IT'S TIME FOR UNIVERSAL HEALTH CARE

Perhaps firefly has read Ivan Illich's Medical Nemesis. That might be accused of hyperbole.

Obviously, the average patient does not easily recognise strategies for increasing profits.

The problem is somewhat obscure.

It is ambiguous because you don't know if the "offices of physicians" are mutually exclusive to those employed by hospitals. You are making that assumption, but it is not necessarily true.

Anyone who visits a private internist's office knows that often the least amount of time during the visit is actually spent with the doctor. Medical assistants (who are paid far less than the doctor collects) draw blood for blood tests, administer EKGs and sonograms, take x-rays, administer vaccines, and often take the patient's blood pressure. In some offices, physician's assistants do a good part of the physical examination of the patient as well.

This delegation of labor allows the physician to see more patients per hour and consequently generate a higher income. All services given to the patient, whether by the doctor or someone else, are billed under the doctor's name. This is cost efficient business practice for the doctor, who then usually spends very little time talking to or listening to his patient. Most doctors want to increase patient flow in their offices. They want to see as many patients as possible. That's why they also "overbook" appointments, so if someone doesn't show, they don't lose the time slot. They don't care if this results in long periods spent in the waiting room for the patent. Doctors, like a lot of other people, are motivated to try to make as much money as possible.

Of course there are professional ethics and standards in medicine. But, as I pointed out in an earlier post, the medical profession does not do a good job of policing itself. There is poor or marginal medicine practiced, other doctors often know this, but they look the other way. Malpractice suits then become the vehicle to expose much of this.

As an extreme example of doctors doing "everything under the sun" to increase income, just consider the case of Dr Conrad Murray, the physician who was "treating" Michael Jackson at the time of his death. Dr Murray, who was heavily in debt, gave MJ what he wanted (drugs which were neither medically necessary, nor even medically indicated, nor even medically appropriate), because that's what Murray's pay check depended on, keeping MJ satisfied.

A less extreme example would be the average doctor who writes a prescription (for sleeping meds, or pain meds, or tranquilizers, or anti-depressants, for instance), just to shut his patient up, or to make the patient feel as though the doctor is doing something for him, even though the doctor knows the drug may be ineffective, or unneeded, or even potentially addictive, and that the patient's complaint should be addressed in some other way. This goes on all the time. Why? Doctors don't like to lose patients. Prescriptions help to keep the patient coming back to you.

And the reason that most doctors do not work in, or for, hospitals is because they make more money in private practice. The majority of doctors in the U.S. have always been in private practice.


Of course

You are taking the practices of a small number of physicians, who will almost always be subspecialists, and applying it to all physicians.



You are right that physicians will often write prescriptions to shut up a patient. They may even order unneeded tests. But it isn't about keeping that patient coming back. I know many doctors who would love to be rid of those types of patients, and many of those patients are fired by their doctors. The scripts and tests are often given to prevent complaints to the state board of healing arts, or to prevent bad patient satisfaction scores which most hospitals use to determine compensation.



Again, you are taking information that applies to a small group and trying to apply it to all physicians. Cardiologist or dermatologists may make more in private practice. But GPs or MEDs and several other less glamorous "front-line" types will make considerably more working for a hospital system. In that way, they are shielded from the horrible reimbursements from Medicaid/Medicare and usually work for a set salary with bonuses for extra duty.

Surely, Montery Jack, you must be aware of the massive costs TO THE PATIENT of the huge insurance costs that physicians such as Neurologists, ObGyn and Orthopedic surgeons must pay. It is not unusual for a physican to pay $100,000 off the top for insurance. This is only because of the rapacious trial lawyers who, of course, are among the highest contributors to Barack Hussein Obama.
Do you know that the physicians increase their rates as much as they can to cover insurance costs?

But don't worry, Monterey Jack, AT THIS TIME, "repeal and replace" is doing well. Just check the polls covering the Senate Seats in 2010. The Demos running are getting murdered, starting with dingy Harry Reid.

We will see what happens on Nov. 2, 2010.

You, of course, overlook the lies told by the Obama Administration. Why the newspaper in Obama's home town, Chicago, took the president to task just last last Monday.
Quote the Tribune Editorial:
Sunday night's voting in the House, like that Dec. 24 action in the Senate, had Democrats unilaterally in charge " and voting against the wishes of a majority of Americans. The Democrats are convinced that their legislation is good not just for health care but for already overextended federal finances.

