Home

“Coverage” Isn’t “Care”

1 Comment

Contributor & author: Dr. Keith Smith, medical director, CEO and managing partner of The Surgery Center of Oklahoma and Member of the AAPS. See Dr. Smith’s bio at the bottom of this page.

Interview – Contact:  g.keithsmithmd@gmail.com or phone Dr. Smith directly at 405-627-0274

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Preview: 

  • if you have “coverage” and are low on funds, you should always ask the “cash” price for a service before revealing that you actually have “coverage.”
  • Perhaps the only gift of Obamacare was that the deductibles were very high and very few physicians or facilities actually signed contracts with these plans. This created a vigorous cash market, where patients who are “covered” but without benefit, could negotiate cash prices with physicians and facilities for the care they needed.
  • Medicare has criminalized charity, as demonstrated in a recent case of a Medicare beneficiary with a broken ankle who is stuck in a wheelchair because she can’t come up with her $2,000 deductible.
  • Leave it to government to force the purchase of this “coverage.” All who have been victimized by this cronyism have earned a seat on the #metoo bandwagon.

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – -~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

January 16th, 2018

“Coverage” Isn’t “Care”

by G. Keith Smith, M.D.

If you are following health-related topics on social media you have likely encountered “coverage is not care,” as a theme or #hashtag. This phrase/quip should be viewed as an opportunity and lens through which the dysfunction of the crony-dominated “healthcare system” in this country can be viewed.

Not only is “coverage” not equivalent to “care,” “coverage” can and many times does create a barrier to care.

It might shock you to learn that the “cash” price for many medications at your local pharmacy is less than the co-pay if you are using your “coverage” to buy these same medications. In other words, you are better off claiming to be uninsured when you buy certain pharmaceuticals! Why is this? Your “coverage” represents an additional, contracted layer—a toll booth—through which the exchange between you and the pharmacist must take place. This toll to pharmacy benefit companies/wholesalers is removed from the purchase if you represent yourself as uninsured. The presence of this middleman/distributor can and does increase the price of pharmaceuticals dramatically, representing as much as 50% of the purchase price for a large number of medications.

The same goes for the care at many physician offices. Any physician who is contracted with insurance companies labors under their fee schedules, any departure from which risks expulsion from the “network.” Physicians who waive all or part of deductibles for patients or treat cash-strapped patients free of charge run the risk of running afoul of these same “network” contracts and may also face legal action. What gives? More

Advertisements

Universal Coverage Means Less Care

1 Comment

Contributor & author: Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons (AAPS)

Interview – Contact Dr. Orient directly at (520) 323-3110 or by email at janeorientmd@gmail.com

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

When the money is gone, treatment is canceled. There will be fewer beds, fewer CT scanners, fewer drugs, and fewer doctors. But all will be fair. No rationing by price, just by waiting lines, political pull—and death. There will be no medical bills to pay after a service, if you get any service. Only taxes in advance, service or no service.

That’s why the universal care advocates count enrollees, not the number of services, and constantly harp on “excessive” treatment, even while planning to make patients wait months for an appointment.”

______________________________________________________________________________________________________

May 16th, 2017

The reported success of the Affordable Care Act (ACA or ObamaCare) is based on enrollment numbers. Millions more have “coverage.” Similarly, the predicted disasters from repeal have to do with loss of coverage. Tens of thousands of deaths will allegedly follow. Activists urge shipping repeal victims’ ashes to Congress—possibly illegal and certainly disrespectful of the loved one’s remains, which will end up in a trash dump.

Where are the statistics about the number of heart operations done on babies born with birth defects, the latest poster children? How about the number of babies saved by this surgery, and the number allowed to die without an attempt at surgery—before and after ACA? I haven’t seen them. Note that an insurance plan doesn’t do the operation. A doctor does. The insurer can, however, try to block it

Also missing are figures on the number of courses of cancer chemotherapy given, or not given, or the time from diagnosis to death in cancer patients before and after ACA. Five-year survival of cancer patients in the U.S. is generally better than in countries that have universal coverage, or the type of plan progressives want to import. Again, the insurance plan isn’t medicine. You can get medicine without insurance, and if you have insurance it might refuse to pay.

