WhiteCoat

The Demise of American Health Care

closedA couple of news headlines paint a bleak picture about the future of healthcare in this country.

First are some comments made by US Republican Senator George LeMieux. During a news briefing (video here), LeMieux expressed a concern that Obama’s healthcare plan would amount to “Medicaid for the masses” and would put all Americans on a government run or government controlled health care.

The Palm Beach Post News also ran a story regarding a speech given by Senator LeMieux where he stated that the cost of the bill over the next 10 years was grossly understated due to “funny math”. He estimated the true cost of the bill to be more than $2.5 billion over 10 years rather than the projected $849 million.
LeMieux stated that in order to decrease costs, the bill intends to cut Medicare spending by more than $500 billion – through $400 billion in cuts to home health providers, hospitals, hospices and others while decreasing subsidies to Medicare recipients by more than $100 billion.
My favorite quote from the article is the following: “If we really want to provide health care for Americans, why shouldn’t we give them the tools to go out into the marketplace and be a consumer, which we know will end up driving down costs.”
Another free market advocate. I love it.

As our legislatures plans to significantly cut spending on the Medicare program, today several Massachusetts hospitals are filing a lawsuit against the state of Massachusetts because the current reimbursements from Medicare and Medicaid are already too low. According to this article in the Boston Herald, Massachusetts currently reimburses hospitals for only 40% to 86% of the costs of providing care. Because at least 63% of patients going to these hospitals have Medicare or Medicaid, the low payments are pushing many hospitals “to the brink of financial ruin.” The state countered by stating that it recently increased payment to the hospitals by 10 percent. Unfortunately even a 10% increase still leaves hospital payments at 44% to 95% of the cost of providing care – still below the break even point.
No business can stay afloat when the costs of doing business exceed revenues.

Recall that in 2006, Massachusetts was the same state that established a mandate that every person in the state have health insurance … similar to the mandate proposed in the current US health care bill.
Also recall how, since this Massachusetts mandate was created, the number of visits to Massachusetts emergency departments increased 7 percent and how the cost of caring for patients in Massachusetts emergency departments increased 17 percent – due to the lack of primary care providers in the state.
Oh yeah, and in a survey last year, only 2% of graduating medical students in the country plan to go into primary care internal medicine.

So the plan in Massachusetts to insure all of its state residents has resulted in almost every state resident having insurance … and in more people having trouble finding care.
The greater number of insured patients increases the costs of providing care to those patients.
Then, to control costs, the government cuts or maintains ridiculously low payment schedules to providers – to the point that the providers are having difficulty staying in business.

Welcome, ladies and gentlemen, to your new national health care system.

The current health care bill plans to cut Medicare spending by $500 billion.
Medicare plans to cut physician reimbursement by 21% next month.

What good will your new health insurance be few providers are willing or able to provide care for you?

The biggest myth of this health care debate is that having “insurance” is equivalent to having “health care.” The two are not the same, nor will they ever be the same. Just ask people who have Medicaid “insurance.”

If the hospitals in Massachusetts want to get more reimbursements, suing the state is the wrong way to go about doing so. In this case, lawsuits are a costly lose-lose situation. All the money the hospitals spend in attorneys’ fees and court costs could be put to better use. Boston Medical Center already tried suing the state for the same reason and the litigation is still dragging out in court.

A lobbyist once told me that the quickest way to enact change is to cause a public outcry.

You hospitals want an increase in funding? Drop the lawsuits and just shut your doors. Take your ball and go home. Too many patients and almost every legislator in our government take their access to health care for granted. Let patients walk up to your facility with their insurance card in hand and let them jiggle the handle on on the door a few times before realizing that they cannot get inside. Stop providing care until the state and federal government provide better reimbursement.

If it costs these hospitals more to provide care than the hospitals are being paid, closing the doors would save the hospitals money each day that the doors are closed. Divert ambulances. Transfer admitted patients to other facilities. The 1.5 million patients each year, including more than 300,000 emergency department patients each year that are being treated at the near-bankrupt Massachusetts hospitals will have to be redirected to another facility to find their care – if care is available.

At the entrances of each closed hospital, post giant pictures of the state and national legislators and an explanation of how their actions or failures to act have caused the hospital to close. Make sure to include the date that the legislators are up for re-election.

Then give the local news stations a call to let them know what’s happening.

They’d have funding within a week.