That dubious conclusion rests on a Congressional Budget Office guesstimate that Washington can spend nearly $1 trillion more on health care over 10 years " and also cut the deficit by $138 billion. Writing in Sunday's New York Times, former CBO director Douglas Holtz-Eakin profoundly disagreed: "(T)he budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out. In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion."

Oops. Someone is terribly wrong here " and sure to be mighty embarrassed when the truth emerges. Having parsed his explanation of the CBO's sleight of hand, and knowing how unlikely it is that future Congresses will make the difficult decisions that this Congress wouldn't, we suspect it .

end of quote

http://www.chicagotribune.com/news/opinion/editorials/ct-edit-health0322-20100321,0,7727464.story.

All you have to do to discover the odds against Barack Hussein Obama's forces are in November, Monterey Jack, is to look at the polls on the Senate Races.
Start with Dingy Harry Reid's race.

My understanding is that most fraud is due to double billing . . . that is, sending the request both to Medicaid/Medicare and to private insurance a patient might hav.

Note that your own statistics say that only 12% of physicians are self-employed, making very few small business people.

This article http://www.nextgenmd.org/vol2-5/private_practice.html says that the “proportion of physicians working in private practice is decreasing while the proportion of salaried physicians is rising.”

This blog http://www.kevinmd.com/blog/2009/03/doctors-leaving-private-practice-and.html reinforces that notion and proclaims that “private practice model of primary care is dying a slow death.”

Several other articles described the burden of establishing a private practice and the trend toward small group practices which are cheaper to run or toward what can best be described as medical temping.

Do you understand that doctors are hamstrung by insurance companies that often refuse to pay for certain prescriptions because the representatives of a rival drug company has made a pitch for his own product . . . in other words, that insurance companies are practicing medicine?

http://www.nytimes.com/2010/03/26/health/policy/26docs.html?hp

funny timing, as the NYT just came out with a peice about that.

sstainba, I have no idea where you are getting your information from. You have yet to post any statistics that show that a majority of doctors in the U.S. work in, or for, hospitals. I suspect it's because you cannot find such statistics to back up your claim. On the other hand, I can find considerable data that attests to the fact that most doctors are in private practice, either self-employed, or in group practices where they are employed by other physicians, or as contractors with private companies which are not affiliated with any hospital.

Other than government or municipal hospitals, and some teaching or specialty hospitals, most hospitals would not need a large full time staff of physicians. The majority of physicians one finds in community or private hospitals are attending physicians, who do not work for the hospital and who are paid by the patient (or the patient's insurance carrier), for each visit or procedure they perform. Doctors would be up the creek if they had to depend on hospitals for employment--there just aren't that many hospital jobs, even including outpatient hospital treatment clinics.

I have also never heard of "bad patient satisfaction scores" determining a doctor's salary at a hospital. Where did you come up with that one? At government and municipal hospitals the salary levels are standardized and available to the public. One's salary does not vary because of any patient satisfaction scores. The doctor is simply expected to show up for work and perform the duties given in his job description. At private hospitals, doctors have individual contracts with the hospital and the salary is stipulated in the contract, and remains in effect for the duration of the contract.

Similarly, I have never met a physician in any area of medicine who wrote a prescription for a patient simply because he feared the patient would complain to a state medical board if he didn't write that script. If, in the doctor's judgment, a prescription is not medically necessary, or could be potentially harmful, he doesn't have to write it, or be bullied into writing it by his patient--and the state medical board will back him up on that. That's what really good doctors do--they don't write prescriptions just to shut a patient up. Complaints to state boards about things of that nature are meaningless, and generally ignored. It is the doctor who is supposed to determine treatment, not the patient.

Our entire medical health care system currently reimburses physicians for the types of interventions and procedures they perform. This is true of Medicare, Medicaid, and private insurance companies. Medical specialists perform more expensive procedures, that's why they make more money than family doctors or primary care doctors, and that's one main reason why the number of U.S. med school graduates going into family medicine or primary care has dropped precipitously, leaving significant shortages in these areas. And, sstainba, I think you have it backward-- it's the family doctors and primary care doctors who have to employ more medical assistants, physician assistants and nurse practitioners, just so they can see the maximum number of patients in a day to insure their income. These are the doctors who don't perform the very expensive procedures, so they have to try to compensate by seeing a high volume of patients. And hospitals don't make that much by employing one of these doctors full time either, for the same reason--they won't get reimbursed very much for the services these doctors perform, so they have to depend on patient volume too. Hospitals like to make money, and they definitely don't want to lose money.