There are selected comparisons of change in mortality rates in states that did or did not expand Medicaid (such as New York vs. Pennsylvania). On the other hand, mortality did not decrease in one state (Oregon). These estimates—guesstimates really, are based on the weakest type of data, and the differences may have nothing to do with Medicaid. Maybe it was better AIDS treatments. We hope that the FDA does not use evidence this poor to evaluate drugs.

But what effect did ObamaCare have on overall U.S. mortality?

Between 2014 and 2015, U.S. mortality rates increased for the first time in decades. This primarily affected less-educated whites. Is ObamaCare the cause? There are many factors involved, drug abuse probably being the most important. But I suspect that if repeal had happened in 2012 or 2013, it would have been blamed.

More

New Obamacare Mental Health Policies Can Take Your Gun and Put You In a FEMA Camp

Leave a comment

Pay attention to this!

A NATION BEGUILED

http://www.thecommonsenseshow.com/2016/02/26/new-obamacare-mental-health-policies-can-take-your-gun-and-put-you-in-a-fema-camp/?utm_source=rss&utm_medium=rss&utm_campaign=new-obamacare-mental-health-policies-can-take-your-gun-and-put-you-in-a-fema-camp

2-27-2016 9-31-14 AM

by Dave Hodges

There is an ongoing battle for the psychological health and welfare of America’s children and eventually all Americans. Since 2002, the government has been intent on testing millions for mental illness. This obsession even extends to our veterans as they return from combat and leave the service. The veterans are increasingly being diagnosed as having PTSD and they are subsequently being adjudicated to not being eligible to own a firearm.

Marti Oakley has been at the forefront on covering elderly abuse in which the courts are stealing the property and incarcerating the elderly into mandatory detention in a care facility because they are mentally infirm. And why is this happening? If an elderly person fails to balance their checkbook, for example, they are robbed and confined by the courts.
These practices are reminiscent of how the Soviets used to imprison political enemies. The Soviets simply said…

View original post 1,754 more words

Candidate Bush Thinks Medicare Funds Should Be Redistributed From The Elderly To The Young

2 Comments

new-logo25By Elizabeth Lee Vliet, M.D.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

In an odd sense of timing, Jeb Bush, former Republican governor of Florida, released his plan for overhauling Obamacare on the same day as the first debate for the Democrat Presidential candidates, so there was little media attention to his proposals. Governor Bush’s plan does address some of the worst provisions of Obamacare and pushes for a more limited role of the federal government. But it’s still a very mixed bag.

On the plus side, the Bush plan lacks the massive micromanagement of Obamacare. It would08-10-2015_Illusion give states more flexibility to decide how best to use a pool of money from federal taxpayers to provide medical coverage for those with low income and/or pre-existing conditions. But each state would still have to meet federal criteria on various outcome measures, yet to be determined. This is a “tweak” but not a “fix” for a serious flaw of Obamacare.

Bush proposes an overhaul of the Food and Drug Administration (FDA) that is long overdue and badly needed. As he stated, “It should not cost $1.2 billion to $2.6 billion nor take 12 to 15 years to advance a medicine from discovery to patients, but that is the case under the Food and Drug Administration’s current regulatory mess.” In my field of medical practice, American women were denied FDA approval of Estrogel, a bioidentical estradiol gel for menopause therapy, for 30 years after it was approved in France and widely used around the world.

Another plus is that Bush proposes to end the inequality in tax treatment of employer-sponsored health insurance plans, which are free of both income and payroll taxes, and individually purchased policies, which are not tax-deductible, and must be purchased with after-tax dollars. In other words, owning your own policy absorbs up to twice as much of your earnings as an employer-owned policy. This inequity leads to “job lock”—people are dependent on their employer for affordable health coverage. Your employer doesn’t own you, but he may own your health insurance!

