Consumer Power Report #180

Published June 2, 2009

We had a meeting of the Health Care Freedom Coalition on Thursday, May 27. It included a lot of reports from a lot of people, but most notable was the extraordinary surge of grassroots groups that don’t normally pay a lot of attention to health care. Americans for Prosperity has created a new group, Patients United Now, to do advertising and hometown rallies around the country. The Tea Party groups are working with Conservatives for Patient Rights to also do ads and rallies, Freedom Works is focusing on the tax increases associated with the Dems plans, CAHI has developed a Patients Bill of Rights, and much, much more.

A couple of months ago I was worried that the people who want to dictate health care from Washington had free sailing. There seemed to be no effective opposition. Now, I’m not so sure. Hold on to your hat. This is going to be a wild ride.



Revenue Down

News stories report that federal tax collections are down 34% from a year ago, resulting in $138 billion less money in April. It makes you wonder how they plan to pay for their health care schemes.


VAT Tax?

But not to worry, Lori Montgomery in the Washington Post reports that Ezekiel Emanuel, M.D. brother of White House chief of staff Rahm Emanuel and the White House’s primary health policy advisor, is calling for a Value Added Tax (VAT). The article says, “Emanuel argues in his book that a 10 percent VAT would pay for every American not entitled to Medicare or Medicaid to enroll in a health plan with no deductibles and minimal copayments.”

But in Congress, “Key lawmakers are considering other ways to pay for health reform, including new taxes on sugary soda, alcohol and employer-provided health insurance.” But that would do nothing to solve the larger budget problems, according to the article–“The federal budget deficit is projected to approach $1.3 trillion next year, the highest ever except for this year, when the deficit is forecast to exceed $1.8 trillion. The Treasury is borrowing 46 cents of every dollar it spends, largely from China and other foreign creditors, who are growing increasingly uneasy about the security of their investments. Unless Congress comes up with some serious cash, expanding the nation’s health-care system will only add to the problem.”

The article includes a frightening graphic that shows projected budget deficits from 2008 ($459 billion) to 2019 ($779 billion and growing). And this is under pretty rosy projections of economic growth and does not include a penny for new health programs.

SOURCE: Washington Post

Don’t Plan on Social Security or Medicare

The fiscal picture has gotten so grim that financial advisors are beginning to tell clients to forget about ever getting Social Security or Medicare, according to an article in Investment News. The article quotes Erin Botsford, president and chief executive of The Botsford Group of Frisco, Texas, which has $700 million in assets under management, as saying, “You now have to plan for the absolute worst-case scenario. You can’t count on Big Brother to pick up the tab for retirement — you have to self-fund.”

The article adds, “Some advisers are also urging clients to take advantage of health savings accounts — which essentially function like a 401(k), but specifically for health care and medical costs during retirement. ‘There’s very little downside to using one of these accounts,’ said Drew Tignanelli, president of The Financial Consulate in Hunt Valley, Md., which manages $175 million. ‘It’s 100% tax-free if you withdraw the money for medical costs, and if you don’t need all of it for your health care expenses, then it’s basically an ordinary retirement account.'”

SOURCE: Investment News


CBO and Scoring Mandates

Another article by Ms. Montgomery looks at how the CBO is likely to score Obama’s health reform proposals. She reports that CBO director Douglas Elmendorf wrote, “Premium income — for a public plan (or plans) and for insurance purchased through exchanges or in the private market — should be classified as federal revenues if there is an individual mandate and tight government control of the insurance market.” If there is no mandate and loose regulation, it would not be considered a tax increase.

SOURCE: Washington Post (CBO)

Americans Oppose an Individual Mandate

The Rasmussen surveys found that “Fifty-six percent (56%) (of Americans) say that if someone doesn’t want to buy insurance, they shouldn’t have to,” while “31% of the nation’s adults believe even those who are young and healthy should be required to buy health coverage.” On the other hand, the numbers are switched when asked about an employer mandate — “Fifty-nine percent (59%) of American adults believe all companies should be required to buy health insurance for their employees while 30% are opposed.”