For an insight into why doctors do favor health care reform, read this article. It is the private insurance companies who are trying to control medical care.
http://www.prospect.org/cs/articles?article=the_doctors_revolt

While health care reform will bring millions and millions more people, with insurance, into doctor's offices, we really won't have enough family doctors, or primary care doctors, or even general internists, to care for these people--mainly because so many med school graduates now go into more lucrative specialties, and this situation has been going on for a while. This will be a major problem in delivering care, particularly if we want to focus on wellness and prevention as a way of reducing costs. These "gatekeeper" doctors will have even more jammed waiting rooms and appointments will be even harder to get. Much more has to change in our health care system than just providing insurance to the uninsured, or altering who pays the bills. Medicine has become very specialized. And, as long as a good many doctors want to continue to earn incomes well into six figures, the costs of medical care will remain quite high.

plainoldme, patients wouldn't have Medicare, Medicaid, and private insurance--they would only have one of those. It's not double billing that accounts for most fraud, it's billing for things that were never done, or which were so blatantly inappropriate that they were unnecessary (like a psychiatrist billing Medicare for therapy sessions with patients who suffer from moderate Alzheimer's). I read recently that physicians have billed Medicare for things like artificial legs, when the patient had no prosthesis. Some doctors run "Medicaid Mills", see a very high volume of patients, but spend next to no time with those patients, and bill Medicaid for services which were never rendered. Unfortunately, it's hard for the government to catch a lot of this fraud.

plainoldme, private insurers do try to control the types of prescriptions that doctors write--and that's particularly true when it comes to the Medicare Part D prescription plans (which are administered by private insurers). They can flatly refuse to pay for a particular drug, or even to put it in their formulary, because it is too expensive. The insurers tell the patient, for instance, that they will pay for drug A (a lower priced drug) but not drug B (a higher priced drug) to treat hypertension, even though the patient's doctor is prescribing drug B for hypertension. These decisions are made solely on the basis of the insurance company's profit motive. This leaves the patient in a terrible quandary. They can ask their doctor to call or write to their prescription drug plan and appeal this decision, but many doctors don't want to spend the time or go through the hassle of doing that (and the insurers know that), or the patient can ask the doctor if they will change the medication to comply with the cheaper medication their insurer will pay for. Many doctors will do this, simply so the patient will have a medication to treat the condition, since otherwise the patient may not be able to afford the medication the doctor prefers and would be without medication. Some doctors will not agree to making a substitution, leaving the patient to possibly look for a new doctor.

But, with Medicare Part D, patients' medical treatment is being determined by a non-physician in an insurance office somewhere, solely based on the profit motive--they want all patients on the cheapest drugs possible, regardless of whether they are the best drugs for the patient in the opinion of the treating doctor. This is one of the worst aspects of having Medicare Part D administered by private insurance companies, and it is made worse by the fact that Congress has thus far prohibited Medicare from negotiating drug prices directly with the pharmaceutical companies ( as the V.A. does). If Medicare could negotiate directly, the drug prices would drop drastically--then seniors would see a real savings in the cost of medications, and they could likely get the medications which are their doctor's first choice. So far, the only changes I have heard about in the new health care legislation involve closing the donut hole, or coverage gap, in Medicare Part D. A lot more needs to be done to correct the problems in that plan. Congress needs to stop protecting big pharma and let Medicare negotiate with the drug companies. Bush was staunchly against this. Obama, I believe, is in favor of it. So, we shall see...

This would be funny, if it wasnt so sad.
Here we have a democrat that is also a lawyer, AND whose committee oversees the federal court system, making up clauses in the constitution that he says gives congress the power to mandate that everyone buy health insurance.

As a lawyer, isnt he supposed to know what the constitution says?

http://blog.heritage.org/2010/03/24/rep-conyers-discovers-new-clause-in-constitution-more-than-200-years-later/

Here is another terrific Krugman piece.


Going to Extreme


By PAUL KRUGMAN
Published: March 25, 2010

I admit it: I had fun watching right-wingers go wild as health reform finally became law. But a few days later, it doesn’t seem quite as entertaining " and not just because of the wave of vandalism and threats aimed at Democratic lawmakers. For if you care about America’s future, you can’t be happy as extremists take full control of one of our two great political parties.

