No one denies that the state of healthcare in America
is atrocious. Most talk about change, but few really know what the problems truly are, and if they did know they would be disinclined
to change them. Change, if properly done, would strip many segments of the healthcare industry of massive and undeserved profit
margins. It is my feeling that if a just and equitable system for healthcare delivery is ever to be enacted, it will require
a grass roots push and a pledge from the average man or woman to vote out of office any elected official who votes against this reform.
I have been a physician for 22 years and I love my job. I work with patients I truly care for and for whom I want the best. I have a better than average income, although I work far more hours a week than my friends in other industries. I also have community
recognition, a sense of purpose, a sense of job satisfaction and of job security, This is tempered, however, by
the long hours mentioned above, by the declining role physicians play in health care delivery, by a sense of helplessness in
dealing with the insurance and legal industries, by a profound sense of the unfairness of health care delivery and of the waste in
the system, and by the increasing despair caused by the mounds of paperwork with which I am increasingly having to deal. I want
to keep practicing general internal medicine, though it is becoming progressively more difficult to justify to myself or my family.
There is much discussion of the problems with healthcare and multiple plans outlined to confront the
system and to mold it into one vision or another. In general, though, no one will attack it head on and do what needs to be
done. Healthcare is expensive, though I believe there is currently enough money being spent to adequately fund the system. A large part of this money is sequestered from patient care by being tied up in waste, inefficiencies, legal fees, defensive medicine,
excessive drug and medical equipment costs, and especially in insurance industry and medical plan profit margins. The following are
a few of the details that need to be addressed.
Each day I deal with scores of insurance companies,
and with many times that in individual insurance plans. Each has its own rules, regulations and paperwork exchange that are
independent of actual patient care. Each company is required to verify the credentials of each provider, carry out chart reviews
and office surveys, operate patient wellness programs, operate pre-approval systems for procedures and medications, as well many other
programs and are all dollar intensive. Simply marketing all of these plans must cost a staggering sum of money. Considering
all of the separate insurance companies, each spending money as above, one can appreciate the built in and expensive redundancies
that are contributing to the costly system that is health care. An easy way to eliminate a huge cost is to eliminate the multitude
of insurers and substitute a single payer system.
Private insurance companies offer us nothing. The only management they can effect is to simply deny procedures, drugs, treatments and/or services. They are beginning to try
to modify patient behavior, though it is very late in the game. Private insurance is obtainable for the low risk and relatively
healthy person. This is a profitable patient type for an insurance company to underwrite. Care for the chronically ill,
infirm, deficient, malformed, or cancer ridden patient is left up to a patchwork of governmental and taxpayer based entities. All efforts to “reform” health care delivery simply by trying to buy private insurance for the “uninsurable” is simply guaranteeing
a profit margin to insuring companies that contribute nothing to the real health of Americans.
No one
begrudges a reasonable profit margin to any business. Unfortunately, greed seems to know no bounds. This greed ranges
from practitioners who fraudulently bill for services, mobility stores who charge $5200 for a scooter that can be bought on the internet
for $2700, to pharmaceutical companies who minimally alter a drug at the end of its patent life only to charge full price
as a “new medication”. It includes the massive salaries of upper management of most any insurance giant, the unquestioned legal
fees charged by the ever-present healthcare lawyers, to home equipment suppliers who continue to bill for home oxygen well after the
patient no longer has a need. The list is nearly endless. It is impossible to track this waste across so many thousands
of insurance companies and plans, so many drugs and medical equipment suppliers, so many practitioners, and so many hospitals and
other institutions. The best answer may be to manage and pay them all through one system.
There are a lot of people who are against a single payer system, however they generally have a vested interest in the current system
staying as it is. They use terms like socialized medicine and point to the inadequacies of socialized systems in other countries. Socialized medicine would not work in America for many reasons. The United States is fortunate, however, in that we already have an
insurance system in place that functions well and grants universal health care coverage to its clients. What is Medicare except
guaranteed health care for those 65 years and older and by a single payer? No one tells me how to treat my traditional Medicare
patients. No one is constantly looking over my shoulder telling what to do. In fact, traditional Medicare insurance requirements
are the least intrusive to my practice. Medicare is not considered a socialized system by the patients participating in it,
nor by physicians in general. There is nothing magic about 65 years of age as a starting point. Since the system functions
well already, it would be simple to expand it in increments until all persons are covered. As new ages are incorporated the money
they are now paying for their current insurance would be paid into Medicare itself, but at reduced rates. Since there is currently
a massive amount of money being paid into the insurance industry and since waste, redundant functions, and huge profit margins could
be eliminated, Medicare could again be solvent and self-sustaining. Further details are available (on a following page). As stated
above, the majority of people voicing an opposing opinion have a strong interest in the current system. As examples, consider
insurance and medical plan executives, investors in those companies and plans, practitioners who make large salaries from the system
as it is, stock brokers, investment lawyers, bankers, retirement plan advisors, and many other people, many who are simply fearful
of change. Many politicians will voice strong opposition to this type of change. I am sure that some are well meaning,
though under informed. Others are financially hooked to the current system and would loose money with change. Still others
owe favors to important people and campaign contributors whom they cannot afford to disappoint. I would encourage all people
interested in health care reform to analyze opposing opinions to see if they are rooted in self interest.