46 Responses to “The Demise of American Health Care”

  1. Matt says:

    So all those physicians, nurses, and staff are just going to agree to be out of work during this proposed lockout?

  2. brett says:

    Why do they have to agree to it nitwit? When Circuit City closes the door do the employees and independent contractors have to agree to it?

    • Matt says:

      By “staff” I also mean the administrators. You know, the people who run it on a daily basis but are not nurses, physicians, etc?

      Circuit City filed BANKRUPTCY, smart guy. They didn’t just close to exert some political pressure. They had NO MONEY LEFT.

      Get the difference?

      • Ryan says:

        In the not so distant future there won’t be much of a difference.

      • Matt says:

        I don’t know. The government seems to be willing to keep printing money for healthcare – maybe not as much as one would like, but still.

      • throckmorton says:

        Matt:

        In our area only one of 6 hospitals operated in the black last ear. Each has maintained an 85% level of occupied beds. Hospitals make money on private insurance, lose big on self pay and Medicaid and lose a little make a little on Medicare. Hospital expenses are increasing each year.

        As more patients are shifted to a government pay such as Medicaid, the hospitals will be forced to close because they will just not be able to meed expenses. It is simple economics.

      • Matt says:

        Makes me wonder why you guys spend so much time worrying about and lobbying about malpractice issues that only benefit your insurers and so little time lobbying on things that truly affect your bottom line. Because here’s the deal – politicians will make sure their constituents, particularly the older most politically active ones, do get care. If they have to take over the whole system. You think you’re under a lot of regulation now? You have no idea.

      • WhiteCoat says:

        Unless they’re going to bring back slavery, no one can “make sure that their constituents get care”. You need to make sure that someone is willing to provide the care first. That will never occur by cutting funding to the point that it costs more to provide care than it does to close one’s doors.
        If the feds take over the whole system, then they’ll have to create enough providers to *run* the whole system. With the aging of the baby boomers and fewer students going into primary care, that simply won’t happen.
        You know why malpractice is a fundamental issue. I won’t continue to argue the point with you. Whether or not the fears are rational, they are real and will continue to have an adverse impact upon the system until they are addressed.

      • brett says:

        bankruptcy is bankruptcy a$$wipe whether it is a hospital or Circuit City. There are three hospitals within 35 miles of where I sit that had to do just that. Sorry door is closed….head to the next closest overburdoned ED and wait 8 hours-12 hours to get seen….if you require admission then wait 48 hours in the ED until you have a bed in the hospital.

      • Matt says:

        WC, you act like this is an impossibility. Yet it’s done all over the world in those same countries whose legal systems you want to emulate. France and England have doctors and single payer. Of course, their physicians make nowhere near what ours do. The developed world has doctors, and many people believe their healthcare systems are better than ours. So believing that this can’t happen is the height of foolishness.

        And you guys don’t have anywhere to go anyway. As toul your fears, the unbiased evidence shows little to no impact no matter what you want to believe. Your “reform” has been tried for decades with no discernible effect on healthcare costs or access. But you keep trying to put out the campfire while the forest burns around you. The funny thing is you might have a real impact on your life if you spent your time reforming a system you know and understand rather than one you don’t.

    • throckmorton says:

      Matt:

      Hospitals lobby far more than physicians. In fact, the hospitals secured the biggest deal from the Obama Administration and past administrations. This is why physician pay has remained the same over the last 15 years while hospital pay has rose.

      • Matt says:

        I would think that would make you reasess your lobbying/legislative priorities into things that more directly benefit you rather than your insurers.

      • throckmorton says:

        Matt;

        The hospitals are lobbying and still going out of business. They spend far more on payments than any other area. Still, they are going broke.

      • Matt says:

        I was looking for something on the overall economic state of that industry. You seen anything? Obviously some will go broke sometimes, like any business, while others will prosper. And I realize with many being non-profits its hard to really assess, but surely there is something which will give us an accurate picture.

      • WhiteCoat says:

        “things that more directly benefit you rather than your insurers”

        You’ve piqued my curiosity. What is it exactly that you think we should be focusing upon?

      • Matt says:

        Reform of your payment model. Something that has an immediate, direct impact on your income, your ability to control that income, your negotiating power, your professional autonomy, and your relationship with your patients.

        Now, I only have the knowledge you’ve shared with me about it, and people have a tendency to complain more than they praise, but it seems based on your complaints that you would desperately like to change this. Not only that, it seems odd to me that you can’t make more if you’re a better doctor. Instead of a professional whose advice and time is valued, you’re more like a delivery system getting paid per procedure performed.

