Health care Systems in Europe

It is down  to 'crunch time'. The media are calling this the biggest speech of President Obama's first year in office.  The media thrives on playing off Republicans vs. Democrats, Left vs. Right.

We physicians are cynics when it comes to government and bureaucracy.  We like to get down and 'dirty' and see and treat with minimal interruption, minimize record keeping, and other paperwork.   Let's be real....for every patient encounter..ten minutes of recording data or notes adds up to several hours/day.

Will EMR improve efficiency?  Perhaps it will if someone other than the physician enters the data.  At 200 dollars/ physician  hour in productivity assigning this responsibility is both foolish, and not cost effective.  How many secretaries earn two hundred dollar/hour?

Physicians are a 'hard sell', by the very nature of our training, we observe, gather facts, study, analyze and render opinions, and diagnoses. 

Most of us have had the privelege and ability to chose the type of organization in which we practice and see patients.  Whether it is a group, large integrated healthcare organization or solo practice, we have had the ability to chose.

This weekend from September 10th through September 13th a number of physician groups will travel to Washington, D.C. to  meet with their representatives.  No doubt the media will be there as well.

Our angst will be shared with the unemployed, foreclosed, and uinsured, amidst a sea-change in credit markets, corporate mergers, federal bailouts of banks, financial markets, and underwriting the automobile industry, once the golden measure of American success .

Our government borrows money for many reasons...to fight wars, to fund large building projects, for operational expenses of the pentagon and many other government activities, NASA included.

Many of these activities are accomplished at the expense of healthcare. What are our priorities? 

This does not seem to be a prudent  time to make another revolutionary change in a segment of our economy which now represents 16% of the GDP. 

Most of us patients, and providers alike see access as a problem both in terms of availablilty and affordability, as well as predatoroy insurance company practices.

We need to plug the holes in our system.  There are many other health systems that do just this.  Universal payor is not synonymous with socialized medicine, despite what the AMA and some physicians state.

T.R. Reid points out the strengths of the systems in France, and Switzerland, which provides guarranteed health care for all citizens. 

Depending on the way of financing there are 4 healthcare models

Health Care Systems - Four Basic Models

“Semashko” model – state monopoly

“Bismark” model –social health insurance system

“Beverage” model – a combination of National Health Service and health insurance

“Kennedy” model – also a mixed system, with private structures prevailing in both healthcare and health insurance.

THE GATEKEEPER

Labor Day

Here it is the last of the four day weekend for me.  Seems it was just Friday with three days off.

I had a chance to do much reading and study all the different propositions for health care reform.

Analysts all agree that the United States has the best quality of science, and technology available to those who can pay for it. Our system of health care payments is failing (or has failed), much like the 'bubble' in real estate, financial markets, and internet technology.

So why should we be any different?

T.R. Reid offers a dispassionate appraisal of health systems throughout the developed world.  Reid is a strong proponent of unified health care delivery. He states that the best programs, such as those in Switzerland, France, Germany and Taiwan (yes Virginia, Taiwan). are actually private models, unified by universal access, universal payment standards, and governmental subsidy for those that are uninsured, or uninsurable. They are not employer based.

He espouses the opinion these systems are not 'socialized medicine systems.

His 2008 Frontline documentary, "Sick Around the World", looked at the comprehensive health care systems of five developed economies from around the world. The first two countries visited were the U.K. and Japan, where he had previously worked and also received medical care.^[4] They were followed by Germany, Taiwan, and Switzerland.^[5]  

The AMA has a Blog

The AMA has a blog (no comments allowed, yet), and a VISION for Health Reform. It all sounds so wonderful and idyllic. Some of us bought into this mindset decades ago with good intentions, only to be used, abused, and betrayed by many who we thought were on the same road to provide care to our patients. The AMA still has good intentions, but it may be warped into positions which are not intended by the membership, (and non-membership). These physicians have little to say in the organization, if they continue voting with their feet.

del.icio.us Tags: ama,blog,social media,health reform

Universal Debt

I have not been posting as regularly as I would like to. I've been busy working and spending whatever leftover time reading about proposed health care reform....The townhall meetings have raised a lot of questions and questionable answers.  Legislators admit, there is no bill.  (How could President Obama even suggest it could be decided an passed before the August recess?)

One has to learn to read between the lines and hear what is not being said during these townhalls.

A disturbing trend is how the media develops opinions and offers criticisms regarding the proposals.  I've taken some time to read parts of the drafts and read some analysis by those who have a lot more time than I do.

There is a high interest and    opinions in the blogosphere as well. I check on that daily to find bloggers have a lot of  'sechel', a yiddish term for common sense and smarts.

