Tuesday, August 25, 2009

White House Conference Call

Dear Colleagues:

Today in the evening, I participated in a White House Office of Health Reform conference call to discuss health insurance reform. The call was intended as a briefing for physicians to discuss issues related to health reform. It started at 8:35pm and lasted for an hour. The call was moderated by Dr.Kavita Patel, who serves with Senior Adviser Valerie Jarrett and worked herself a practicing Internal medicine physician. According to her information ~ 1900 physicians participated and > 400 questions were submitted in advance.
After a briefing about the status of the current health reform efforts ( see http://www.healthreform.gov) Dr. Patel answered several questions submitted in writing and then also by people who queued for a life Q&A sessions.
Several of these questions can be grouped as follows but this does not represent a complete list:

1) Medicare Advantage plans and how they can be adjusted to provide competitive and similar-priced services to all Medicare recipients. This question focused on the preferred financing of CMS for Medicare Advantage plans.
2) Increased reimbursement for primary care services and emphasis on quality versus quantity of care. Dr.Patel clearly identified with practicing primary care docs because she herself experienced the grueling schedule and resulting deficiencies in quality of care.
3) Training of more primary care physicians by dramatically increasing funding for the National Health Service Corps programhttp://nhsc.hrsa.gov/. Unfortunately, she missed addressing the necessary funding increase and removing of restrictions for primary care residency positions.
4) One doctor suggested moving from a fee-for-service reimbursement system to a global fee schedule, which in my opinion is sorely needed.
5) Another doctor suggested an end-of-life conference at the White House to rationally discuss this controversial issue and to debunk the "death-panel" propaganda perpetuated by some media outlets and political pundits.
6) In a final question a doctor asked why CMS does not reimburse for preventive care services.Definitely, a golden opportunity to change the current reimbursement system to emphasize and validate our daily effortsd and hard work.

In summary, this was an excellent opportunity to connect, to listen and to ask questions in a relaxed, well organized and calm atmosphere. The focus is on primary care: to emphasize preventive services, and to provide funding for increased reimbursement.
I am pleased that rational thought can prevail and I applaud the White House of Health Reform for their efforts. They announced more phone calls in the future. I strongly urge each of you to participate and to engage in a thoughtful conversation.

Bernd Wollschlaeger,MD,FAAFP,FASAM

Monday, August 24, 2009

Universal Health Insurance

Attached you find a summary of a bill (HR676)which so far has not been discussed during the current healthcare refom debate.It should be at least considered as an option and not discarded just because its politically difficult to promote.
Bernd Wollschlaeger,MD

H.R. 676, “The United States National Health Care Act,”
Or “Expanded & Improved Medicare For All”
Introduced by Rep. John Conyers, Jr.

Brief Summary of Legislation

The United States National Health Care Act (USNHC) establishes a unique American universal health insurance program with single payer financing. The bill would create a publicly financed, privately delivered health care system that improves and expands the already existing Medicare program to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income or health care status. In short, health care becomes a human right. With 47 million uninsured Americans, and another 50 million who are underinsured, the time has come to change our inefficient and costly fragmented non-system of health care.

Who is Eligible

Every person living or visiting in the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.

Health Care Services Covered

This program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, palliative care, podiatric care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. There no co-pays or deductibles under this act.

Conversion To A Non-Profit Health Care System

Doctors, hospitals, and clinics will continue to operate as privately entities. However, they will be unable to issue stock. Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHC program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those workers who are displaced as the result of the transition to a non-profit health care system will be the first to be hired and retrained under this act. Furthermore, workers would receive their same salary for up to two years, and would then be eligible for unemployment benefits. The conversion to a not-for- profit health care system will take place as soon as possible, but not to exceed a 15 year period, through the sale of U.S. treasury bonds.

Cost Containment Provisions/ Reimbursement

The USNHC program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment. A “Medicare For All Trust Fund” will be established to ensure a dedicated stream of funding. An annual Congressional appropriation is also authorized to ensure optimal levels of funding for the program, in particular, to ensure the requisite number of physicians and nurses need in the health care delivery system.