        But, admittedly, your payment model does make your profession much more highly paid than it does mine, so maybe you’re ok with it and just haven’t talked about the good parts. Like not having to worry about your clients’ solvency.

      • WhiteCoat says:

        How many times have I advocated for “free market” principals?
        Payment reform will come, it will just be a gradual process. The transition is already underway – concierge care, urgent care, limiting beds in the emergency department, etc.
        The only problem is that the losers will end up being the patients who were sold some pipe dream about how having “insurance” would be a cure to all their ills and then woke up one morning and were unable to find a doctor that takes their insurance.
        I mentioned before that I think the health care system will become like the criminal legal system – “public defenders” for those who can’t pay and flashy big name attorneys for those with cash.

      • Matt says:

        Saying I am advocating “free market principles” doesn’t mean much. Because you tend to be somewhat of two minds in your specifics and tend to only support the free market when it benefits you, but not across the board for all.

        I realize payment reform is coming – what I wonder though is why you aren’t advocating with your dollars towards your lobbyists and in your public forum for one that truly benefits YOU. With specific legislative proposals.

        As to your comparison to the criminal system, I would agree with you in large part. Although I don’t know why you put public defenders in quotes. But again, is this what you want? And if not, what are you doing to stop it, or what are your lobbyists doing to stop it?

  3. jb says:

    It will happen. Also, what I do predict, is some hospitals will just stop taking Medicare and Medicaid. They will then change their ER to an Urgent Care Center taking only paying customers. Even though everyone will pay high taxes, people with money will go to these private hospitals, and we will go back to what we had 50 years ago where the rest go to the charity centers, with the nice hospitals providing cost efficient cheaper care.

    • MV says:

      If most visits to the ER aren’t emergencies and thus could be handled by Urgent Care Centers for much less money, then why don’t hospitals routinely divert non-emergency cases to urgent care? I have been to hospital waiting areas where on the left is the ED and on the right is urgent care at a tenth of the price, so I know it can be done.

      Or do most hospitals actually use those non-emergency insurance covered patients to pay for the hospital (or at least reduce the red ink)? In other words, if only emergeny patients showed up to an ED, would most of them have an even greater budget problem? It seems like such a simple solution, so there must be a reason it hasn’t been done….

      • Fyrdoc says:

        One acronym -EMTALA. You can not divert a patient to a lower level of care and every patient who presents to the department must get a medical screening exam. This exam takes time. Additionally a patient must be “stabilized” and the courts have held that if the patient claims to have pain greater than their “goal”, they are unstable.

      • Fyrdoc says:

        BTW – “Same department” urgent cares are considered emergency departments under EMTALA. They are one department, they just divide staff. The Michael Woods case began in the urgent care…

      • brett says:

        “then why don’t hospitals routinely divert non-emergency cases to urgent care?”

        EMTALA and LIABILITY

      • MV says:

        Frydoc:

        Thanks for the explanation.

        I find this interesting because this happened to me for treatment related to a work injury about five years ago in a large city in Ohio. While I went to the ED (virtually empty), I was evaluated in an urgent care setting I think it was extremely practical and cost effective (judging from the bill they sent me by mistake).

      • Max Kennerly says:

        Fyrdoc is right that EMTALA requires screening, but after that point the patient can indeed be “diverted” (EMTALA calls it “transferred”) so long as they don’t have an emergency condition. It’s thus possible, but complicated, as the ED would have to set up a “screening” that complies with EMTALA but is less than a full-fledged standard-of-care diagnosis. This isn’t impossible, but it’s not how most EDs are set up.

        The comment that “the courts have held that if the patient claims to have pain greater than their “goal”, they are unstable” is news to me. I haven’t seen that; what I’ve seen is that a hospital can get an EMTALA claim dismissed by asserting they never recognized an emergency. EMTALA doesn’t require hospitals meet the standard of care, just that they (1) screen patients and (2) stabilize patients they know to have emergency conditions.

      • Fyrdoc says:

        Max,

        From: http://www.emtala.com (a frequently utilized reference source for emergency physicians):

        What is an “emergency medical condition”?

        An attempt is made by the statute to provide a definition, but as usually happens, the legal definition leaves much to be desired. The determination is ultimately a medical one rather than a legal one. That is not to say that it is sheltered from review. As is the case with any medical decision, it must often be made quickly, with such information as is available, and is subject to critical retrospective review by physicians testifying as expert witnesses in the alien setting of the courtroom, in the event of litigation.

