirely different reason than once believed.

 

If you are sick and need to see a doctor and you don’t have a primary care physician, I would challenge you to A)  Fine one, and more importantly B) Find one that will see you right now to treat your acute medical issue, not in four or six weeks.  Studies are reflecting the fact that sick people seek medical care in the ER because they cannot see a doctor without waiting days or often times weeks…far too long for someone who is sick and hurting.

And, Medicaid is simply not the answer.  In fact, the Annals of Emergency Medicine published a survey that reflects this startling fact…61% of Medicaid patients visited the ER in the previous year.

 

Even those Medicaid patients who have primary care physicians — and that is less likely than for people with private insurance — report significant barriers to seeing their doctor.” senior study author Dr. Adit Ginde, of the University of Colorado School of Medicine, said in a journal news release.

 

“Medicaid patients tend to visit the ER more, partly because they tend to be in poorer health overall,” Ginde added. “But they also visit the ER more because they can’t see their primary care provider in a timely fashion or at all.”

 

“The efforts by some states to keep Medicaid patients out of the ER do not take this lack of access to primary care into account,” Dr. David Seaberg, president of the American College of Emergency Physicians, said in the news release. “It puts both patients and providers into an impossible position that will only get worse as more people enroll in Medicaid.”

 

The real problem with healthcare in the U.S. is a drastic lack of primary care health providers and the ACA does absolutely nothing to help resolve this issue.  Further, it does almost nothing to reduce costs in this fee for service industry.

 

We can offer many suggestions on how the ACA should have been structured, but that won’t be constructive.  But, here are a few suggestions for reforming the ACA and making it more viable:

 

  • Immediately launch new educational programs outside the purview of the AMA for educating and training new primary care physicians.  Federally fund it by expanding the National Health Service Corps program to include urban areas.
  • Pass federal legislation empowering Physician Assistants and Nurse Practitioners to provide the basic functions of the primary care physician unfettered from the overly protective AMA guidelines and various state legislatures.  This will free up many primary care doctors to handle the more complex levels of treatment needed.
  • Federalize Medicaid and simply make it a part of Medicare…which would remove the hurdles to care and the stigma of being poor or unemployed.
  • Fund the Medicare system so healthcare providers at all levels will accept it and earn a well-deserved living for their many years of education and training they have invested;
  • Accomplish what has been threatened by every Congress since LBJ. REALLY get rid of fraud and waste without the accompanying silliness that drives providers crazy, wastes their time and doesn’t reduce costs or improve the system.
  • And yes, pass tort reform to protect both the patient and the system;

 

The problem of reform is extremely difficult if not impossible in the current political environment.  The unilateral approach to passing the initial legislation has led to the most cantankerous atmosphere not seen before in politics.  There is virtually no hope of cleaning up the ACA at the moment.  Perhaps our “best shot” is a one party takeover of the congress and their best effort to “save” health care by making some the much needed and obvious changes.   I honestly believe if either party had complete power, they would make the necessary changes, but the current split will simply not allow it.

 

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Musings of a Politically Independent Healthcare Provider

Welcome to my Blog.

I created this blog to offer my opinion on a variety of subjects.  My areas of interest include politics, healthcare, New York City, fairness, diversity and a desire to help the needy and protect our children.  I do have opinions. I will express them, some will agree and others will not.  My purpose is two-fold:  express myself and instigate a dialogue.  I hope you enjoy my comments even though you may not agree.

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Filed under Children, Diversity, General, Healthcare, New York City, Politics