obamacare

Now That Most Of The Stimulus Checks Have Been Cut, The Bill Has Come Due

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Since 2010, our government has “given free money” to people. Yes, billions were siphoned off the top to people that don’t need it and were just dipping their hands in the till. There are plenty of cases documented. In the court of law, it’s called money laundering.

COVID Relief Program is the ‘Biggest Fraud in a Generation’

We’ve known about the fraud associated with the COVID relief program known as the Paycheck Protection Program (PPP):

Many who participated in what prosecutors are calling the largest fraud in U.S. history — the theft of hundreds of billions of dollars in taxpayer money intended to help those harmed by the coronavirus pandemic — couldn’t resist purchasing luxury automobiles. Also mansions, private jet flights and swanky vacations.

They came into their riches by participating in what experts say is the theft of as much as $80 billion — or about 10 percent — of the $800 billion handed out in a Covid relief plan known as the Paycheck Protection Program, or PPP. That’s on top of the $90 billion to $400 billion believed to have been stolen from the $900 billion Covid unemployment relief program — at least half taken by international fraudsters — as NBC News reported last year. And another $80 billion potentially pilfered from a separate Covid disaster relief program.

COVID Relief Program is the ‘Biggest Fraud in a Generation’

Like hitchhiking; it’s ass, grass or cash, no one rides for free. The bill is now due and it’s being paid at the grocery store and the gas pump. I’ll give it to you that the gas pump prices don’t have to happen, but the current administration is just giving us pain. It was half the price a year and a half ago and the ability to take it back to that prices is available still, if they wanted to do it.

The State of Healthcare Firsthand, From the Doctor

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I went to a hospital today to have a procedure done.  When the nurse apologized for the quantity of paperwork, I casually mentioned that things might become more complicated with Obamacare.
I was not ready for the answer.  Actually, being in a very socially liberal city and healthcare system, I thought I was going to hear support for the program.  I instead was told how government has corrupted the system, made it worse for both Doctors and patients and other horror stories.  I replied that the government has not helped healthcare in a long time to which the nurse responded that the decline of morals in our culture was the beginning of the problem.  How correct this nurse was.

Next, I met with the Doctor to go over what the procedure was going to entail.  I again mentioned whether the healthcare system was affecting his job.  Again I received a surprise answer.

The doctor told me of his passion for his practice all of his life.  He then told me that what is being done to us by Washington has him considering getting out.  He was honorable enough to not practice if he couldn’t do his best.  It was a John Galt conversation.  There are others like this doctor.  I’ve found that if you are contemplating your retirement in your mind, you are already in the process of retiring.

To a person, the hospital staff admitted that Washington and the damage they have done and are doing to our healthcare system makes it worse for patients and providers.  This is not a partisan statement for the record.

Let me point out that this was a highly successful practice with state of the art equipment and professional personnel making these perspicacious comments to me.

It was  clear that they wanted to help people and do their job, but our own government is in the way.  It seems obvious that they have overstepped their role in making sure that medicine is safe and lawful.

If I hadn’t heard it from the horse’s mouth, I wouldn’t have known.  I did go in looking for a cure, but I left with a dose of information.  It is easy to conclude that we need to fix or excise Washington from the healthcare system and put it back in the hands of the doctors.

Here is another story by a Doctor in a completely different area of the country from me that I read by chance on the same day as my procedure.

After 18 years in private practice, many good, some not, I am making a very big change.  I am leaving my practice.

No, this isn’t my ironic way of saying that I am going to change the way I see my practice; I am really quitting my job.  The stresses and pressures of our current health care system become heavier, and heavier, making it increasingly difficult to practice medicine in a way that I feel my patients deserve.  The rebellious innovator (who adopted EMR 16 years ago) in me looked for “outside the box” solutions to my problem, and found one that I think is worth the risk.  I will be starting a solo practice that does not file insurance, instead taking a monthly “subscription” fee, which gives patients access to me.