        The definition provided under the statute is:

        “A medical condition manifesting itself by acute symptoms of sufficient severity (including SEVERE PAIN) such that the absence of immediate medical attention could reasonably be expected to result in —
        placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

        serious impairment to bodily functions, or
        serious dysfunction of any bodily organ or part, or

        “With respect to a pregnant woman who is having contractions —
        that there is inadequate time to effect a safe transfer to another hospital before delivery, or
        that the transfer may pose a threat to the health or safety of the woman or her unborn child.”

        “Severe pain” is in the definition. “Severe” is defined by TJC as pain above the patient’s pain control goal.

        When can a patient be transferred to another facility?

        Under EMTALA, unless the patient requests transfer, this depends on whether the patient has become stable — i.e., whether his emergency medical condition has resolved.

        A transfer to another facility before the patient has become stable can only take place if it is an “appropriate transfer” under the statute.

        A transfer after the patient has become stable is permitted and is not restricted by the statute in any way. The statute’s restrictions apply only to transfers before the patient has become stable, either on his own or as a result of medical treatment. Of course, the question of whether the patient has become stable is sure to generate factual and medical issues when litigation ensues, so the prudent hospital is cautioned to tread carefully here.

        A transfer of a patient who is not experiencing an “emergency medical condition” is permitted and is not restricted by the statute in any way. In other words, and speaking a bit loosely, a patient may be freely transferred either before the emergency condition arises or after it has been resolved, and may only be transferred under a defined set of circumstances while the condition exists.

        What is meant by “stabilized”?

        As is the case with the term “emergency medical condition”, the statute offers a definition, but this determination is ultimately a matter of clinical judgment on the part of the medical professional assessing the patient. By contrast, the definition for a pregnant woman is clear and has little need for interpretation.

        The definition is:

        * (for emergency medical conditions) that no material deterioration of the patient’s condition is likely to result from the transfer or is likely to occur during the transfer;

        * (for patients in active labor) the infant and the placenta have been delivered.

        What is an appropriate transfer?

        An “appropriate transfer” (a transfer before stabilization which is legal under EMTALA) is one in which all of the following occur:

        * The patient has been treated at the transferring hospital, and stabilized as far as possible within the limits of its capabilities;

        * The patient needs treatment at the receiving facility, and the medical risks of transferring him are outweighed by the medical benefits of the transfer;

        * the weighing process as described above is certified in writing by a physician;

        * the receiving hospital has been contacted and agrees to accept the transfer, and has the facilities to provide the necessary treatment to him;

        * the patient is accompanied by copies of his medical records from the transferring hospital;

        * the transfer is effected with the use of qualified personnel and transportation equipment, as required by the circumstances, including the use of necessary and medically appropriate life support measures during the transfer.

        The statute provides that, if a physician is not physically present in the emergency room, the written certification in support of transfer may be signed by a “qualified medical person” in consultation with the physician, provided that the physician agrees with the certification and subsequently countersigns it. [42 USC 1395dd(c)(1)(iii)]

        Additional regulatory provisions

        The regulations add a requirement that the written certification contain an express summary of the risks and benefits upon which it is based [42 CFR 489.24(e)(1)(ii)(C)] and that the transferring hospital forward copies of test results which become available after the transfer. [42 CFR 489.24(e)(2)(iii)]

        The regulations also require that, if a physician has violated the EMTALA provision requiring that he respond if he is on call, the information conveyed by the transferring hospital to the receiving hospital must include his name and address. [42 CFR 289.24(e)(2)(iii)]
        What if an emergency medical condition is not properly diagnosed at the transferring hospital?

        If the patient is erroneously diagnosed, and the physician mistakenly believes that he does not have an “emergency medical condition”, when in fact he does, several courts have held that the statute does not apply to that case. Urban v. King, 834 F Supp 1328 (1993). There could, of course, be a claim for professional negligence for failure to make a diagnosis under State malpractice law in this situation.

        The court in Jones v. Wake County Hospital System, Inc., 786 F.Supp. 538 (E.D.N.C. 1991) stated that EMTALA requires only that a medical screening procedure be established and that it be followed in every case, without regard to ability to pay, and that EMTALA is not violated even if the screening procedure is insufficient under state malpractice law.