The Bush plan, however, like many other supposedly conservative plans, uses the idea of a “refundable tax credit” to help pay for health insurance. If the amount is greater than taxes you owe, it is an outright subsidy, a transfer from other taxpayers’ earnings to health insurance companies. In other words, it is a wealth redistribution scheme that distorts the market by prepaying for other people’s “healthcare” (which means their medical care plus a generous cut to its managers and payers).

Fundamentally, Jeb’s plan suffers from several fatal flaws common to many proposals:

  • The idea that government should be involved at all in regulating and overseeing medical care. Government-mandated coverage and onerous regulations are at the root of the massive cost increases in health insurance premiums under Obamacare.
  • The idea that funds should be redistributed from Medicare serving the elderly to pay for the expansion of Medicaid for younger people. Obamacare’s redistribution of medical service funds takes money from sick older patients needing cancer treatment, joint replacement, hospital readmissions for relapses of heart or lung disease, hospice, and home health care of the sick to instead provide “free” abortion, contraception, and preventive screenings to younger, healthier people. Bush is apparently silent on the more than $700 billion Obamacare cut from Medicare to spend on more politically favored younger groups and their lifestyle choices.
  • The idea that Obamacare can be “tweaked” rather than repealed in its entirety. To date, Senator Ted Cruz is the only Presidential candidate of either party to call for total repeal of Obamacare, not just “tweaking.”

Obamacare is a “bomb” about to destroy the world’s best medical services. It is already causing health insurance premiums to explode, and causing massive damage to the economy with its job-killing mandates on employers. You wouldn’t want the bomb squad to “tweak” a bomb that is under your house, as Bush proposes. It is time for this bomb to be dismantled and removed completely as Senator Ted Cruz proposes, before more damage is done.

We need a candidate who sees clearly the harm that Obamacare is doing to individuals, medical practices, patient services, and the economy. We need to repeal Obamacare’s whole tangled structure and start over, with market-based, patient-centered solutions. We need to end the idea that the federal government can “fix” quality or cost by overseeing and interfering in medical decisions. The power to make those decisions belongs in the hands of patients, in consultation with their chosen physicians.

http://www.aapsonline.org

Author/Contributor short bio:  Elizabeth Lee Vliet, M.D.,

Dr. Vliet is Chief Medical Officer of Med Expert Chile, SpA, an international medical consulting company based in Santiago, Chile whose mission is high quality, lower cost medical care focused on preserving medical freedom, privacy, and the Oath of Hippocrates commitment to individual patients. Dr. Vliet is a past Director of the Association of American Physicians and Surgeons (AAPS). Dr. Vliet also has an active US medical practice in Tucson AZ and Dallas TX specializing in preventive and climacteric medicine with an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems.   Dr. Vliet received a NECO 2014 Ellis Island Medal of Honor and the Arizona Foundation for Women 2007 Voice of Women award for her pioneering medical and educational advocacy for overlooked hormone connections in women’s health. She received her M.D. degree and internship in Internal Medicine at Eastern Virginia Medical School, and completed specialty training at Johns Hopkins Hospital. She earned her B.S. and Master’s degrees from the College of William and Mary in Virginia. Dr. Vliet has appeared on FOX NEWS, Cavuto, Stuart Varney Show, Fox and Friends, Sean Hannity and many nationally syndicated radio shows across the country as well as numerous Healthcare Town Halls addressing the economic and medical impact of the 2010 healthcare law. Dr. Vliet is a past co-host of America’s Fabric radio show. Dr. Vliet’s health books include: It’s My Ovaries, Stupid; Screaming To Be Heard: Hormonal Connections Women Suspect– And Doctors STILL Ignore; Women, Weight and Hormones; The Savvy Woman’s Guide to Great Sex, Strength, and Stamina, and The Savvy Woman’s Guide to PCOS. Dr. Vliet’s websites are www.HerPlace.com, and www.MedExpertChile.com.  