I must confess that there are still a lot of details I need to work out, and plan on sharing the process of working these details with colleagues, consultants, and most importantly, my future patients.

Here are my main frustrations with the health care system that drove me to this big change:

  1. I don’t feel like I can offer the level of care I want for my patients.  I am far too busy during the day to slow down and give people the time they deserve.  I have over 3000 patients in my practice, and most of them only come to me when there are problems, which bothers me because I’d rather work with them to prevent the problems in the first place.
  2. There’s a disconnect between my business and my mission.  I want to be a good doctor, but I also want to pay for my kids’ college tuition (and maybe get the windshield on the car fixed).  But the only way to make enough money is to see more patients in my office, making it hard to spend time with people in the office, or to handle problems on the phone.  I have done my best to walk the line between good care and good business, but I’ve grown weary under the burden of having to make this choice patient after patient.  Why is it that I would make more money if I was a bad doctor?  Why am I penalized for caring?
  3. The increased burden of non-patient issues added to the already difficult situation.  I have to comply with E/M coding for all of my notes.  I have to comply with “Meaningful Use” criteria for my EMR.  I have to practice defensive medicine to avoid lawsuits.  I have more and more paperwork, more drug formulary problems, more patients frustrated with consultants, and less time to do it all.  My previous post about burnout was a prelude to this one; it was time to do something about my burn out: to drop out.

Here are some things that are not reasons for my big change:

  1. I am not angry with my partners.  I have been frustrated that they didn’t see things as I did, but I realize that they are not restless for change like I am.  They do believe in me (and are doing their best to help me on this new venture), but they don’t want to ride shotgun while I drive to a location yet undisclosed.
  2. I am not upset about the ACA (Obamacare).  In truth, the changes primary care has seen have been more positive than negative.  The ACA also favors the type of practice I am planning on building, allowing businesses to contract directly with direct care practices along with a high-deductible insurance to meet the requirement to provide insurance.  Now, if I did think the government could fix healthcare I would probably not be making the changes I am.  But it’s the overall dysfunctional nature of Washington that quenches my hope for significant change, not the ACA.

What will my practice look like?  Here are the cornerstones on which I hope to build a new kind of practice.

  1. I want the cost to be reasonable.  Direct Care practices generally charge between $50 and $100 per patient per month for full access.  I don’t want to limit my care to the wealthy.  I want my practice to be part of a solution that will be able to expand around the country (as it has been doing).
  2. I want to keep my patient volume manageable.  I will limit the number of patients I have (1000 being the maximum, at the present time).  I want to go home each day feeling that I’ve done what I can to help all of my patients to be healthy.
  3. I want to keep people away from health care.  As strange as this may sound, the goal of most people is to spend less time dealing with their health, not more. I don’t want to make people wait in my office, I don’t want them to go to the ER when they don’t need to.  I also don’t want them going to specialists who don’t know why they were sent, getting duplicate tests they don’t need, being put on medications that don’t help, or getting sick from illnesses they were afraid to address.  I will use phones, online forms, text messages, house calls, or whatever other means I can use to keep people as people, not health care consumers.
  4. People need access to me.  I want them to be able to call me, text me, or send an email when they have questions, not afraid that I will withhold an answer and force them to come in to see me.  If someone is thinking about going to the ER, they should be able to see what I think.  Preventing a single ER visit will save thousands of dollars, and many unnecessary tests.
  5. Patients should own their medical records.  It is ridiculous (and horrible) how we treat patient records as the property of doctors and hospitals.  It’s like a bank saying they own your money, and will give you access to it for a fee.  I should be asking my patients for access to their records, not the reverse!  This means that patients will be maintaining these records, and I am working on a way to give incentive to do so.  Why should I always have to ask for people information to update my records, when I could just look at theirs?
  6. I want this to be a project built as a cooperative between me and my patients.  Do they have better ideas on how to do things?  They should tell me what works and what does not.  Perhaps I can meet my diabetics at a grocery store and have a dietician talk about buying food.  Perhaps I can bring a child psychologist in to talk about parenting.  I don’t know, and I don’t want to answer those questions until I hear from my patients.