        Some of the cases have suggested otherwise, however. There was a brief mention in Deberry v. Sherman Hospital Association, 741 F. Supp. 1302 (N.D. Ill.1990), to the effect that a hospital could be found to be in violation of EMTALA for failure to diagnose an emergency medical condition through an inadequate screening procedure. This principle is at least implicitly recognized in other cases as well. See, for example, Power v. Arlington Hospital, 42 F3d 851 (4th Cir 1994) (failure to order CBC, leading to missed diagnosis of sepsis).

        The most prominent case on this point is Summers v. Baptist Medical Center of Arkadelphia, 69 F.3d 902 (8th Cir. 1995), rev on reh en banc 91 F.3d 1132 (1996). In that case, an examination of a patient who had fallen from a tree stand while hunting was allegedly incomplete because a chest x-ray had not been included when a set of spinal x-rays was ordered. The physician did not believe that the patient had any fractures, and discharged him home, with instructions. There was no transfer to another facility involved. The patient presented at another hospital two days later, and he was diagnosed with an acute comminuted vertebral fracture, a sternal fracture, and bilateral hemopneumothoraces secondary to untreated rib fractures.

        The original decision of the three-judge Court of Appeals was that the Complaint did state a claim on which relief may be granted, and that the failure of a doctor to follow what he admitted was a standard screening diagnostic protocol supported a claim for a violation of EMTALA. When the case was decided on rehearing by the full Eighth Circuit, sitting en banc, this decision was reversed and it was held that providing a screening examination, even if it is negligent under state-created malpractice law, is sufficient to provide full compliance with EMTALA, and that only disparate treatment in the screening process would support a claim.


        So, in short, a person’s pain must be controlled to their target to be transferred unless the treatment of that pain is beyond the capacity of the original institution. It would be very difficult to imagine this can be done from an ED to an UC.

        Max, the regulations clearly state pain is an emergency condition and the patient must be stabilized. Some EDs have tried putting a physician in triage, doing MSEs and turning away any “non-emergent” cases without demonstrated ability to pay. That has saved money but has brought a great deal of regulatory scrutiny.

      • Max Kennerly says:

        Two points.

        First, “pain” alone is not an emergency condition requiring stabilization under EMTALA, because it is not a condition “such that the absence of immediate medical attention could reasonably be expected to result in … placing the health of the individual … in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part …” Again, I know of no cases in which somebody’s “pain goal” was considered an emergency medical condition requiring stabilization, and you haven’t referenced any.

        Second, you didn’t read your own quote. The very last case cited held “that providing a screening examination, even if it is negligent under state-created malpractice law, is sufficient to provide full compliance with EMTALA, and that only disparate treatment in the screening process would support a claim,” which is an even harsher rule than the one I stated. Under that rule, absolutely no one can recover under EMTALA unless they can show deliberate disparate treatment due to their ability to pay.

        Moreover, those cases are all over 10 years old. I can’t speak for every district and circuit, but, in the ones I know of, EMTALA case law has become even more anti-patient over time.

      • TG says:

        Max- The 6th Circuit recently made EMTALA significantly more “patient friendly”. Check out Moses v. Providence.

        You are also right about this “severe pain” debate. Pain is not an emergency medical condition. It may be a symptom of an EMC, that would require stabilization before transfer or discharge, but I have never seen a case that revolved around a patient’s self-established pain threshold. And I have looked at a lot of EMTALA cases.

      • Fyrdoc says:

        TG (and Max),

        I agree, pain alone is not the problem. But my screening has to be the same for every patient with a similar complaint. Now chest pain and abdominal pain together provide a majority of my patients. Each requires extensive work up to derive the etiology. I can not transfer that patient until stabilized (thus, pain-free). Solely pain? No. Pain as the symptom of a problem? Must be “stabilized”.

      • jb says:

        Yeah, but if you don’t take Medicare or Medicaid, and I predict some hospitals in the future won’t, then EMTALA is just a bunch of letters. In the UK and Canada there are completely private hospitals. We will get those too.

      • Fyrdoc says:

        jb,

        Nope, private hospitals are not the answer. In most states, a licensed health care facility (accepting MA/MC or not), must go through a “certificate of need” procedure in order to get a permit for the purchase of large new equipment (e.g., CT, MRI) / construction of facilities. The states have effectively used CONs to force facilities into accepting MA/MC in order to gain approval.