This release was brought to you by Angel Pictures & Publicity

 

Danger: Interstate Compact Could “Fundamentally Transform” Medicine

2 Comments

new-logo25

Jane M. Orient, M.D.

While Americans are preoccupied with the political theater of the Presidential race, special interest groups toil to pass legislation that could radically transform your medical care. One example is the Interstate Medical Licensure Compact, which has passed in 11 states. Pennsylvania has joined a number of others in proposing it.

The proposal promises to provide “remote communities with access to high-quality care through telemedicine” and “address a shortage of medical personnel in underserved rural and urban regions,” according to an article in the Pennsylvania Business Daily.

Americans need to remember three things about proposed legislation:

  • Its real purpose is likely to be very different from the stated one, and the result may be the opposite of the one that is promised.
  • Especially when the same law is surfacing simultaneously in a number of states, some vested interest wants to make money from it. A lot of money—getting laws passed can be very expensive.
  • There may be no way back, as the law empowers and funds interest groups that will oppose repeal.

So what does the Compact do to bring telemedicine to underserved areas? By itself, nothing. It’s about a bypass to state control of licensure, not about providing care. If telemedicine were the real object, the way to expedite it would be to define the location of medical care as the location of the doctor, not the patient. The doctor would need a license in only one state. Compact proponents oppose a telemedicine bill in Congress that would do just that.

Some physicians already hold a license in several states—they just apply to each state. Under the Compact, they would apply to a private interstate commission, which would have its own rules, possibly overriding rules of the states, and which would have no public accountability. This would add costs, not eliminate them. It could also allow doctors to evade state laws meant to protect patients. For example, a carpetbagger abortionist could fly in to do late-term abortions forbidden by the state, under his Compact license. More

Be Careful about Replacing ObamaCare

1 Comment

new-logo25Marilyn M. Singleton, M.D., J.D.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Since the day the Affordable Care Act was enacted, we have been subjected to the “repeal and replace” mantra. Replacement offerings are basically slimmed down versions of the ACA. A few brave souls have proposed a straightforward repeal. Of course, such bills were merely making political hay since Obama would never sign away his namesake law.

Several GOP presidential candidates have doubled down on the misguided “repeal and replace” promise, including the yet-to-be-elucidated “Donaldcare.” But the real question is whether the ACA should be replaced at all.

Any healthcare “system” – new or old – is subject to the long arm of the federal government. Central control does not have a good track record for creative solutions, security, fraud control, administrative efficiency, or the ability to change personal habits.

The federal government has yet to figure out a way to comply with HIPAA’s twenty-year-old mandate to remove Social Security numbers from health insurance cards. Consequently, the mere possession of a Medicare card poses the risk of identity theft in our most vulnerable population.

And speaking of identity security, a core tool of the healthcare system is the electronic health record. Health “providers” seeing Medicare or Medicaid patients must have “meaningful use” of electronic records in their offices or face monetary penalties. However use of wireless networks for sensitive information requires sophisticated security measures most physician offices do not have. Moreover, even with the highest-level resources at its disposal, the federal government has failed to secure its own records.

More

King v. Burwell: The Fix Was Definitely In

3 Comments

new-logo25Richard Amerling, M.D.

________________________________________

As I predicted back in March, the U.S. Supreme Court ruled for the administration in King v. Burwell. So I was not surprised by the decision, but that doesn’t mean I am not deeply disappointed. I am.

Beyond the ramifications for the continuation of the abominable Obamacare, the obvious truth is that we are being ruled by a corrupt oligarchy that includes the majority of the Supreme Court. This was driven home on Friday by the discovery by Justice Anthony Kennedy of a right to same-sex marriage in the “shadows and penumbras” of the Constitution, which will certainly ignite another never-ending culture war in the country.