To keep my brain from rotting out as I approach retirement I have  contracted with the --------- (at an undisclosed location). After a long and busy professional life in private practice I am now a 'humble" worker in a defense installation. I've been here about a year and as I have always suspected that this is how socialized medicine would be.

I see 14 patients a day, spend about half of my day entering histories and finding into the EMR.  Sometimes I have a technician, and rarely have an assistant with me at surgery. In private practice most eye surgeons will do 4 cases/hour, here it's about one and maybe 2 cases/hour.  No ASC or surgery center could make it on that volume.  In a socialized system, it would not matter....in fact it would be a good thing.  I do my own clerical work, phone calls, chase down small things (much like an intern). I have volunteer workers who come to my office and open my cabinets, to explore and see if I have any 'unauthorized and/or expired bottles of drops in my cabinets. If so, they disappear without any communication with me.  I am not allowed to keep things like 1% Atropine in my lane, for fear I might use it to dilate a general by mistake for over a week. 

Surprisingly coding is a big issue....and I spend at least half of my documentation with CPT and ICD coding.  The  ----- does use an accountability system based on RVUs and each doctor is audited, so that the budget can be justified.  The system however is a bit unique and allows 'up-coding' generously, in that bilateral procedures are coded for twice the RVUs.

On the up side,as I head closer to retirement, this phase of my career allows me to continue caring for patients...the reason I went into medicine in the first place...We all know how much commitment, dedication and sheer will power and energy is required to practice medicine either solo or in a group setting.

Interspersed with all of this  is the necessary day to day family and individual personal and financial commitments.

Unless you have walked in my shoes....don't criticize, or give me unneeded advise, unless I ask.  I am not bashful about telling some pundits and 'reformers' to "buzz off"

HR 3200--The not so Fine Print

Congressman Mike Rogers, Michigan speaks about HR 3200.

 

Pass this along to your colleagues, and  your patients.....

Perverse incentives:::

Don't Leave Us Behind

KEVINMD always finds these 'neat programs'.

The AMA has a Blog

The AMA has a blog (no comments allowed, yet), and a VISION for Health Reform. It all sounds so wonderful and idyllic. Some of us bought into this mindset decades ago with good intentions, only to be used, abused, and betrayed by many who we thought were on the same road to provide care to our patients. The AMA still has good intentions, but it may be warped into positions which are not intended by the membership, (and non-membership). These physicians have little to say in the organization, if they continue voting with their feet.

del.icio.us Tags: ama,blog,social media,health reform

Travel Subsidy on the Health Train Express

The real 'deal'

The American Medical Association came out in favor of the House Democratic health care bill when the House Democratic leadership promised the doctors $230 billion in new spending to cancel out any future Medicare physician cuts (which are scheduled under an existing law called the Medicare Sustainable Growth Rate Formula). As a result, the doctors don’t have to give up anything under the health bills, and would actually pick up $230 billion under the House bill over 10 years.

Hundreds of 'sound bytes' and snippetes of highly charged statements are read daily by patients, providers and decision makers. Unfortunately for the uninformed (and even the informed) ferreting out the 'truth' is very difficult.

Both Republicans and Democrats seek the position to regain p ower, or retain power.  One has to take with a grain of salt, analysis from either side of the aisle.

It's up to we the people to analyze and make your own decision regarding health issues, and be certain your opinion reaches your representatives.  Avoid being a leftist or a right winger.

Perhaps we should not make any decision this year in the midst of economic upheaval from which we have not yet recovered.

Bailing out banks, financial institutions, automobile industry have left us all a bit depleted and in no position to make such a critical decision.

Professionals cast a jaundiced eye upon statistics and projections of healthcare financing.  In reality it is difficult to imagine health care costs in 2016, while dealing at the present moment with a diffiicult system that is challenging to navigate for providers and patients alike.

I like to compare health reform to  the end goal of  orbiting  a satellite. The most effective means of accomplishing this task is by 'staging' a rocket with three booster segments.

It would be almost impossible to accomplish this task with a 'one stage rocket'. This is also true of health reform. 

One Small Step

Gravity acts to keep objects on earth and our present health system also retards change with inertia.

Here is some of the last weeks analysis.

WSJ's blog on health and the business of health.

Claims that health reform will be disastrous for businesses and government are wrong, writes Gary Locke, the U.S. secretary of commerce in an op-ed in the WSJ. Making his case for reform, Locke says that climbing health care costs already cost American businesses jobs and revenue, as well as entrepreneurship, and that isn’t sustainable. “In the short term, health-care costs pose a major problem for companies and their employees,” writes Locke. “In the medium and long-term, these costs pose serious challenges to our economy.”