To be sure, it was enjoyable watching Representative Devin Nunes, a Republican of California, warn that by passing health reform, Democrats “will finally lay the cornerstone of their socialist utopia on the backs of the American people.” Gosh, that sounds uncomfortable. And it’s been a hoot watching Mitt Romney squirm as he tries to distance himself from a plan that, as he knows full well, is nearly identical to the reform he himself pushed through as governor of Massachusetts. His best shot was declaring that enacting reform was an “unconscionable abuse of power,” a “historic usurpation of the legislative process” " presumably because the legislative process isn’t supposed to include things like “votes” in which the majority prevails.

A side observation: one Republican talking point has been that Democrats had no right to pass a bill facing overwhelming public disapproval. As it happens, the Constitution says nothing about opinion polls trumping the right and duty of elected officials to make decisions based on what they perceive as the merits. But in any case, the message from the polls is much more ambiguous than opponents of reform claim: While many Americans disapprove of Obamacare, a significant number do so because they feel that it doesn’t go far enough. And a Gallup poll taken after health reform’s enactment showed the public, by a modest but significant margin, seeming pleased that it passed.

But back to the main theme. What has been really striking has been the eliminationist rhetoric of the G.O.P., coming not from some radical fringe but from the party’s leaders. John Boehner, the House minority leader, declared that the passage of health reform was “Armageddon.” The Republican National Committee put out a fund-raising appeal that included a picture of Nancy Pelosi, the speaker of the House, surrounded by flames, while the committee’s chairman declared that it was time to put Ms. Pelosi on “the firing line.” And Sarah Palin put out a map literally putting Democratic lawmakers in the cross hairs of a rifle sight.

All of this goes far beyond politics as usual. Democrats had a lot of harsh things to say about former President George W. Bush " but you’ll search in vain for anything comparably menacing, anything that even hinted at an appeal to violence, from members of Congress, let alone senior party officials.

No, to find anything like what we’re seeing now you have to go back to the last time a Democrat was president. Like President Obama, Bill Clinton faced a G.O.P. that denied his legitimacy " Dick Armey, the second-ranking House Republican (and now a Tea Party leader) referred to him as “your president.” Threats were common: President Clinton, declared Senator Jesse Helms of North Carolina, “better watch out if he comes down here. He’d better have a bodyguard.” (Helms later expressed regrets over the remark " but only after a media firestorm.) And once they controlled Congress, Republicans tried to govern as if they held the White House, too, eventually shutting down the federal government in an attempt to bully Mr. Clinton into submission.

Mr. Obama seems to have sincerely believed that he would face a different reception. And he made a real try at bipartisanship, nearly losing his chance at health reform by frittering away months in a vain attempt to get a few Republicans on board. At this point, however, it’s clear that any Democratic president will face total opposition from a Republican Party that is completely dominated by right-wing extremists.

For today’s G.O.P. is, fully and finally, the party of Ronald Reagan " not Reagan the pragmatic politician, who could and did strike deals with Democrats, but Reagan the antigovernment fanatic, who warned that Medicare would destroy American freedom. It’s a party that sees modest efforts to improve Americans’ economic and health security not merely as unwise, but as monstrous. It’s a party in which paranoid fantasies about the other side " Obama is a socialist, Democrats have totalitarian ambitions " are mainstream. And, as a result, it’s a party that fundamentally doesn’t accept anyone else’s right to govern.

In the short run, Republican extremism may be good for Democrats, to the extent that it prompts a voter backlash. But in the long run, it’s a very bad thing for America. We need to have two reasonable, rational parties in this country. And right now we don’t.

I think that there are several financial and economic matters that people ignored for years . . . perhaps because they were too busy with their own lives and making a living . . . that are coming to the fore now and that this is one of them.

Have you heard of AARP's supplemental insurance? It supplements and completes MEdicare. There are other private insurances that do the same.

I guess you have never read the many articles that appeared for years about double billing.

Furthermore, several doctors spoke at a forum on health care reform that I attended about how insurance companies dictate what may be prescribed.

I agree with the others that you are making unfounded remarks.

A friend sent this to me:

TUESDAY, MARCH 23, 2010
Think The Democrats Just Scored One for the Little Guy? Think Again.

By Robert E. Prasch
Professor of Economics
Middlebury College

As a resident of Massachusetts, where the backlash is already well underway, I thought I should add a comment. Let's begin by considering the origins of "Obamacare". It comes from Massachusetts. It was passed early in Gov. Patrick's reign because during the campaign it was already in debate as it was Gov. Mitt Romney's proposal. Now, one might wonder where the conservative, free market, head of Bain Consulting governor might go finding a healthcare plan? Well, he got it from the Heritage Foundation. And why did they have such a plan? Well, they developed its broad outlines during the 1993-4 years as the Republican ANSWER to Hillary's effort. So, that is our new federal plan -- it is a warmed over version of the Heritage Plan. This, I submit, might explain a few things. (1) It was Obama's idea all along to "triangulate" the Republicans on this issue, and (2) why many of them are really very bummed out that their leadership did not take up the chance to show "bi-partisanship" on this issue (see David Frum on this).

Now, I tend to be skeptical of Heritage Foundation health-care plans. For several reasons:

(1) By design, costs are not contained, neither is health care reformed. This means that "affordability" does not come from controlling costs, but by shifting them. Shift to whom? A hallmark of the Heritage/Romney plan is that no change of the distribution of income is to occur with the financing of this plan. NONE. Rather, funding is to be from three sources --- those with supposedly "Cadillac" plans, those who have "opted out' because of the laughably high cost of coverage relative to their own risks, and to the state general fund. (2), In light of state budget shortfalls, it is no surprise that the latter source is declining quickly, and tens of thousands of Mass residents have ALREADY lost their subsidies (this trend will certainly occur on Capitol Hill over the next several years as 'deficit mania" kicks in). So, get this, as your income declines and your house is repossessed, the cost of your health care rises with higher premiums AND lower subsidies. But, make no mistake, even as the subsidies decline, the mandate will stay -- why should the big companies give up this huge windfall of unchecked access to the wages of the low paid?

(3) I also wish to warn against the 'NPR version' of the story that this bill "gives" health care for those without. Nothing is given, it is a MANDATE. Now, while the original 'vision' of the bill had subsidies, these are fading rapidly. So, now we have a dramatically underfunded mandate. Solving the lack of insurance by mandating the poor to buy it is, to be blunt, Dickensian. Obama himself stated it very well during the campaign "It is like solving homelessness with a mandate that those living on the streets buy a house". Those who are poor understand this point, and resent it. True, there are some young people who are in good health and, understanding statistics and rapacious health care insurance firms, "choose" not to get health insurance (as I did for several years in my 20s as the teaching assistantship I got from DU during my years studying for my MA could not cover my living expenses AND health insurance), yet the bulk of non-buyers are people who have found that with little in the way of family funds, other priorities (rent, car repairs, food, school fees, etc.) are a greater priority.

So, now the Democrats have taken it upon themselves to decide the priorities of millions of our poorest citizens. Thus, thanks to the Democrats, non-negotiable required fees from the insurance industry will be several multiples of the current income taxes of the lowest paid. This is sticker shock at its worse. Even Republicans know that the money will go to rapacious, soulless, insurance companies under the careful guidance of the IRS (here in MA, we have several extra highly-complex pages on an already long tax form where we have to prove that we have insurance). Stated simply, the Democrats have decided to go into the business of being the "enforcers" of the big insurance firms. This is NOT a good place to be in an election year. This is ESPECIALLY not a good place to be when you are already presenting yourself to voters, as Obama seems committed to do, as the die-hard supporter of the big banks that foreclosed on people's homes and blew up their economy.

With such a context, along comes someone who calls himself a "regular guy" with a pickup truck (he failed to mention that he has five homes, one in Aruba, but the truck was in all the ads), and he takes Kennedy's seat in Mass. In MASSACHUSETTS! Only one year after Obama wins this state by 20 points! Wow. This, folks, is what a backlash looks like, and it is enormous. Turning the wages of the working classes over to the insurance companies, without recourse or mercy, is not going to win this state, and it will not win in many others. If the Democrats lose any less than 35 house seats this election I will be amazed. And, note my wording, the Republicans did not, and will not, win them. No, the Democrats have decided to lose these seats. Amazing.