This is the first of a whole bunch of posts on this subject.  My hope is that the dialog started by my big change (and those of other doctors) will have bigger effects on the whole health care scene.  Even if it doesn’t, however, I plan on having a practice where I can take better care of my patients while not getting burned out in the process.

Is this scary?  Heck yeah, it’s terrifying in many ways.  But the relief to be changing from being a nail, constantly pounded by an unreasonable system, to a hammer is enormous.

Doctors Disagree on How, But Most Want To Fix Healthcare

/ John / Leave a comment

From Kevin MD:

Three out of four dentists recommend this tooth brightening toothpaste — make your smile sparkle like never before! Six out of seven plumbers recommend this drain opening de-clogger — make your bathtub drain like never before! Nine out of ten doctors recommend improving the medical system in the United States — make your health care system heal like never before!

But how do we do that?

Do doctors think the Affordable Care Act is the soothing balm for the festering wound that is the economics of the American medical system—paying too much while delivering too little population health? What do our health care experts think about health care reform? Do we think it is a step in the right direction? A step towards doom and damnation?  A small step for insurance companies, a huge leap for mankind?

It goes on to say that they need to read the bill to see what is in it.

Read more here

However, here is what is in the bill  click on it to find out what is in the bill and what rights we the people lose like financial control over our own assets and our own doctors.  We do lose that despite what congress and the POTUS say to the contrary.

Self Help Healthcare

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I checked in with KevinMD for this piece of helpful information.  The free market will produce a better product than the government will ever be able to handle.  Capitalism always provides competition which drives DOWN prices and drives UP services.

f you cannot measure it, you cannot improve it.
-Lord Kelvin

Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.
-Nassim Nicholas Taleb

Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the Quantified Self blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. Most of us do not keep track of our moods, our blood pressure, how many drinks we have, or our sleep patterns every day. Most of us probably prefer the Taleb to the Lord Kelvin quotation when it comes to living our daily lives. And yet there are an increasing number of early adopters who are dedicated members of the quantified self movement.

 

They are an eclectic mix of early adopters, fitness freaks, technology evangelists, personal-development junkies, hackers, and patients suffering from a wide variety of health problems. What they share is a belief that gathering and analysing data about their everyday activities can help them improve their lives.

According to Wolf four technologic advances made the quantified self movement possible:

First, electronic sensors got smaller and better. Second, people started carrying powerful computing devices, typically disguised as mobile phones. Third, social media made it seem normal to share everything. And fourth, we began to get an inkling of the rise of a global superintelligence known as the cloud.

An investment banker who had trouble falling asleep worried that his concentration level at work was suffering. Using a headband manufactured by Zeo, he monitored his sleep quantity and quality, and he also recorded data about his diet, supplements, exercise, and alcohol consumption. By adjusting his alcohol intake and taking magnesium supplements, he has increased his sleeping by an hour and a half from the start of the experiment.

A California teacher used CureTogether, an online health website, to study her insomnia and found that tryptophan improved both her sleep and concentration. As an experiment, she stopped the tryptophan and continued to sleep well, but her ability to concentrate suffered. The teacher discovered a way to increase her concentration while curing her insomnia. Her experience illustrates a phenomenon that Wolf has noticed: “For many self-trackers, the goal is unknown … they believe their numbers hold secrets that they can’t afford to ignore, including answers to questions they have not yet thought to ask.”

Employers are becoming interested in this approach in connection with their company sponsored wellness programs. Suggested experiments include using the Jawbone UP wristband to see if different amounts of sleep affect work performance such as sales or using the HeartMath emWave2 to monitor pulse rates for determining what parts of the workday are most stressful.