Further legal challenges to federal over-reaching are likely to fail. There are constitutional remedies to this tyranny, as Senator Ted Cruz points out, including action by Congress to either impeach members of the Court, or to limit the Court’s jurisdiction. Neither of these options is feasible, given current lily-livered Republican leadership, and of course, a presidential veto. This leaves a constitutional amendment to overturn the decision, originating either in Congress, or in a convention of the states, as specified in Article V.

We are living, as says radio host Mark Levin, in a “post-constitutional republic,” where rules and laws are concocted by a small group of elites, either unelected or elected in perpetuity by a tiny fraction of the electorate, and who are unresponsive to the will of the people.

What does this decision mean for the medical profession, and for those who depend on us for care? We are in dire straits!

Obamacare, and more recently the Medicare Access and CHIP Reauthorization Act (MACRA) solidify bureaucratic control over the practice of medicine. We have already seen the widespread closing of private practices, with now over two-thirds of physicians working under a hospital umbrella. Those who remain private are under immense pressure, both financial and regulatory, and many will fold their tents. In addition to rigid price controls on their fees, there are never-ending requirements for documentation via the electronic health record of personal clinical details, to be used eventually to centrally direct care.

MACRA cements into place various payment schemes such as bundling, accountable care organizations (ACOs), and other forms of “payment-for-outcomes,” that will be applied to the Medicare program, and ultimately to private insurance.

All of these systems create financial disincentives to caring for truly sick patients, and will have a devastating effect. Patients will be increasingly subjected to one-size-fits-all care, dictated by algorithms inserted into the electronic health record. These will be created by professional groups, such as the American Medical Association, the American College of Physicians, and the American Board of Internal Medicine, and will be labeled as “evidence-based,” or “best practices.”

This will lead to even greater over-prescription of statins, anti-hypertensives, and diabetes medications, based on achieving certain numerical “targets.” Many individual patients will certainly be harmed by this approach.

To maximize revenue, physicians will dutifully click on boxes and comply with the central mandates. Thus will fade the Hippocratic ethic to render their best judgment on behalf of their patients. Over time, the medical profession will devolve from a science-based art into a trade requiring less training and less experience. Doctors are already being indoctrinated away from a commitment to individual patients and towards allegiance to the state, or to “society.” This should be of grave concern to all of us.

To defend what is left of the private, independent practice of medicine, doctors will have to “opt out” of official, government medicine, and go back to the days when we worked for, and were paid by, our patients. This will allow the continued delivery of high quality, personalized care, and the survival of Hippocratic medicine for future generations of physicians.

And given the tyrannical nature of our government, doctors need to opt out while they still can. It is not inconceivable that the federal government would, completely without authority and violating the 10th Amendment insuring state sovereignty, federalize all state medical boards. They could then institute a federal medical license, and make licensure conditional on agreeing to accept all government insurance as full payment. We need a critical mass.

And who would stop such a move? Clearly not the Roberts Court!

###

http://www.aapsonline.org/

Richard Amerling, MD (New York City) is an Associate Professor of Clinical Medicine and an academic nephrologist at Mount Sinai Beth Israel in New York. Dr. Amerling received an MD from the Catholic University of Louvain in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is President of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence and is a seasoned speaker and on-air contributor.
• Dr. Amerling on the Steve Malzberg Show: http://www.youtube.com/watch?v=2Jav5QONqlw
• AAPS Director (Dr. Amerling) on Glenn Beck Show: http://www.youtube.com/watch?v=HX0WRvwaw5Y
• Dr. Richard Amerling is Associate Professor of Clinical Medicine at Mount Sinai Beth Israel in New York City and he gives Dr. Gina the facts on Ebola: http://www.politichicks.tv/2014/10/much-worry-ebola/

Older Entries

%d bloggers like this: