Sunday, October 25, 2009

Cover Florida

Attached an article in todays Miami Herald pointing out the problematic issues of the so-called " Cover Florida" insurance program touted by Governor Christ as the solution for the Uninsured.
Here are some facts:

* in many cases it offers a barebone service package.
* participating insurance companies still do not offer comprehensive services for competitive prices DESPITE the claims made by the Governor that" each provider was chosen by the state through a competitive bidding process."
* To date, about 4,500 people have enrolled -- about 0.1 percent of the state's uninsured population. More than 3800 Floridians loose their health insurance every week!!!

The question remains: is this program the result of an honest effort to find a solution to cover the Uninsured, or just another political campaign trick meant to boost the chances of Governor Christ to enter the US Senate?
Needless to say that he still refuses to accept a public option, but has yet to declare if Florida will opt out such an option if offered on federal level.
My gut feeling? He will do anything to get elected even if it means to scarify more Floridians on the altar of political vanity.

Posted on Sat, Oct. 24, 2009
Crist exaggerates benefits of Cover Florida Health Care program

PolitiFact Staff Writer

In a recent Fox News interview, Florida Gov. Charlie Crist boasted about Cover Florida Health Care, an effort to provide low-cost healthcare coverage to the nearly four million uninsured in the state.
``There are no government mandates to it, no tax dollars utilized for it,'' Crist said on Wednesday. ``Just good, aggressive negotiating by our administration with health insurance companies. . . . And, really, the problem with healthcare is that it's expensive. And so what we've attempted to do is reduce the cost by reducing the expense and the premium of health insurance, and we've had success doing so. Usually it's about $900 a month to get health coverage. We've reduced that, on average, to about $150 a month.''

Given all the debate over the high cost of healthcare, we wondered if the plan could be as inexpensive as Crist claims. We found he was distorting the savings by mixing apples and oranges.

The program, which was started in 2008, allows individuals who have been without coverage for at least six months to pick from plans offered by six insurance companies. Each provider was chosen by the state through a competitive bidding process, and each offers at least two options -- one with catastrophic and hospital coverage, and another plan that can provide less coverage.

The program's website says that individual plans can be purchased for as little as $23 or as much as $800 a month, depending on age, gender and level of coverage. Patients pick and choose between various options offered through the six insurers. So, for example, a woman who is between 19 and 29 years of age can pay $130 a month for a plan that includes no deductible, $10 copays for doctor visits, but no hospital inpatient coverage.


Since Cover Florida Health Care was enacted, critics have said the program hasn't done enough to cover the uninsured. To date, about 4,500 people have enrolled -- about 0.1 percent of the state's uninsured population.

The low-cost options so often touted by state officials don't offer patients much of a safety net, said Florida state Sen. Nan Rich.

``People are beginning to see that it doesn't cover anything,'' said Rich, a Democrat from Weston. ``It may be inexpensive, but it's inexpensive for a reason. It's a very low level of coverage.''

When we asked Crist's office about his claim -- that healthcare costs are on average $900 a month compared to $150 under Florida's plan -- we were told that the $900 figure cited by the governor came from the nonpartisan Kaiser Family Foundation and that it refers to the amount of money a family pays, on average, per month. Crist's office also noted that the figure is outdated (for instance, in 2006, the average monthly cost per family was about $950) and pointed us to a new Kaiser report released Sept. 15, 2009, that estimates families now pay about $1,114 a month.

So Crist is off by about $200 for family coverage.


As for the average cost under the Cover Florida program, Crist's office pointed us to a document that lists the different providers and their rates for individuals. The average for the higher-end coverage, which would include hospitalization and catastrophic insurance, is about $227, while the average for the less-expensive ``preventive'' plan was $89. So Crist's $150 number is the approximate average of the two.

But wait. The first number Crist cited is the Kaiser estimate for a family. The second number is for an individual.

We went back to the Kaiser report and found that the average cost for an individual plan is actually around $400 a month, which would mean the gap was not as dramatically different as Crist claimed.

Crist spokesman Sterling Ivey acknowledged the apples and oranges comparison but said the underlying point is still valid that the Florida average is lower.

But we find Crist is using sleight-of-hand, comparing numbers that aren't comparable. He's used a higher family number with a lower number for individuals. We rate his claim False.

Herald/Times staff writer Steve Bousquet contributed to this report.

Saturday, October 10, 2009

Healthcare Reform and Insurance Exchanges

Saturday, October 10, 2009

Letter To The Editor:

When reading John Dorschners article “Healthcare reform proposal on insurance exchanges was tried in Florida” I reached only one conclusion: why to try it again ?
The current system is broken. Costs are soaring and so are the numbers of uninsured Floridians.
The current reform proposal would require all Americans to purchase a flawed product: private health insurance which wastes one-third (31 percent) of Americans’ health dollars on nonsensical administration, huge profits and exorbitant executive pay. But there is one solution which few dare to explore: a single-payer system. Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Single-payer financing is the only way to recapture wasted and precious healthcare dollars. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care. Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace skyrocketing insurance premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing. Lets not waste this opportunity for meaningful change. It’s not too late!

Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717

Friday, October 09, 2009

The Old Guard Reveals Itself!

In a recent member communication the President of the FMA reflects on the issue of "Advanced Medical Home" and the primary physician shortage. I agree with him that we need more primary care physicians but his remarks reveal the true attitude towards family physicians by stating that "We in organized medicine need to make sure that secondary providers don’t usurp our traditional role as captain of the ship." Who are those "secondary providers?"
Family doctors, general internists, pediatricians, ARNPs, PAs??? Are we second class citizens too???
This dismissive remark is indicative of the pervasive mind set within the leadership of the FMA which thrives on the cold war-like black-and-white view of the world. But the current healthcare industrial complex (HDIC) consists of a tight web of services delivered across a horizontally and vertically structured set of providers, including physicians and allied healthcare professionals.
Its takes an unhealthy dose of delusional thinking to claim that ANYONE will be the "captain of the ship."
Moreover, Dr.Dolan and other FMA leaders refuse to recognize this reality and want to roll-back in time to the Garden of Eden of medicine where doctors and patients lived together happily until someone introduced the forbidden fruit of health insurance and government intervention.
We have to strike back against the perpetuation of those false beliefs suggesting that family physicians are taking over medicine as THEY know it.
These ideologues are beyond education. They cannot be talked too anymore. Its also useless to work with them on any issues as it pertains to primary care!! We have to define who we are and what we want and work together with consumer groups, unions and patient advocates to create the healthcare delivery system that we all deserve. Change is tough but necessary. Success favors the prepared and open mind. The odds are in our favor. Lets not miss this opportunity.

Tuesday, October 06, 2009

FMA Board Member in the News

In an (attempted) scholarly treatise Betsy McCaughey, the self-declared patient rights advocate, cited another "scholar", a fellow Florida doctor, as the new oracle of Delphi predicting the demise of medicine. Dr. David McKalip, a Florida neurosurgeon and a board member of the Florida Medical Association, predicts: "The only doctors left in Medicare will be those willing to ration care and practice cookbook medicine." Well, I am glad to know that Dr.Mc Kalip's looney-tunes are hitting the national headlines because it illustrates how he, and his fellow FMA apostles, really think about the future of medicine in this country.
The editorial is filled with half-truth, delusional confabulations using fear-based agitprop, or political propaganda promulgated chiefly in the former USSR.
Well, read it yourself to understand how our fellow FMA colleagues really feel. Enjoy and if you need something for nausea call me.


The 'kill granny' bill
Last Updated: 11:18 AM, October 5, 2009
Posted: 1:05 AM, October 5, 2009
AS the health-reform bills move through Congress, the prognosis for Medicare pa tients gets worse and worse.

The Senate Finance Committee bill (generally called the Baucus bill, after Chairman Max Baucus) robs the elderly to cover the uninsured -- like snatching purses from little old ladies. The House bills already cut future funding for Medicare by $500 billion over the next decade. The Baucus bill would slash a similar amount, just when 30 percent more people enter the program as baby boomers turn 65.

The Baucus bill also puts new limits on what doctors can do for patients in Medicare:

* A "race to the bottom" provision (p. 102 of the revised chairman's mark) would take effect each year for the next five years. The provision penalizes doctors who end up in the 90th percentile or above on the cost of what they use to treat their patients, compared with national averages. The intent is to force down the cost of care, year by year. Yet this blunt instrument can't determine which care is actually wasteful -- it will punish doctors for treating high cost patients with complex conditions. Inevitably, it will lower the quality of care.

* Even more devastating is the amendment Sen. Maria Cantwell (D-Wash.) got inserted into the bill (revised chairman's mark, pp. 102-3). It gives the Secretary of Health and Human Services the power to define quality, cost-effective care for each medical condition and penalize doctors who spend more on their patients.

The law establishing Medicare in 1965 barred the federal government from interfering in doctors' treatment decisions. Slowly, Medicare regulations have begun unraveling that protection. Now the Cantwell amendment finishes the job.

This is the most extreme change to Medicare ever. Dr. David McKalip, a Florida neurosurgeon and a board member of the Florida Medical Association, predicts: "The only doctors left in Medicare will be those willing to ration care and practice cookbook medicine."

It's reasonable for Medicare administrators to strive to get value for dollars spent. In recent years, Medicare has taken a slow, tight-fisted (and sometimes arbitrary) approach to paying for new drugs or medical devices. But Cantwell aims directly at doctors' decisions.

That's not surprising. President Obama and his advisers vilify doctors for over-treating patients. Dr. Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel and a key Obama health-care adviser, argues that the Hippocratic Oath is largely to blame for the "overuse" of medical care.

In his view, doctors focus too much on the needs of their own patients; they should be taught to ask whether the money they're spending on a patient is worth it. To curb doctors' spending, the stimulus legislation launched a process of sending doctors protocols via computer on what the government deems "appropriate" and "cost-effective" care. Doctors who are not "meaningful users" will be punished financially.

When I warned that this meant the government would be interfering in doctors' treatment decisions, CNN and said that was untrue. But Dr. David Blumenthal, appointed in March to head the new system of computer-guided medicine, settled that debate. In the New England Journal of Medicine (April 9), he confirmed that "embedded clinical-decision support" (his term for computers telling doctors what to do) would be used to reduce costs, and he predicted that some doctors might rebel against tight controls.

The Baucus bill completes the framework for tying doctors' hands when treating the elderly.

Driving all this is the misconception that doctors spend wastefully on patients who are about to die. Newsweek's recent cover story, "The Case for Killing Granny," argues that "the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate."

Numerous studies prove that is false. In 2006, Emory University researchers examining the records of patients in the year before they died found that doctors spend far less on patients who are expected to die than on patients expected to survive.

The Emory researchers said it's untrue that "lifesaving measures for patients visibly near death account for a disproportionate share of spending." They also found that doctors often can't predict when a patient is in the last year of life.

In any case, the health-reformers' plan to cut spending on patients 65 and older won't simply reduce end-of-life care, it will also eliminate care for patients who are perfectly capable of surviving their illness and going on with life.

Betsy McCaughey is chairman of the Committee to Reduce Infection Deaths and a former New York lieutenant-governor.