THE HEALTH CARE TRIPLE PLAY

THE HEALTH CARE TRIPLE PLAY

You the patient, are about to hit into a triple play.  The new Obama healthcare is now in effect. Four separate players who reluctantly joined the Obama health care team: insurance companies, hospitals, drug companies, and the doctors---, are now feeling betrayed after  reluctantly endorsing the president’s plan.

 You were told you could hold onto your  current health  care plan unless your employer made significant changes in its coverage.   To everyone’s surprise, common adjustments as increased deductibility  or co-pays or a reduction in benefits are now considered quite significant.  Over half of the healthcare employer-sponsored plans no longer will qualify as grandfathered. You can’t  keep your plan even if you like it--- Unless, you’re a union member, where grandfathering regulations is much softer.

 Insurance company plans

 Insurers are now cutting down on non-medical services, and cutting programs so they can keep their heads above water.  at a the health insurance plans are now told they must meet medical loss ratios.   They must divide their premium dollars into two buckets:  15% will go for administrative costs and the other 85% for medical services or activities that improve the quality of healthcare.  The kicker is that hospital regulators will decide which specific activities fall into each bucket.

 The 85% bucket includes everything from doctors visits, hospital stays, surgery, prescription drugs, medical equipment,  and all soul programs to help patients cope with chronic diseases and even remind patients to take prescription medicines.

 The other 15% of premiums, administrative,  include profit compensation, agent commissions, overhead marketing, and salaries.   To meet the government’s requirements, insurance companies are cutting back on activities that are labeled administrative.

 Plans will have to choose between priorities that benefit them by preventing health-care fraud and reducing unnecessary services by creating technical innovations,and  upgrading equipment.   Patients will discuss and monitor their health with a team of nurses and this too will be lumped into an administrative functions, along with fraud prevention programs that endanger patient care. 

Programs that set standards to help cut down MRI and CAT scan used are now categorized as increasing your cancer risk so would be good to improve their health. These tests soon will not be taken.  Picking on the doctors who are ordering repeated imaging services in the name of “improved quality of health care” will reduce the administrative cost of doing business.

All of these activities are lumped in the 15% administrative cost.  This means that the government will  be able to control the payments and reduce  insurance company profits.  All of these critical services will be deemed to be administrative expenses paid to improve quality and lower costs. By placing all these services in this bucket, health care plans cannot invest in  other essential programs,  the costs will keep going up, and the health programs and care will go down dramatically.

 Another scheme by the government is the medical loss ratio. This is a difference you pay an insurance company and what the insurance company pays doctors for their care.  20 years ago insurance companies kept a nickel on every dollar for their services. Today the insurance company is trying to keep nearly 1/4 of your insurance bill and call it paperwork, which is truly only  profiteering.

Drug companies

 Drug companies made a deal with the White House and made out quite well under the plan by bargaining. This has resulted in the same price regulation that is taking place in Europe now.  The deal determines competitive pricing that will support real innovation.   This change makes drug costs rise inside Medicare and this will discourage investment. New tools allow Medicare to set rules on prices but also clinical criteria for accessing new medicines.

 Today companies are making a number of variations to their core drugs and this has led to fewer new drugs on the market.  They pstented novel compounds that limits the maneuvering room for new players. Now that human gene patents have been invalidated, this is their way of getting around the problem. Generic drugs limit compensation of drug companies by preventing new scientific insights and technologies. The FDA also is become stricter and the insurance companies distort priorities in the way you pay for drugs.

 Doctors

  Doctors find it increasingly difficult to practice on their own. They are face with a lot of fear and paranoia.  This has resulted in doctors and hospitals rethinking what they do. Private fee-for-service doctors are, in droves, joining  paid positions on a hospital team.

Doctors don’t want to be told to see their  patient for only 15 minutes,  They no longer  want to hear all your aches and pains when you come for an ear ache.  A  treatment will be prescribed and, any other symptoms  you may have, will have to wait for another visit.  Since your doctor will be forced to limit your visit to  only 10 minutes, he will be forced  to make each visit count-- for insurance reimbursement.  

Primary care doctors are suffering because they have lower fees and work longer hours.  Both hospitals and insurance companies are teaming up to squeeze these doctors even more. Your family doctor will be extinct in 2 to 3 years. Most independent doctors are selling or closing their practices and going to work for big hospitals.  Others are simply retiring early.  Big hospitals no longer have competition from independent doctors.

 By practicing independently with multiple insurers, uncertain Medicare money, and many new requirements to start using electronic health records, it is difficult for the doctor to  continue to practice independently.  Medical schools never taught doctors medical economics nor how to run their practices as businesses, but stressed  patient services as the core to success.

 The government soon will flood  the healthcare industry with many new doctors, that will be controlled.  By paying the full cost of medical education for these doctors, the doctors will feel they are being treated as human beings and the doctor will commit himself to work for the health service to whatever tune the government chooses. This free education idea will quickly sneak socialized medicine into America.

 Hospitals

 Big hospitals will soon no longer have competition from individual doctors and the pain will come later when the big hospitals act as businesses not services. Those of you in poor neighborhoods and retirement communities. may soon not have doctors to service you.  When the hospital controls the lion money share, it’s going to be the first in line to get paid.

 Conclusions

 The healthcare industry is a 2 1/2 trillion dollar industry.  Costs will be driven up for everyone, and we will  create the HMOs that we had 20 years ago where we had  restricted patient choices and access to care.

 Medicare wants alliances if they can reduce the cost of caring for patients and still improve quality. This means fewer hospitalizations and lower costs.  Your diseases will be managed by managing the expenses your diseases incur. Hospitals are getting primary care doctors on the payroll to benefit from  insurers  and Medicare.

Everyone knows we have to change the way people practice medicine. When hospital beds are full, hospitals will earn more money .  There is a big difference in providing health insurance for everyone and providing healthcare for everyone. We need to concentrate on providing service rather than  concentrating on payments.

 The government now can make and enforce private health plans to make business decisions and can set  regulations on economic costs rather than what is best for you.  Having free markets insurers does not result in free-market medical care.

There is no free lunch. Instead of dining at fancy restaurants, you will start eating peanut butter and jelly sandwiches at home. If you need a new pancreas or kidney, your insurance company program will develop a medical loss ratio for you to determine whether you’re worth getting it.

Visit www.americanacupuncture.com for more discussions of controversial medical subjects by Dr Needles

As a medical physician for over 52 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogs Visit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing.