Every American is entitled to affordable healthcare!

Saturday, April 4, 2009


Letter To The Editor

“Every American is entitled to affordable healthcare!”


The Miami Herald Editorial Board is correct: every American should have access to affordable healthcare delivered by a physician of their choice. But expanding coverage only increases the volume of healthcare services and costs! This shortsighted focus misses the bigger picture.
We have to realign our payment system and reward quality and not the quantity of medical services rendered. The current reimbursement system is centered on a volume-based model and must shift towards a value-based system instead. We have to rebuild our primary care system and reward family physicians who spent valuable time with patients teaching healthy lifestyle and nutrition to prevent the incidence of chronic diseases. We should motivate and reward physicians to integrate their practices within collaborative practice models or groups. Utilizing shared Electronic Health Records based on Web 2.0 technologies physicians can communicate easily and securely. Such systems can measure and compare their performance, create a framework for quality and not quantity based reimbursement. Furthermore, physicians will learn to work within a team of medical professionals to optimize the treatment outcome for their patients.
As a result of the above outlined steps we can finally provide a Patient Centered Medical Home with a high degree of personalized care coordination, access beyond the acute care episode, and identification of key medical and community resources to meet the patients’ needs.
We as physicians have the choice to proactively change the delivery of healthcare today! We have the tools available to make this happen. Lets not miss this opportunity!

Bernd Wollschlaeger,MD,FAAFP,FASAM - President, Dade County Medical Association
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com

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MIAMI HERALD

Posted on Fri, Apr. 03, 2009
Health insurance out of balance

Among the many issues on America's healthcare-reform agenda, one deserving a high priority should be to level the playing field for people looking to buy health insurance. As it now stands, insurers have most of the advantages. Example: rejecting potential customers because of ''preexisting conditions.'' Congress and President Barack Obama should put a stop to this practice. Meanwhile, Florida Insurance Commissioner Kevin McCarty should ask the Legislature for reforms.
Patients blacklisted

In a Page One story last Sunday, Miami Herald reporter John Dorschner described how some insurers use secretive underwriting guidelines to blacklist people with certain ailments or who take certain drugs. For example, one insurer's guideline recommends rejecting people who have diabetes, multiple sclerosis, schizophrenia, Parkinson's Disease, Hepatitis C or AIDS/HIV. Other guidelines suggest automatic denial of people who take the anti-clotting drug Plavix or Seroquel, of those who use prescribed anti-psychotic medications, and anyone who uses certain medications for sleep apnea.

Insurers should not be expected to automatically enroll anyone who applies for a policy. They must be able to determine the amount of risk they are taking on in order to price policies appropriately and to earn a profit. Insurers also need to be able to protect themselves from people who lie about ailments in order to get coverage. At the same time, though, honest consumers should get a fair shake, which means not having to demonstrate a level of pristine health that virtually no one can attain. Without the right rules in place, insurers would cover only healthy people and have no risk at all.

Insurers say that their underwriting rules are based on standards set by the industry and by the state and federal governments. This is where change should begin. President Obama has said he wants to make insurance much more affordable and that having nearly 50 million Americans without health coverage is unacceptable. He stops short, however, of embracing universal healthcare.

A bit of progress

In December, some of the country's top insurers said they were willing to stop using preexisting conditions as a basis for pricing policies in return for laws requiring universal coverage. This, at least, is a start. Universal healthcare may, or may not, be the best solution, but it is clear that too many Americans have been squeezed out of the insurance market -- and that must change.

Commissioner McCarty can get the ball rolling by asking the Legislature to adopt underwriting guidelines that protect consumers. Congress should help President Obama make health insurance available to every American.