If we had a one payer
of health care benefits, we could standardize coverage and extend it to all Americans, regardless of age, sex, race, disease, or disability. We could analyze the unified system for medical errors and waste, and we could eliminate the patchwork of coverage, and non-coverage,
that exists now. Do we not deserve this as Americans?
One possible scenario is for Medicare to
have an age sensitive baseline benefit plan and an optional Medicare sponsored supplement. Past that, private insurance companies
could offer other supplement plans as they see fit. Furthermore, drug formularies for medications used to treat most major illnesses
could cease to exist. Medicare would simply pay a set amount for a given class of drugs. That price would be paid no matter
what drug of that class was written. If the patient or physician desired a different drug of that class, the patient would simply
pay the difference. The patient would steer the physician to the lowest cost drug unless they both were convinced that the different
drug choice was justified. Common drug cost would decrease as the drug companies make an effort to capture part of the market. Certain classes of drugs could not be accommodated in this way for many reasons. An example would be cancer therapeutic medications.
All concerned want high quality healthcare, and a one party payer system would finally allow this to happen. Medical errors
waste and inefficiencies are hard to track across the multitude of payers. One system would allow aggregate tracking across
all providers, equipment suppliers, patient age groups, illness and treatments. The current system cannot hope to capture all
of this data. The discovery of patterns or systems of errors could steer us to a safer delivery of health care and improve the
educational process giving better trained providers right out of training. Hopefully we could finally eliminate the need for the rampant,
wasteful, unfair, and punitive insult that is now the malpractice litigation industry. It certainly is an industry and they certainly
will oppose these changes to the current system.
There needs to be a big change in healthcare and I
believe that all Americans need to be covered from cradle to grave. I challenge anyone to justify to me how the current patchwork
of insurance plans and government programs with all of it gaps of coverage and paperwork can ever hope to be efficient enough to work
for America.
Please E-Mail me with your thoughts, for or against!
Mark E Green, MD
463 POB BMH
Maryville, TN 37804
865-980-5360
MarkGreen@OurHealthReform.com
Health
Care Reform
What
can we do to help launch Health Care Reform?
As noted above, we cannot expect our elected
officials or the health care industry in general to effect meaningful reform. This must be a true grass roots effort to make it happen.
We do have the power of the vote. Do not underestimate its value.
Only wide spread “common citizen”
support will drive this effort. If there is enough interest from others we can spread this concept to hundreds of thousands of voters,
if not millions. As interest builds, this and other web sites can be built into effective communication tools. There should be no
money made from these sites. I am sure there are thousands of people out there, perhaps retired and experienced in efforts such
as this, who could really contribute to raising American health care delivery to the highest level. Certainly we can overcome our
37th in the world status.
Over the last 22 years I have put a lot of thought into the problems we have
and also in how we might fix them. Not just by throwing dollar after dollar into a dysfunctional institution. There are ways we need
to retrain our primary care physicians, to educate the public in general about their responsibility for themselves, to redirect our
specialists, to reform some payments schedules, to streamline our medical information system, and to extricate ourselves from our
legal quagmire, to name a few. Paramount is the main goal of ridding ourselves of the private health insurance parasite and
thereby capturing all of the money available for health care and to use it for health care. I want to interact with persons of similar
or opposing interests to further refine these concepts. All opposing opinions are welcome.
I
want employees of the insurance industry to realize there will be opportunities to roll most everyone into the new system. For instance,
claims processing will always be needed, nurses will be needed, home health will surely expand, and hospitals and other providers
will need to be fairly paid and administered, simply to name a few. The real change will be for the upper financial echelon of the
current system.
Please give this some dedicated thought. Talk to your friends, colleagues, union members,
family and anyone else, not only to spread the concept, but to better refine our arguments. Our most important job is to talk
to other persons to promote the concept of a Medicare based universal health care system. We need a bill written for introduction
into the legislative system and then to push each legislator to pass it uncorrupted. We can do this!
Health
Care Reform
About Me:
I am an average person who happens to be very concerned about the state of health care delivery in
the United States. So many politicians and other persons of interest spread so much misinformation about reform, the only way to make
it happen is to mobilize average Americans. This is my first attempt to expose my ideas to criticism. This is not a professional web
site and it is crude. It should, however, allow me to get some feedback on the potential to generate some controversy.
