The Covid pandemic did not produce new problems, it pointed out many that have been in the system for decades, but did not rise to the awareness of the media.
Most of us are too busy with other daily problems of life and have little idea of how the health system is not functional, until they are faced with a serious illness, and get a bill.
Federal Involvement in Health Care Drives Treatment Choices
'Doctors cannot question the federal government. That's how health care works in the United States right now.
Around the United States, in numerous cases, hospitalized COVID-19 patients have asked for Ivermectin but were denied the drug, and then sought a court order forcing the hospital to provide the requested medication. Ivermectin, which has been used safely in humans since 1985, has shown promise in treating the virus, especially when taken early. Although it is an off-label use and not guaranteed to work every time, it is legal for doctors to prescribe Ivermectin for COVID-19, and many patients, some desperate and dying, want to give it a try.
Why are so many hospitals opposed to trying safe, inexpensive Ivermectin? The answer is tied to the complicated financial house of cards covering the entire health care system.
This isn’t a story about Ivermectin; it’s about what COVID-19 exposed in America’s health care system. The federal government, pharmaceutical, and insurance companies hold the reins on what care hospital administrators can offer. They never looked at your chart, but have a say in your treatment, and doctors who stray from administrative protocol can kiss their careers goodbye.
Here is a look at the many forces driving health care decisions outside the doctor-patient relationship.
Sick People Are Profitable
Indiana-based Dr. Dan Stock is a family medicine physician connected to America’s Frontline Doctors, a medical freedom organization promoting treatments such as Ivermectin for COVID-19. He says finances guide much of today’s health care landscape.
“Almost no one pays for direct care anymore,” Stock told The Epoch Times. “You pay for your care as you give your money to the federal government through taxes, or to an insurance company through premiums.”
The insurance company or the government buys the service for you as a third party. That’s a problem, Stock says, because “The federal government never has paid its bills. Every doctor and every hospital lose money on every Medicare and Medicaid patient who comes in the door.” And to make up the loss, he says, the cost of health care is inflated for those with private insurance.
A 2017 fact sheet produced by the American Hospital Association said the annual shortfall borne by hospitals is $57.8 billion, and privately insured patients and others make up the difference.
Nonprofit hospitals are federally required to accept Medicare, Medicaid, retired military insurance, Indian Health Services, and all federal insurance programs.
This cost-shifting caused inflation of medical prices and that sparked increases in private health insurance premiums.
“Employers started screaming about it, people started dropping their private insurance because it just wasn’t worth the money anymore, so that’s why the Affordable Care Act got passed,” Stock said. “The idea was, look, market forces won’t make you join in and buy through the third-party payment scheme to keep Medicare and Medicaid afloat. Hospitals are screaming ‘we’re going to go bankrupt.’ So the Affordable Care Act comes out, which says that everybody in the country has to buy insurance, and if you’re an employer, you have to buy it for your employee. You’re not allowed to say no. If you do, we give you a great big tax.”
That kept Medicare and Medicaid funded, Stock says.
“But there was a problem with the Affordable Care Act. They have this thing called Medical Loss Ratio,” Stock said. “Somebody talked to these idiots in our federal government into saying, hey, if you’re a private insurance company, you have to spend 80–85 percent of the premiums you take in on medical supplies and services. Only 15–20 percent of it can be given to the stockholders or be used to pay administrative fees.”
Health Care Systems and Codes
How do insurance companies predict the public’s health?
Electronic records, developed around 20 years ago, helped doctors track patient data such as sodium level, blood sugar, and kidney function. About five years later the government realized hospitals and independent doctors were tracking that information but couldn’t share data with each other because of privacy rules associated with the HIPAA Law.
That is why, in 2012, Accountable Care Organizations (ACO) were formed. Doctors and hospitals that join an ACO are now working for one big employer.
Medicare and Medicaid said anybody who is not part of an ACO would have their reimbursement cut by 3 percent. It also offered a 2 percent increase to those who did join an ACO, Stock said.
“You’ve got to know that the margins in medicine are really narrow. Most hospitals have a one or two percent margin,” Stock said.
“The federal government then said, to get that 2 percent and to maintain your reimbursement, there are two other things you have to do,” Stock said.
First, ACOs became obligated to use an electronic medical record system and report data back to the feds and insurance companies.
The data doesn’t drill down to the level of “John Smith has asthma,” but it does tell what percentage of coronary artery disease patients are on a statin drug, or what percent of people with COVID-19 are being treated with respirators.
To enter the information into the computer system, doctors must link a treatment to a diagnosis. They must link a Current Procedural Terminology (CPT code) with an International Classification of Diseases (ICD diagnosis code).
“For instance,” Stock said. “I’m not allowed to just go write somebody a prescription for Losartan. I have to write a prescription for Losartan and link it to a diagnosis, in this case blood pressure, so they can tell what I did.”
If a doctor were to link a treatment like Ivermectin to an off-protocol diagnosis, such as COVID-19, the ACO will be financially punished and the doctor would face consequences, Stock said. To change the diagnosis code to a government acceptable code but use the medicine for something else would be fraud. The prescription must match the diagnosis in the protocol.
Here’s the second thing the government said you had to do to maintain your 2 percent reimbursement: the government and insurance companies came up with a Pay for Performance plan, also known as value-based programs.
“These programs reward health care providers with incentive payments for the quality of care they give to people with Medicare,” the Centers for Medicare and Medicaid Services (CMS) website says. “Our value-based programs are important because they’re helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.”
The CMS website lists “quality improvement organizations” that develop and implement these programs, including the National Quality Forum; the Joint Commission of the Accreditation of Health Care Organizations; the National Committee for Quality Assurance; the Agency for Health Care Research and Quality; the American Medical Association. Some of these groups are led by former insurance, pharmaceutical or CMS executives.
Now the government, advised by insurance and drug companies, defines what good medicine is, Stock says. Doctors must make a diagnosis and provide the protocol code of care.
CMS bases reimbursements on how well health care systems meet these guidelines.
Like a social credit score, individual health care providers are being scored by their performance.
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