Beyond the Cusp

September 19, 2017

The Grand Healthcare Fiasco

 

Has anybody honestly thought the concept of “Single Payer Government Healthcare” through completely? Senators Bernie Sanders and Elizabeth Warren claim they have the entire thing sorted out. What is their solution, you ask? They will tell everybody that it is easy-peasy-lemon-squeezy. The answer is to simply give everybody a Medicare Card and presto-chango and you have universal healthcare. Nothing will change other than the government will now pay all your healthcare expenses. You actually do get to keep your doctor. Of course, you do not get to keep your healthcare insurance because the government will become your health insurance provider. Now, what could be any more simple? When you go to your doctor, you just show them your Medicare card, they take down the number, you sign that you received the care listed and the government pays your doctor. Well, you will need to press down when signing the paperwork because there are tons of copies being produced, at least five with an unknown upper end. Well, there will be a little more to your doctor getting his money, but your work will be finished. Your physician will then be required to also complete some additional forms further describing the services delivered and the resources used and any testing which was required and any other incidentals which might be required to satisfy the government regulations and specific other essential requirements to complete and satisfy every criteria which the government and Medicare requires. Then the entire package is wrapped-up and mailed using Fed Ex, UPS, DHL, USPS or other mode of delivery of your physician’s choice and after the government Medicare workers complete processing and approving the claim, then the check is in the mail. Well, actually, not necessarily.

 

Medicare requirements are very particular and it will probably take some adjustment in meeting their standards and style requirements as well as quantitative and qualitative requirements as well as making sure that you utilize the perfect and correct forms for each specific set of procedures as well as the right entries for items utilized and which form for each procedure and a million other vitally important minutia; all of which will take a little period for adjustments. Then, and only then, things will move along smoothly for you, your physician and everyone involved. Of course, there is a faster means your physician might consider in order to make their reimbursement less painful and less time consuming, they might actually consider trying hiring somebody with experience in government forms and government lingo with a specialty in Medicare forms and formulations. Once the wrinkles have been ironed out, then will come the initial shock for your physician, the fact that he will be receiving less for each visit and delivered medical services than he may have become accustomed. With some fine-tuning of how he represents each service rendered and supplemental services required and other technicalities, your physician will be able to rectify some of the deficit he first encountered. The one thing he should be forewarned is that the government may decide to audit his practice if they suspect they might be cheating the government to increase his profit margin by cheating the government by charging for things either he did not provide or for items he did not use. What adds to the overall confusion is that government processing of claims and auditing of these same claims are actually somewhat subjective just as much as objective. That leaves some wiggle room, often some very noticeable wiggle room. Much of that is due to regulations written in order to protect, favor or punish specific items, procedures and a variety of other items and even people which often lead to regulations which are all too often contradictory with all too often vague wording such that things depend upon the person reviewing the same procedural sequence coming out with very different results. This also means that what applied one time might not be acceptable the next which makes for some difficulty complying with every regulation and requirement.

 

Senators Bernie Sanders and Elizabeth Warren

Senators Bernie Sanders and Elizabeth Warren

 

But let us leave all this aside and pretend that every provider is fully capable of meeting every wrinkle and requirement in the paper jungle which is government forms and requirements and understand and interpret every regulation with the greatest of ability. So, your physician is now a professional at all things government requirements, what could be the problem now? But what about these HMO, PPO and the rest of the alphabet soup of group coverage? Well, their problem will be to completely standardize treatments for every scenario and also make sure that the physicians itemize and document with great accuracy such that their administrative professionals can accurately file with the government. Our bet is that very quickly the idea of having your own private physician will very quickly become a thing of the past and most physicians will run and hide behind the bureaucracy of some group healthcare facility be it a hospital, clinic or HMO, PPO styled health provider. Yes, there will always be the pay for service providers who will be required to at the least file the Medicare paperwork despite taking an additional fee from their patients. Whether such will be theoretically permissible under the single payer government Medicare for all healthcare packages which the law suggested by Senators Saunders and Warren are suggesting is debatable because, as we all know, the government hates competition when taking over an industry. But there is another item which might allow for such care to exist, the wealthy are unlikely to be kind to having to accept the same level of care as the average person. As the wealthy are the meat behind campaign financing, our government representatives are extremely sensitive to their desires, wishes and comfort, and that means that the wealthy will be permitted their own better healthcare, thus, paying an additional fee to your personal physician will very likely be permitted or opting to go your own way and paying your physician as long as you also pay for government healthcare despite not taking full advantage of their wonderful services. But even all of this is not going to be the biggest problem because to assure that the majority of people end up in the government healthcare system, private health insurance will need to be made illegal across the board, which is why the wealthy will be paying directly to the physician for services and not purchasing an insurance plan. Further, the government will very likely allow membership hospitals charge their flat entrance fee either monthly or annually and any additional fees per service as required to continue to provide their services as long, again, as their members pay their Medicare fees to the government plan.