I am 55
years old, married to my wife Debbie for 30 years, and have four children. I am a medical doctor, and have my master’s degree in Microbiology/Immunology.
I practice general internal medicine in Maryville, Tennessee, at Blount Memorial Hospital where I am currently Chief Of Staff.
My
hobbies include hiking in the Great Smokey Mountains, learning the guitar, and writing poems. I have a collection of various firearms,
though I do not hunt. I ride my motorcycle (Dynaglide) daily and work out in the gym at least twice a week.
Mark E Green
Health
Care Reform
A
Very Long Road
Any meaningful attempt to reform health care and to direct as much money as possible
to patient care, will meet with an unbelievable amount of resistance from the powers that be! Our elected officials are much more
interested in being re-elected than effectively guiding this country. On their own, I have NO confidence that they will do anything
except modify our existing private insurance based system, replete with its high profit margins, incalculable redundancies, unnecessary
drug plans and drug restrictions. It is increasingly patched up by a confusing hodgepodge of governmental plans meant to cover those
segments of the population that are not profitable in our “free enterprise “system. The rest of the patients that fail to fit into
even the government entitlement plans, are cared for at financial loss by local hospitals and providers. All this allows private insurance
companies to reap huge sums of money from the lowest risk patients. These huge sums of money are what could bring Medicare, as well
as health care in general, back in to black numbers.
Partly in the defense of congress, this is a complex
and entrenched system and unless one has experience on the inside of health care, it is hard to understand what needs to be done and
what should be done. For those of us in health care, knowing what needs to be done may actually make some resist reform, knowing that
profit margins for us will change as well. For this reason, it is vitally important to expose as many people/voters as I can to the
possibility of what is possible. Through education and prodding from average citizens, congress could enact meaningful reform of health
care delivery, under threat of expulsion by the people, at the next election. They must feel enough pressure from the public to overcome
the pressure they will feel from insurance companies, lobbyist, special interest groups, and from their own stock portfolios.
If this concept builds momentum, there will be an unbelievable amount of smoke blown by profiteers of the
health care delivery machine. They will scream “Socialized Medicine” and will produce anecdotal instances of health care reform gone
wrong. What they cannot refute is that Medicare works and that it is not delivered in a socialized manner. Sure there are changes
that need to be made to Medicare, but these changes are in the depth of coverage and not in the mechanism of delivery itself. They
also cannot argue that what we are doing now is not working.
This site is a work in progress. I welcome
any input that will help lead to the long needed reform of the way we deliver health care in America. Opposing arguments will also
help by educating me to the concerns of the average American or helping me better understand how to dissect and to counter the counterattacks
that are bound to arise. All input welcome.
Mark E Green
18July2008
OurHealthReform.com
Health
Care and the Legal Industry
It is hard to comprehend how much health care money is wasted each year
due to the legal industry. From malpractice insurance payments and defensive medicine to the huge volume of medical records now generated
simply to cover all possible angles of a potential lawsuit. Recently a patient of mine was in France and had the onset of a cardiac
condition. She was treated for five days in a French hospital and discharged back to me. I received a full copy of the medical records
by mail. The records were medically complete and detailed. Interestingly, there were fewer pages from her five day stay in the hospital
than in one of our routine emergency visit charts. They seem more centered around medical information rather than on legal protection.
Malpractice decisions have in some cases increased the chance of a bad outcome. When the “clot busting
drugs” first became available for use in stroke patients we had some leeway on a time frame in which to use them. There is a risk
anytime these drugs are used though the balance is that often this is the only chance one has to avoid certain paralysis. The current
"legal" time window is three hours. At this point in time, if a stroke workup is completed at 3 hours and 15 minutes, the option to
use this treatment will not be extended. We know if there is a bad outcome we will be sued due to being 15 minutes past the accepted
time window. If we explain this to the stoke patient and if they would rather risk death than to be severely disabled, we could still
be sued by the patient or the surviving family simply because they were under duress at the time of the stroke and therefore could
not really give informed consent. In other words, we have very little option to treat this patient as they might want.
In the same pattern, I saw a patient in an outlying Emergency Room when I was a resident who had suffered a bee sting respiratory
failure and was brought in by ambulance. He was a lung cancer survivor by almost ten years, but still had a “Do Not Resuscitate” order
on his medical record. He was unconscious and no family was available. I elected to put him on the ventilator anyway and within two
hours he recovered enough to breath on his own. He was thankful. Never-the-less, for a solid year I worried about the possibility
of a lawsuit for violating his written request. For if he had died in the process or within a year of the event, a gold-digging next
of kin and a clever lawyer could have made a case against me. Interestingly, had I let him die by honoring his ten year old
paperwork, I would have been fully protected legally, though not morally.
What is needed is to establish
free standing 3 member arbitration panels that render binding judgments in the face of a bad outcome. Reasonable monetary damages
could be awarded for ongoing care, treatments and support and would be based on similar judgments from across the entire medical system.
Any practitioner mistakes could be tracked specifically and in aggregate to allow re-education or disciplinary action for the practitioner
as needed and the data could be reviewed for system wide problems that also need correcting. This would eliminate the legal industry
mantra that some lives are worth more than others simply because they earn more money. The latter is the reason we have life insurance.
In medical circles, the life of a janitor is just as important as the life of a corporate executive.
The malpractice/legal industry
has no place in medical care!
Mark E Green
18July2008
OurHealthReform.com
Rational
Health Care Reform
The first step in health care reform is to make a Medicare sponsored “Medicare Supplement”
available directly from Medicare for those current Medicare patients who want a supplement as part of their plan. There would be a
reasonable premium charged for the extra coverage. A Medicare Part D drug benefit would be part of the standard offering. Then to
dismantle all of the Medicare Advantage plans and roll their existing patients back into Medicare, as expanded above. Fees currently
being paid into those plans would be scrutinized for fairness, adjusted as needed, and paid directly into Medicare. Standard fees
would have to be reasonable for everyone, though there will need to be a declining “co-pay” schedule for those in lower economic classes.
With this in mind, however, everyone needs to have to pay something to help them feel vested in the system and to help prevent over
utilization. In the process we need to ensure we have the infrastructure in place to handle the increasing administrative load. This
might be a way to utilize some of the existing claims processing capacity of the current private plans, allowing many of their employees
to transition into Medicare based employment, as opposed to losing their jobs as the private market contracts.
The next step is to organize the second most expensive segment of society, one that is in large part supported by a huge and inefficient
patchwork of governmental agencies and programs, all well as private insurance. All persons under age 18 would be enrolled into the
Medicare plan as expanded above. Each enrollee would have benefits specific for them, as opposed to being a member of a “family plan”.
Monies currently utilized for the current coverage could be consolidated and used to defer the cost of the new system. Costs would
be further reduced by establishment of a reasonable resource based premium accessed to all. These monies would be collected from the
parents or guardians, much as their current insurance premiums are at present. Again, time would be allowed for the consolidation
of the infrastructure required to run the aystem.
Once the two most expensive age groups above are fully
incorporated, we could then incorporate the remaining, and more “profitable” age groups into this expanded Medicare plan. Perhaps
starting at age 64 and working backward till all are incorporated. The speed of this enrollment would only be limited by the expansion
of the required infrastructure. As each age group is enrolled, they would begin paying their health care premiums directly into Medicare,
as mentioned above.
One of the many downfalls of the current system is the inability of persons with
heath risks to obtain insurance. Accordingly, premiums would be built on a much more rational consideration. A child born with a defect
or an adult who develops leukemia have done nothing wrong and should not be penalized for the rest of their lives by doing without
health insurance or by paying exorbitant rates for it. Accordingly, premiums would be established by age and would be independent
of uncontrollable risks, as exampled above. We could elect to modify premiums upward in relation to controllable risks. Examples would
be smoking, excessive alcohol use, and obesity. We could also consider charging some amount extra to persons for medical noncompliance.
Examples are in not controlling their blood sugars, blood pressures, or cholesterol. These extra amounts need not be excessive. It
is likely that many patients could be steered toward improving their health simply by getting their premium statement each month showing
their basic premium and optional supplement plus the extra assessments for their controllable risks that are not currently controlled,
each itemized with the related extra charge. Those 65 and over would be assessed a flat age related rate modified as above for controllable
risk factors. Correspondingly, we could consider reducing the premiums some amount for those people who successfully control their
risks. Obviously, the monies need to be fully evaluated before the exact possibilities can be determined.
Provisions will have to be made for the collection of monies due to be paid to the Medicare system, such as premium payments. Industry
currently plays a role in supplying health care and they still would in the new system. Industry would benefit from controlled costs
and protection from rampant heath care inflation. Payments for individual premiums would have to be collected. These payments
could be deducted from payroll checks, as is currently done for persons who get their health insurance through work. For persons getting
their support from the government, insurance premiums could be deducted directly from their checks as well. Self employed persons
could pay monthly or have their premiums added to their income tax indebtedness. No matter what payment arrangements we try to make,
there will always be people who show up needing health care, but who have sidestepped the system. These people will have to have care
and a pool of monies will have to be made available.
Any laws that need to be changed to accommodate
this reform can be passed through congress. There are, of course, many aspects and possibilities that need to be fleshed out as the
current legal restrictions reveal themselves. It will be up to the American voter to force our elected officials to do what is right,
and to enact any legislation that needs to be in place to see is done.
Mark E Green
463 POB BMH
Maryville, TN 37804
24August2008
OurHealthReform.com