SOURCE: The Rasmussen Surveys

The Auto Insurance Fallacy

One of the biggest justifications for an individual mandate is that we mandate auto insurance coverage. Never mind that:

  • The federal government doesn’t mandate auto coverage, the states do.
  • What is being mandated is coverage for the damage you do to other people, not the damage you do to yourself.
  • An auto mandate is tied to a privilege, driving, not to merely existing in the United States.
  • The rate of non-compliance for mandated auto coverage is pretty close to the rate of uninsured for health care, and in some states is far higher.

Now the Insurance Research Council has issued a new report predicting the rate of non-insurance for auto will increase from 13.8 percent of drivers in 2007 to 16.1 percent in 2010, due to rising unemployment. Golly, who’da thought it? People are willing to break the law when they can’t afford to do what the politicians tell us we should do!

SOURCE: Insurance Research Council


Writing in the DC Examiner, Byron York says, “Barack Obama is making an enormous mistake on the most important initiative of his presidency. In recent weeks, Obama has stressed that health care reform is the essential ingredient for the success of his economic recovery plan. Yet the president, easily the most gifted White House communicator since Ronald Reagan, has the message all wrong. When Obama talks health care, it’s cost, cost, cost.”

He quotes Frank Luntz as saying, “Americans will prioritize cost over quality right up until the moment they realize that it’s their quality that they are sacrificing. Nothing else turns people against the government takeover of healthcare more than the realistic expectation that it will result in delayed and potentially even denied, treatment, procedures and/or medications.”

Mr. York concludes, “There’s a consensus among the Washington punditocracy that health care reform will succeed this year because the time is simply right. But it’s almost June. Obama and his Democratic allies have not even introduced a reform proposal, and yet the president demands that ‘We’ve got to get it done this year.’ And all the while he is sending out the wrong message on what really matters. Unless the White House changes course and pays more attention to what Americans really want, Obamacare will lose.”

SOURCE: DC Examiner


Waiting Times Worst in Massachusetts

The firm of Merritt Hawkins has issued a report on a new study of waiting times in 15 American cities. Using “mystery shoppers” it asked about getting an appointment for a physician in five medical specialties: cardiology, dermatology, obstetrics-gynecology, orthopedic surgery, and family practice. It also asked whether the office accepted Medicaid patients.

As one news report put it, “Boston is experiencing the longest average doctor appointment wait times overall of the 15 metro markets examined in the survey: 70 days to see an obstetrician/gynecologist, 63 days to see a family physician, 54 days to see a dermatologist, 40 days to see an orthopedic surgeon, and 21 days to see a cardiologist.”

The study itself puts it even more starkly. Totaling up the average wait time for all five specialties, the survey finds that cumulative average wait time is 248 days in Boston — almost twice as much as the next highest area (Philadelphia at 135 days) and over twice as much as the third highest, Los Angeles at 121 days.

The study says, “Long wait times in Boston may be driven in part by the healthcare reform initiative that was put in place in Massachusetts in 2006. The initiative succeeded in covering many of the state’s uninsured patients. However, it has been reported that many patients in Massachusetts are encountering difficulty in accessing physicians. Survey results support these reports. Long appointment wait times in Boston also may signal what could happen nationally in the event that access to healthcare is expanded through healthcare reform.”

Actually, the experience in Massachusetts far understates what could happen nationally. That state already had the greatest number of physicians per capita of any state (4.53 per 1,000 residents) and one of the lowest rates of uninsured. If any state was well-positioned to absorb a large influx of newly covered patients it is Massachusetts. Imagine the impact in California with only 2.6 physicians per 1,000 and 20 percent uninsured or Texas with 2.15 per 1,000 and 25 percent uninsured.

SOURCE: Healthy.Net; Merritt Hawkins Study; State-by-state breakdown of physicians per capita

California Mandates Less Waiting

California is already having a problem with wait times for doctor’s appointments, according to an article in the Sacramento Bee. The article says, “The average waiting time to see a general practitioner is 20 days in some of the country’s largest cities.” But, rather than actually solve the problem of physician shortages, the state is going to “dictate the maximum time a person must wait to see a doctor, depending on the illness and the doctor’s specialty.”