H.R. 676 Would Reduce Overall Health Care Costs

Families Will Pay Less

Currently, the average family of four covered under an employee health plan spends a total of $4,225 on health care annually – $2,713 on premiums and another $1,522 on medical services, drugs and supplies (Employer Health Benefits 2006 Annual Survey, Kaiser Family Foundation and Health Research and Educational Trust; U.S. Department of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.) This figure does not include the additional 1.45% Medicare payroll tax levied on employees. A study by Dean Baker of the Center for Economic Research and Policy concluded that under H.R. 676, a family of four making the median family income of $56,200 per year would pay about $2,700 for all health care costs.

Business Will Pay Less

In 2006, health insurers charged employers an average of $11,500 for a health plan for a family of four. On average, the employer paid 74% of this premium, or $8,510 per year. This figure does not include the additional 1.45% payroll tax levied on employers for Medicare. Under H.R. 676, employers would pay a 4.75% payroll tax for all health care costs. For an employee making the median family income of $56,200 per year, the employer would pay about $2,700.

The Nation Will Pay About the Same, While Covering All Americans

Savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all Americans while reducing health care inflation in the long term. Annual savings from enacting H.R. 676 are estimated at $387 billion (Baker).

Proposed Funding For USNHC Program

· Maintain current federal and state funding for existing health care programs
· Establish employer/employee payroll tax of 4.75% (includes present 1.45% Medicare tax)
· Establish a 5% health tax on the top 5% of income earners, 10% tax on top 1% of wage earners
· ¼ of 1% stock transaction tax
· Close corporate tax loopholes
· Repeal the Bush tax cuts for the highest income earners

Sunday, August 23, 2009

Speak Up Against Propaganda

Sunday, August 23, 2009

Letter To The Editor:

RE: Recess Rally

Naturally, every American has the constitutional right to free speech but healthcare protesters are going too far by likening Obama to Hitler or claiming that government will control when people die. It especially puzzles me that the many of those protesters opposing meaningful and necessary healthcare reform are Medicare recipient benefiting from a government controlled, single-payer system! Would those same people be willing to turn in their Medicare cards in protest too? Would those people consider me a “death panelist” because I follow Florida Law and need to discuss advanced directives with them? According to their “logic” hospitals, nursing homes, home health agencies, hospices, and health maintenance organizations (HMOs), which are required to provide their patients with written information concerning health care advance directives, are part of the “death panels” too!
We have to tune down the hyperbolic and toxic rhetoric fueled by fearmongers and anti-government nut wings and return to a rational dialogue to resolve an urgent problem: how to provide healthcare for all Americans.

Bernd Wollschlaeger, MD,FAAFP,FASAM
Family Physician

Friday, August 21, 2009

Lets Get Real:

Over the last few months I witnessed the almost hyperbolic rhetoric used by my colleagues in organized medicine calling for a “battle for freedom” to protect the “sacrosanct patient-physician relationship” against the perceived intrusion by “big government.” They are now joining the chorus of fearmongers who paint the apocalyptic vision of a world dominated by government rationing of healthcare and imaginary death panels forcing seniors to sign living wills condemning them to die.
Meanwhile, those of us who call for a rational discussion about the issues are being marginalized.
The worst if still to come: in exchange for their support of health care reform health insurance companies are being handed the big price: to offer insurance to the uninsured without having to change their business practice. Fiercely defended by Republicans, ideologically motivated leaders in organized medicine and conservative Democrats the CEOs of health insurance companies can continue to reap fat profits by limiting and rationing healthcare for millions of policyholders who are clueless that their policies may not deliver the promised coverage. This win-win situation for insurance companies will result in a loose-loose situation for the average healthcare consumer because the basic principle of meaningful health care reform is missing: tight regulation of the health insurance market.
Uwe Reinhardt, a renowned economics professor at Princeton, got it right. In his recent blog entry “Who Needs The Public Option?” http://economix.blogs.nytimes.com/2009/08/21/who-needs-the-public-option/#more-27531 he states that “Citizens in the rest of the industrialized world have long had easy-to-understand, reliable, life-cycle health insurance. They do not wake up at night worrying that their health insurance might be rescinded over some willful or inadvertent omission on health status during the application for insurance. Nor do they worry that they and their families will lose their health insurance coverage when the family’s breadwinner loses a job or switches jobs or location of residence. It would be very rare, indeed, in those countries to see a middle-class family lose all of its savings and perhaps even its home over unpaid medical bills……….our health insurance system leaves most Americans basically “unsured”: Private, job-based health insurance purchased in the large-group market is stable and reliable only as long as an employee keeps that job. It is not permanent, nor portable. It leaves Americans exposed to considerable financial risk over their life cycle. It is not “insurance,” but “unsurance.”
Even though, I do not agree with his assertion that a public option is not a necessary condition for healthcare reform I wholeheartedly support his argument that we “must convince the public and the legislators who do not trust it that with the help of government – including a wide set of new government regulations – the industry can transform itself into a structure that can offer Americans the same permanent, reliable, easy-to-understand life-cycle financial security that citizens in other nations take for granted and Americans crave.”
The main challenge remains: either creating a purely private-sector model that will offer individuals reliable, life-cycle health insurance with relatively stable premiums, and at premiums that are defensible, or opting for a taxpayer funded single payer health care system (Medicare For All). As long as the typical employment-based health insurance premium for family coverage is $12,688 per year - and rising exponentially – I opt for the only logical solution: single payer healthcare for all Americans!
Bernd Wollschlaeger,MD,FAFP,FASAM

Thursday, August 06, 2009

Healthcare For All

Dear Friends and Colleagues:
Attached a superb article by Dr. Dennis Mayeaux,President of the Florida Academy of Family Physicians, which was published in todays Miami Herald.

Posted on Thu, Aug. 06, 2009
Key to reform is doctor access for all

Comprehensive healthcare reform is a political and social challenge that has escaped this country for more than 30 years. This year, divergent interests are coming together to finally fix our healthcare system. There are proposals in Congress that would provide high quality, affordable healthcare and give people the choice of keeping their current insurance plan and their family physician, internist or other primary-care doctor.

As a family physician, I see the effects of our broken healthcare system every day. Let's face it. Access to coverage is never guaranteed. It is not easy to treat patients who are uninsured because they can't afford coverage or are unable to get coverage because of age or a pre-existing condition. Every day even insured patients are refused care because of coverage denials. I am tired of seeing my patients struggle paying for the healthcare they need. Healthcare reform can't come soon enough.

What does it take to make this happen?

• We first need legislation that covers everyone, requiring insurance companies to sell plans regardless of family history, or pre-existing conditions, and to guarantee that patients can renew their coverage after they've become sick.

• Legislation also needs to ensure that once people have insurance, they also have access to a primary-care physician. Unfortunately, there is a growing shortage of primary-care doctors to meet that need. The reformed system must value primary care if we want medical students to choose careers such as Family Medicine. We need family physicians to keep people healthy, provide early treatment for the most common health problems and coordinate comprehensive and seamless care when subspecialty attention is needed.

There is some good news. We have a vehicle that can begin making all these improvements happen. It's called the Affordable Health Choices Act being debated in the U.S. Senate. The House of Representatives is considering a similar bill, which also includes a focus on primary care. These proposals promise to ensure affordable health coverage for nearly everyone.

It's time to stop playing politics and solve the healthcare crisis. We must find a uniquely American solution that controls skyrocketing healthcare costs and gives our patients peace of mind when it comes to their healthcare.

Our Surgeon General nominee, family physician Regina Benjamin, hopes to be ``America's Family Physician.'' Having a family physician is vital to every Floridian's health. Let us support that goal by providing access to all.

Meaningful and sustainable healthcare reform is possible if Congress passes legislation that gives everyone in the United States access to a patient-centered medical home, where their doctor will ensure they get the care they need, when they need it and where they need it.

Dr. Dennis Mayeaux is president of the Florida Academy of Family Physicians.