 

Finally, the people who will be hurt by any government healthcare system, where all health insurance is replaced by government payment of healthcare fees, is the health insurance company employees and the independent health insurance agents. From what we have read, this would include somewhere from two and a half million to three million people losing their employment. I can hear your claim that most of these people would be required to be hired by the government to do pretty much the same jobs they perform now. Well, that might be true if the only thing that health insurance employees ever did was process insurance claims. But there are also the salespeople, accountants, executives and likely dozens of other positions other than claims processing. Further, as the government will be the sole provider, and there being a number of healthcare insurance providers, the majority of these people employed by these companies will be out of work. There will be some new employees, enforcement investigators who will be sent to investigate fraud, and there will inevitably be fraud just as there is fraud now in Medicare and Medicaid. Then there are the last two and most frightening truths. With time, this care system will run into the same problems the other government healthcare systems already in use in the United States have, namely the “Veterans’’ hospitals and the healthcare system providing care of Native Americans in the various Reservations. This may be the absolutely most frightening reality of the entire healthcare prospects. There has to be a better system than using Medicare for all or any of the other European systems plus Canada, Australia and New Zealand.

 

We might suggest the Israeli system where everybody is required to have coverage and pay the healthcare tax. Here is where the Israeli system diverts from the others. There are four separate healthcare systems which are required to provide basic services by the government. Each of the four offers this basic set of services plus each choose a few additional services for their basic coverage. They each offer additional levels of service, say bronze, silver, gold and platinum (used for example only) which each provide additional services and prescription and other service coverages each for an additional fee to your provider. Physicians are required to provide a set number of hours of their practice to one of the national providers. They can then offer for fee services outside the system and collect fees as they desire to charge, if they are so motivated. This is most often taken up by specialists and surgeons. This also allows for those who desire to choose their own physicians outside of the basic providers to pay only the basic fee the government requires and then get all of their care privately. The four separate providers each are kept providing their services, including their additional service levels, at a reasonable rate as they are competing against one another. They also each provide separate additional plans leading to people choosing whichever of the four provide the services they are most likely to require. So diverse coverages, competition keeping fees low and physicians providing service to the general good before they can sell their services on the open market to earn additional fees. It provides the most for the least for the people and allows for physicians to make as much salary as they are able to command from an open market system as well. Everybody gets their advantages and all receive basic health coverage. Major Medical where hospitalization is covered for all is part of the system which appears to be much of what the United States is aiming to cover. There is one problem with the Israeli system, it is Israeli and that appears to disqualify it for some idiotic reason.

 

Beyond the Cusp

 

October 10, 2014

Ebola: To Quarantine or Not to Quarantine

There has been more than sufficient debate and even beyond to the point of hyperbole. Even mentioning quarantine and you are accused of racism because closing the border to flights originating in the areas which are stricken with the Ebola epidemic will only cause the disease to spread faster across the world and the United States. Statements such as this, which fly in the face of logical thought, are really as ridiculous as any thinking person would first believe. But we are supposed to forgo logic and ordered thought and instead believe those thoughts which we are told solely because these truths are self-evident under the correctness as dictated by political correctness and multiculturalism and the chosen deciders of that which will be considered acceptable thought. We are told that the first person who succumbed to the Ebola virus was a person of color that the treatment he received was racist otherwise he would have lived if he were not a minority. It was due to racism that he was initially sent home when he went to the hospital emergency room with severe flu-like symptoms which should have been diagnosed immediately as Ebola but the hospital sent him home after treating him and the computer misdiagnosed the patient’s high risk for contracting the Ebola virus. Later the hospital readdressed the situation “in the interest of transparency” and stated in writing that “There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.” The latest statement from the hospital released stated, “Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows. It also has been modified to specifically reference Ebola-endemic regions in Africa. We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola.” None of this addresses the debate of whether to quarantine or not, it just restates the fact that even hospitals are staffed by humans and their procedures come from humans and as such are potentially flawed. There was no racial judgmentalism in the mistaken diagnosis and treatment nor was the treatment for Ebola for Thomas Duncan was exactly the same that any person upon diagnosis for Ebola would have been and the result would likely have been the same in any similar case of Ebola.