Sorry about bringing the bad news. But this bill is a disaster, and it is worse than nothing, as it will destroy the incomes of those it purports to help along with the Democratic Party. It is especially bad since a public option was always an option, I do not believe the D.C. spin on this for even a minute. Just as Obama never wanted to renegotiate NAFTA or leave Iraq, it was clear from the outset that the White House never wanted a public option, which explains why Rahm said so early last summer. Why? Because the big insurance companies did not want it, so Rahm did not want it. End of issue.
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POSTED BY ECONOMIC PERSPECTIVES FROM KANSAS CITY AT 8:59 PM

Another sent me this:

Rose Ann DeMoroExecutive Director, National Nurses United, AFL-CIO and California Nurses Association
Posted: March 23, 2010 08:07 PM
Diary of a Wimpy Health Care Bill
Passage of President Obama's healthcare bill proves that Congress can enact comprehensive social legislation in the face of virulent rightwing opposition. Now that we have an insurance bill, can we move on to healthcare reform?

As an organization of registered nurses, we have an obligation to provide an honest assessment, as nurses must do every hour of every day. The legislation fails to deliver on the promise of a single standard of excellence in care for all and instead makes piecemeal adjustments to the current privatized, for-profit healthcare behemoth.

When all the boasts fade, comparing the bill to Social Security and Medicare, probably intended to mollify liberal supporters following repeated concessions to the healthcare industry and conservative Democrats, a sobering reality will probably set in.

What the bill does provide

-Expansion of government-funded Medicaid to cover 16 million additional low income people, though the program remains significantly under funded. This limits access to its enrollees as its reimbursement rates are lower than either Medicare or private insurance, with the result some providers find it impossible to participate. Though the federal government will provide additional subsidies to states, those expire in 2016, leaving the program a top target to budget cutting governors and legislatures.

-Increased funding for community health centers, thanks to an amendment by Sen. Bernie Sanders, that will open their doors to nearly double their current patient volume.

-Reducing but not eliminating the infamous "donut hole" gap in prescription drug coverage for which Medicare enrollees have to pay the costs fully out of pocket.

-Insurance regulations covering members' dependent children until age 26, and new restrictions on limits on annual and lifetime on lifetime insurance coverage, and exclusion of policies for children with pre-existing conditions.

-Permission for individual states -- though weakened from the version sponsored by Rep. Dennis Kucinich -- to waive some federal regulations to adopt innovative state programs like an expanded Medicare.

All of these reforms could, and should, have been enacted on their own without the poison pills that accompanied them.

Where the bill falls short

-The mandate forcing people without coverage to buy insurance. Coupled with the subsidies for other moderate income working people not eligible for Medicare or Medicaid, the result is a gift worth hundreds of billions of dollars to reward the very insurance industry that created the present crisis through price gouging, care denials, and other abuses.

-Inadequate healthcare cost controls for individuals and families.
1. Insurance premiums will continue to climb. Proponents touted a "robust" public option to keep the insurers "honest," but that proposal was scuttled. After Anthem Blue Cross of California announced 39 percent premium hikes, the administration promised to crack down with a federal rate insurance authority, an idea also dropped from the bill.
2. There is no standard benefits package, only a circumspect reference that benefits should be "comparable to" current employer provided plans.
3. An illusory limit on out-of-pocket medical expenses. But even in the regulated state exchanges, insurers remain in control of what they offer and what will be a covered service. Insurers are likely to design plans to attract healthier customers, and many enrollees will likely find the federal guarantees do not protect them for medical treatments they actually need.

-No meaningful restrictions on claims denials insurers don't want to pay for. Proponents cite a review process on denials, but the "internal review process" remains in the hands of the insurers, and the "external" review will be up to the states, many of which have systems now in place that are dominated by the insurance industry with little enforcement mechanism.

-Significant loopholes in the much touted insurance reforms:
1. Provisions permitting insurers and companies to more than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
2. Permitting insurers to sell policies "across state lines", exempting patient protections passed in other states. Insurers will likely set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
3. Allowing insurers to charge three times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
4. Insurers may continue to rescind policies, drop coverage, for "fraud or intentional misrepresentation" -- the main pretext insurance companies now use.

-Taxing health benefits for the first time. Though modified, the tax on benefits remains, a 40 percent tax on plans whose value exceeds $10,200 for individuals or $27,500 for families. With no real checks on premium hikes, many plans will reach that amount by the start date, 2018, rapidly. The result will be more cost shifting from employers to workers and more people switching to skeletal plans that leave them vulnerable to financial ruin.