Fixing Health Care will be good for the Economy

How Hospitals Could Profit from Health Reform

Rick Peters writes in The Health Care Blog

del.icio.us Tags: health reform,health train express,bailout plans

A Missing Passenger of the Health Train

Edward (Ted) Kennedy, D, Mass, departed from the Health Train yesterday. A significant voice in health affairs has left the stage. Not much more can be said by me when others have so elequantly described his life, and times.  Health Train Express offers condolences to his family and constituents.

A moment of silence.....

Ramblings on the Health Train

 

My day here at the government run undisclosed location started off with my morning read of health related blogs, pundits, and rumor mongers.

Buckeye Surgeon from Ohio presents a personal interview with two of his medical school chums, one in private practice and the other who is employed by the Cleveland Clinic. Rather than trusting media sources and medical management statistics, Buckeye decided to do his highly statistically significant study with a cohort of two…..My take on the interview is that some doctors like to work in a group practice, while others are individualists, and like to work alone or in a smaller controllable environment, where you have a choice of wallpaper color, who you hire and fire, and are accountable for just about all you need to practice medicine, and all that you perform. That is what is so unique and vibrant about our health care system….choices for physicians and patients.

Over at MedPolitics , and RealClear Politics The discussion turns to the uninsured.

Here is the “scoop” from t he CATO Institute regarding the uninsured, and who they really are.

 

del.icio.us Tags: uninsured,medpolitics,health train express,buckeye surgeon

Lieberman--A Voice in the Wildness

Joseph Lieberman, (IDem) Senator from the nutmeg state, CT boldly goes where no man goes before...a voice of reason, perspective and quiet reasoning. (typical of Lieberman).

One of the Senate's most powerful Democrats, Joseph Lieberman  said  Sunday that President Obama should take an "incremental" approach to fixing health care and argued that the country should postpone adding nearly 50 million new patients to the government system until after the recession is over.

"We morally, every one of us, would like to cover every American with health insurance," Sen. Joseph Lieberman of Connecticut, told CNN's John King on the "State of the Union" program.

One of the Senate's most powerful Democrats said Sunday that President Obama should take an "incremental" approach to fixing health care and argued that the country should postpone adding nearly 50 million new patients to the government system until after the recession is over.

"We morally, every one of us, would like to cover every American with health insurance," Sen. Joseph Lieberman of Connecticut, told CNN's John King on the "State of the Union" program.

"I'm afraid we've got to think about putting a lot of that off until the economy's out of recession," he added.

"There's no reason we have to do it all now, but we do have to get started. And I think the place to start is health delivery reform and insurance market reforms."

 

 

Although we physicians recognize perhaps more than most that out health system is flawed, most know that this must be accomplished in small steps, focusing first on defects in our insurance system, which lead to the increasing numbers of insured, and increasing overhead to physicians and our society in general.

In the back of each our minds are the millions of uninsured who present in our offices, on an hourly basis,  in the emergency department and public health clinics. 

The term "The Public Option" thus far remains clouded in hyperbole, sounds good or bad, depending  if your leaning is to the left, or to the right.

For many "The Public Option" remains a poorly disguised euphemism for Socialized Medicine.

del.icio.us Tags: lieberman,public option,recession

Value, Security, Beauty and Elegance

Mark Smith, CEO California Health Care Foundation, (video link)  spoke at the Microsoft Connected Health Conference meeting in June.

Comparisons between Richard Nixon’s Health Reform Proposals and Obama’s proposals..as described by Mark Smith, illuminate the similarities and differences. Read what a staunch conservative Republican proposed for a national health universal payor program.

Mark Smith and the things to get ‘right’

1. Standards
2. How will we wire doctors …nagging fear
3. Attributes for providers:
   1. Simplicity, Adaptability, Functionality
4. Attributes for “patients”
   1. Value (for the patient) solve the patients perceived needs.
   2. Security and privacy issues
   3. Beauty, elegance (something ‘they want’)

Dr Smith presented what doctors and patients would like from health IT developers.

K.I.S.S.

Health care financing in itself is a morass of complicated systems. Those who wish to make it as simple as possible, are mistakenly driven toward a universal payor model. What lurks behind the scene with that model is unknown and unintended levels of bureaucracy and the considerable expense of reorganization of the entire system.

It seems public opinion is focusing on these elements:

1. Eliminate cherry picking by private payers, elimination of exclusionary policies and waivers as well as predatory premiums.

2. A public option (which could be temporary) for lapses in employment, and/or insurability, or disability

3. Developing an actuarial insurance base that includes all citizens of the United States.

4. Elimination of free care for undocumented aliens.

5. Elimination of reimbursements based upon procedural coding.

6. Transparency and private oversight of government insurance plans and development of health IT.

7. Improve physician availablity for both primary care and specialty physicians by ''federalizing' medical licensure. Present state regulations amount to restraint of free trade. State licensing largely depends upon national testing standards.

K.I.S.S.  Keep it Simple, Stupid !