The new regulations have been promoted by Anthony Wright of Health Access California. The article says, “Wright’s group won passage of legislation in 2002 requiring state regulators to draft timely access rules for HMOs, which provide coverage for 21 million Californians. The standards were to be implemented by 2004 but were bogged down by delays and intense scrutiny from doctors, health plans and consumer groups.”

The article continues — “On the surface, the issue could be diagnosed as a problem of supply and demand: There are not enough doctors to treat the sick and injured. But most acknowledge the matter is more complicated.” Well, not really. It only gets more complicated when the politicians step in. A spokesman for the California Medical Association worries that simply mandating less waiting without fixing the supply “could push doctors into a stopwatch mentality.”

There you go — to avoid the problem of waiting for appointments, we’ll just get the docs to spend less time with each patient. Who said health reform is hard?

SOURCE: Sacramento Bee

Some Docs Move to “Hybrid Concierge” Model

Healthcare Finance News reports that, “While some physicians are considering early retirement or leaving primary care if reimbursements are cut further, others are turning to a hybrid model of concierge medicine.” The founder of Concierge Choice Physicians, Wayne Lipton, says, “Physicians are truly concerned that health plans tasked by the administration with lowering healthcare costs are going to do so on the backs of primary care physicians by slashing reimbursement.”

The article says that facing further cuts, many physicians are retiring or going into full concierge practices. Mr. Lipton says, “This creates a bit of a paradox as the administration and healthcare leaders are publicly highlighting what an important role PCPs play in providing and coordinating care for Americans.”

Apparently, “Hybrid concierge practices” allow a physician to devote part of the practice to concierge patients, but keep seeing other patients as they have been. I would be skeptical that this sort of divided loyalty would work very well, but, hey, give it a shot. One physician is quoted as saying, “I believe it helps me provide better care to all of my patients. Plus, because the economic pressure has been alleviated, I am able to continue to take care of a broad cross-section of patients from Medicare to private pay and have the ability to give back more to my community.”

SOURCE: Healthcare Finance News

Marcy Zwelling, MD

Speaking of “concierge medicine,” CHCC member and newly elected president of SIMPD Marcy Zwelling-Aamot, M.D. has her own ideas on how to save medicine — keep the government out of our health care decisions. She writes, “As we watch our government take over our lives and our health without debate or deliberation, we can only hope that Congress might start to take their “let’s deal with reality” medications and settle down to consider the precarious future they are navigating for America’s citizens.”

She says, “If Americans would follow the trail of dollars spent in health care, they would soon realize it is government mandates, regulations and price-setting that have accelerated the rise in costs in health care.” And more of the same will only make matters worse.

SOURCE: Long Beach Press Telegram

Don Berwick, MD – – On Second Thought …

Finally, after praising Dr. Don Berwick last week for his fine article in Health Affairs, we must report feeling profoundly disappointed by an article he co-authored with Elliott Fisher and Karen Davis in the New England Journal of Medicine.

This article is a call for physicians to lead the charge towards more third-party control of physician and patient behavior — “We need organizations large enough to be accountable for the full continuum of patients’ care. We will create a high-performing health care system only if integrated delivery systems become the mainstay of organizational design.” So bureaucracy will be in charge of what patients get and what doctors do. Oh, sure, the paper sprinkles the term “patient-centered” throughout to placate Dr. Berwick, but it is nothing more than a throw-away adjective with no meaning or substance. All power is invested in the bureaucracy. It even suggests staff-model HMOs as an ideal system.

The fear of being disempowered and disregarded as a patient that Dr. Berwick expressed in his Health Affairs article would be completely realized in the Franz Kafka world envisioned in this NEJM article. So, which is the real Dr. Berwick? Was the Health Affairs article just window-dressing to disguise his embrace of bureaucracy? Or was he suckered into co-authoring this NEJM article by the cynical and meaningless use of the term patient-centered?

SOURCE: New England Journal of Medicine