Stephen Wolfram recently wrote a blog illustrating just how extensive these personal analytics experiments in self-awareness could become when coupled with sophisticated technologies. Wolfram shares graphs of his “third of a million emails I’ve sent since 1989” and his more than 100 million keystrokes he has typed.

Anyone interested in understanding just how far reaching this approach may become in the future should examine the 23 pages of projects being conducted by the MIT Media Center. My favorites from this fascinating list include automatic stress recognition in real-life settings where call center employees were monitored for one week of their regular work; an emotional-social intelligence toolkit to help autism patients learn about nonverbal communication in a natural, social context by wearing affective technologies; and mobile health interventions for drug addiction and PTSD where wearable, wireless biosensors detect specific physiological states and then perform automatic interventions in the form of text/images plus sound files and social networking elements.

It is easy to get caught up in the excitement of all this new technology and to start crafting sentences about how the quantified self movement will “transform” and “revolutionize” health care and spawn wildly successful new technology companies.

Jackie Fenn’s “hype cycle” concept has identified the common pattern of enthusiasm for a new technology that leads to the Peak of Inflated Expectations, disappointment that results in the Trough of Disillusionment and gradual success over time that concludes in the Slope of Enlightenment and the Plateau of Productivity. Fenn’s book, Mastering the Hype Cycle: How to Choose the Right Innovation at the Right Time can help all of us realize that not all new technologies becomes killer applications.

Jay Parkinson, MD has also written a blog that made me pause before rushing out to invest in quantified self companies or predict the widespread adoption of this approach by all patients. Parkinson divides patients into three groups. The first group is the young, active person who defines health as “not having to think about it until they get sick or hurt themselves.” The second group is the newly diagnosed patient with a chronic illness that will affect the rest of their lives. After a six month period of time coming to terms with their illness, Parkinson believes this group moves closer and closer to group one who do not have to think about their disease. The third group are the chronically ill who have to think about their disability every day. Parkinson concludes that “it’s almost impossible to build a viable social media business that focuses on health. It’s the wrong tool for the problem at hand.”

The quantified self movement should be closely monitored by all interested in the future of the American health care delivery system. The potential to improve the life of patients with chronic diseases is clearly apparent; whether most people will use the increasingly sophisticated tools being developed is open to debate.

Court Weighs Heavy on Health Costs

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From the Raleigh WRAL sometimes news.

WASHINGTON — Death, taxes and now health insurance? Having a medical plan or else paying a fine is about to become another certainty of American life, unless the Supreme Court says no.

People are split over the wisdom of President Barack Obama’s health care overhaul, but they are nearly united against its requirement that everybody have insurance. The mandate is intensely unpopular even though more than 8 in 10 people in the United States already are covered by workplace plans or government programs such as Medicare. When the insurance obligation kicks in, not even two years from now, most people won’t need to worry or buy anything new.

Nonetheless, Americans don’t like being told how to spend their money, not even if it would help solve the problem of the nation’s more than 50 million uninsured.

Can the government really tell us what to buy?

Federal judges have come down on both sides of the question, leaving it to the Supreme Court to sort out. The justices are allotting an unusually long period, six hours over three days, in sessions that started Monday, to hear arguments challenging the law’s constitutionality.

Their ruling, expected in June, is shaping up as a historic moment in the century-long quest by reformers to provide affordable health care for all.

Many critics and supporters alike see the insurance requirement as the linchpin of Obama’s health care law: Take away the mandate and the wheels fall off.

Politically it was a wobbly construction from the start. It seems half of Washington has flip-flopped over mandating insurance.

One critic dismissed the idea this way: “If things were that easy, I could mandate everybody to buy a house and that would solve the problem of homelessness.” That was Obama as a presidential candidate, who was against health insurance mandates before he was for them.

Once elected, Obama decided a mandate could work as part of a plan that helps keep premiums down and assists those who can’t afford them.

To hear Republicans rail against this attack on personal freedom, you’d never know the idea came from them.

Its model was a Massachusetts law signed