-Erosion of women's reproductive rights, with a new executive order from the President enshrining a deal to get the votes of anti-abortion Democrats and a burdensome segregation of funds, that in practice will likely mean few insurers will cover abortion and perhaps other reproductive medical services.

-A windfall for pharmaceutical giants. Through a deal with the White House, the administration blocked provisions to give the government more power to negotiate drug prices and gave the name brand drug makers 12 years of marketing monopoly against competition from generic competition on biologic drugs, including cancer treatments.

Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need.

As former Labor Secretary Robert Reich wrote after the vote "don't believe anyone who says Obama's healthcare legislation marks a swing of the pendulum back toward the Great Society and the New Deal. Obama's health bill is a very conservative piece of legislation, building on a Republican (a private market approach) rather than a New Deal foundation. The New Deal foundation would have offered Medicare to all Americans or, at the very least, featured a public insurance option."

Unlike Social Security and Medicare which expanded a public safety net, this bill requires people -- in the midst of the mass unemployment and the worse economic downturn since the Great Depression -- to pay thousands of dollars out of pocket to big private companies for a product that may or may not provide health coverage in return.

Too many people will remain uninsured, individual and family healthcare costs will continue to rise largely unabated and private insurers will still be able to deny claims with little recourse for patients.

If, as the President and his supporters insist, the bill is just a start, let's hold them to that promise. Let's see the same resolve and mobilization from legislators and constituency groups who pushed through this bill to go farther, and achieve a permanent, lasting solution to our healthcare crisis with universal, guaranteed healthcare by expanding and improving Medicare to cover everyone.

Leaders of the National Nurses United have raised many of these concerns about the legislation for months. But, sadly, as the healthcare bill moved closer to final passage, the space for genuine debate and critique of the bill's very real limitations was largely squeezed out.

Much of the fault lies with the far right, from the streets to the airwaves to some legislators that steadily escalated from deliberate misrepresentations to fear mongering to racial epithets to hints of threatened violence against bill supporters.

For its part, the administration and its major supporters shut out advocates of more far reaching reform, while vilifying critics on the left.

Both trends are troubling for democracy, as is the pervasive corruption of corporate lobbying that so clearly influenced the language of the bill. Insurers, drug companies, and other corporate lobbyists shattered all records for federal influence peddling and were rewarded with a bill that largely protected their interests, along with a Supreme Court ruling that will allow corporations, including the health care industry, to spend unlimited sums in federal elections.

Rightwing opponents fought as hard to block this legislation as they would have against a Medicare for all plan. As more Americans recognize the bill does not resemble the distortions peddled by the right, and become disappointed by their rising medical bills and ongoing fights with insurers for needed care, there will be new opportunity to press the case for real reform. Next time, let's get it done right.

Rose Ann DeMoro is executive director of the 150,000-member National Nurses United

I don't think you actually understand what those statistics say...



You seriously have no idea how physicians are employed... Do you even know what an "attending physician" is? It has absolutely NOTHING to do with who he works for or how he is paid. It is based on his working relationship to the patient's case. The fact that physicians may not work IN the hospital doesn't mean they don't work FOR the hospital and get paid BY the hospital. As I've said several times, many hospitals operate their own clinics and staff them with physicians.

Not that many hospital jobs? Really? The New England Journal of Medicine seems to think that hospitalist positions are growing very, very rapidly...

http://www.nejmjobs.org/career-resources/here-come-the-hospitalists.aspx



Well, if you've never heard of it, then it can't possibly be so, right ? When was the last time a hospital deposited a physician paycheck into your checking account? For me, it was about a week ago. I imagine I am more acquainted with physician compensation and employment agreements than you are. We just mailed a new one yesterday actually.

Here you go:
http://www.kevinmd.com/blog/2009/09/patient-satisfaction-influence-physician-compensation.html

Now, you've heard of it.



Just how many physicians have you met? Have you asked them about their prescription writing habits? Are you sure the medical boards back them up? How do you know what a medical board does with complaints?

I know a good doctor, who didn't order an MRI that a patient insisted on. So guess what? She filed a complaint to the Board of Healing Arts. And while the physician was not found to be at fault, they still officially maintain a "letter of concern". When applying for a license in another state, those types of things must be listed.



I agree with some of this last part. Though, there are also doctors that see this healthcare reform as a mistake. The reimbursement schedule for primary care needs to be increased a good 30% or so to have a chance at convincing new doctors to go into that versus a procedure-based subspeciality.