The claims that quarantine would cause more Ebola cases which would also spread faster within the United States. The claim that the United States should have a special relationship with Liberia because Liberia was founded because America had slavery misses one crucial factor, had the United States continued to allow slavery there would have been no founding of Liberia; Liberia was founded as a result of the United States ending slavery. Why would this be turned around and made to be that Liberia was founded because America had slavery without even bothering to mention that Liberia was founded for freed slaves because the United States ended slavery is an intentional attack on the United States meant to stir up anger and feelings of the death of Mr. Duncan had a racial element. But why would there be a need to quarantine the areas of the world which are facing an epidemic from Ebola and a closure of the border to flights and passengers coming from Western Africa. The CDC (Centers for Disease Control) which had initially stated that there was almost no chance for the spread of Ebola from one person to the next because the Ebola patient is not contagious until they have symptoms and then the virus is not airborne and one needs to have contact with bodily fluids in order to become infected which makes prevention easy. They did not bother to mention that one of those bodily fluids was the spray which results from sneezes and coughs and even sweat and that the Ebola virus could potentially remain active for as long as the moisture from any of the above remained at some residual level. This means that Ebola was far more easily spread than the CDC had initially stated especially considering that sweating, coughing, sneezing and projectile vomiting are all symptoms of a person with Ebola. How long before the CDC informs the public that any surface contaminated with bodily fluids, such as spittle from a sneeze or cough, can potentially remain contagious for hours which means that taking the shopping cart offered in a friendly manner from a person who just emptied it into their car on a busy Saturday where carts are at a premium might become a life threatening event and that you should wipe down the handle area of the cart before touching it and wipe the rest down discreetly out of the friendly person’s sight, especially if they sneeze after handing you the shopping cart. No, there is no reason to initiate a policy which would ban passengers from areas of the world where the Ebola virus is still an active contagion, is there?

The question of whether to quarantine or not to quarantine is even necessary can be blamed upon the invention of aircraft and airlines, especially international direct flights from anywhere in the world to any place else in the world directly. Before airlines shortened travel times between all places on Earth to all other places on Earth within a single day the fastest manner of travel was a steamship which took as much as three weeks to cross the Atlantic Ocean. This meant that Ebola carriers would more likely show signs of the contagion before the ship ever made port in New York allowing for precautions to be taken. Crossing the Pacific took even longer which would really allow sufficient time for Ebola and most other diseases to become evident long before the ship makes port. This was why the immigrants arriving in the United States until World War II landed on Ellis Island where even if a passenger was sniffling they were sent to a neighboring island for medical quarantine and treatment to determine if they should be permitted entry or be returned to Europe or wherever their originating port was. We no longer have that luxury in the modern world where the longest it takes to fly between destinations including stopovers where you do not necessarily need to deplane is under twenty-four hours. The discussion on quarantine is a new one for the United States. In Europe it is an old subject which has already been settled from past experiences and Europe will more often than not opt for quarantine without any concern for political correctness or multiculturalism as their experience where quarantine became their default position has much to do with a small plague which came from the Orient, the Bubonic Plague. From that horrendous time forward quarantine became the default in Europe and Britain but the United States has not yet to discuss quarantine nor have they been forced to before now. The only other time the United States faced an epidemic which was imported came after World War I when the returning soldiers brought the Spanish Flu with them and it spread throughout the United States like a storm, an ill wind blowing across the plains. There was no real alternative as the nations soldiers were already in transit and it was unthinkable to ban them or place them in quarantine, but some towns and even cities enforced short quarantine procedures where they basically had all stores, schools and other places where the public interacted including houses of worship to close and instructed the people to remain in their homes for as long as three or four days which did serve to stifle the spread and such places had far lower death rates than places where they continued life as normal. This is a discussion that should be argued and thought through to a complete and accepted policy for the future which will be applied in all cases of potential pandemic for the future. Any action which simply ignores the subject and dismisses any discussion simply claiming that there is no real need as the Ebola threat is over so there is no pressing reason to address the quarantine subject with any urgency. Such is simply doing what public officials too often use and get away from taking up sensitive subjects known as kicking the can down the road. The problem is nobody can predict when the next Ebola like disease will strike forcing the discussion once again on whether or not to impose quarantine on transit from the effective regions. Starting the discussion while under the gun, so to speak, is waiting too long and is the reason to force the discussion now. Hopefully the people elected to serve the public welfare and wellbeing will take the responsible path and make a reasoned decision now, and if they do not choose to perform their assigned tasks the public must force the discussion until a definitive decision is reached and a definitive policy has been defined and articulated in law, nothing less should be acceptable.

Beyond the Cusp

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