    • TG says:

      Frydoc-
      I don’t think we are really disagreeing. The emergency medical condition must be stabilized and/or the patient transferred. I suppose it depends on the EMC as to whether or not the pain must be reduced or eliminated. Presumably stabilizing the underlying condition would result in the reduction or elimination of the pain. Like I said, I’ve never come across an EMTALA case that centered around pain. However, that doesn’t mean they haven’t/don’t happen.

  4. Ryan says:

    Huff! *Sniff! Why can’t you stupid hospitals just run like the auto industry, Fannie Mae/Freddie Mac, and the US government does, borrowing and spending money that you don’t have?

    Healthcare “reform” is as much about making more of the middle class dependent on big government as it is making the hospitals and their staff dependent on big government.

    Dependent voters are dependable voters, just look at the unions, who without big government would be out of work. Or the elderly, who go out in droves to vote for the candidate who promises not to cut their entitlements. The Dems are betting the farm on healthcare because they know it will secure their party for decades to come.

    Throughout the whole healthcare debate, every industry is trying to jockey their way into getting a little more of the slice of government pie. These industries, as well as individuals, would be better off saving, investing (abroad, of course), and deleveraging instead. Sadly few will see the writing on the wall. It’s not just the demise of healthcare, it’s the demise of America. One self-centered voter at a time.

  5. Max Kennerly says:

    Keep in mind, under “free market” medicine, a substantial portion of the Medicare patients (possibly a majority) wouldn’t have insurance, and none of the Medicaid patients would, either.

    I’d imagine that, too, would make a dent in the availability of care, particularly to those millions of newly-uninsured former Medicare and Medicaid patients.

  6. The Medicare Tomato Market

    This is a very readable analogy and explanation of Medicare economics.

    Say that tomatoes were declared vital to life and made available free through the Medicare National Tomato Bank. The story of the healthcare market is translated to the tomato market.

  7. BK says:

    I find it odd that there is no discussion of the 800 pound gorilla in the room. it’s almost as if the author is ignoring it to make a hackishly partisan point.

    we are in a recession. the economy has been in the dumps for a while now. a significant number of people have been laid off who no longer have insurance. governments at all levels are having trouble with their budgets and some are making tough cuts to programs.

    Saying that all of healthcare’s problems in MA are the result of government run programs ignores that fact that the other 49 states without the government programs are in the same situation. acknowledging this, however, would force one to actually think about what is causing the problems. that would force one to realize that much of the mess resulted from policies that his favored side of the political spectrum has advocated. and, quite frankly, that is a big no-no on this site.

    • WhiteCoat says:

      Because your comment has several vague assertions of some underlying political agenda, but does not clearly state what that alleged agenda is, it is difficult to address your allegations.
      I have no allegiances to any party and am moderate in my political views, although I lean more toward conservative that liberal. Your statement about me being “hackishly partisan” is unfounded.
      Of course there is a recession. Of course other states are struggling financially.
      The point about Massachusetts is that a similar system is proposed for the US right now, being touted as being some “health care for all” panacea. It is not.
      Massachusetts’ initiative was touted in the same fashion. Now look at it. Costs exploding. Unavailable care. Increasing ED visits. Recession or not, the Massachusetts program is not working. The experiment failed.
      What’s going to happen when we implement this system nationwide … during this same recession? You think that health care is going to improve?
      If so, have another swig of Kool Aid.

      “Those who cannot remember the past are condemned to repeat it.” – George Santayana

      • TG says:

        Who is touting it as a panacea? I think it’s mostly being touted as an improvement over the present system. What happens if we keep the system as is? Costs exploding. Unavailable care. Increasing ED visits. Fewer people covered. Recession or not, the current system is not working. The experiment failed.

        I’m also baffled by the hatred of EMTALA. The fact that EMTALA even exists is an embarrassment to the health care industry who were forced by legislation to provide care to people with emergency medical conditions because hospital didn’t want to deal with those who can’t pay. Sure EMTALA has spiraled out of control, but if hospitals hadn’t been dumping patients, it would even exist.

      • Max Kennerly says:

        Three years of Massachusetts’ policies is enough to call it a “failed experiment?”

        Why don’t you apply just as harsh an analysis to the decades the other 49 states have had running their systems?

        Ever seen “Northern Exposure?” It’s not really that hard to obtain new primary care doctors, MA just hasn’t done it. If they did something as simple as paying off med school debt, or issuing a 10-year tax abatement for primary care officers, they could do a lot to reduce the pressure on ERs.

        But, no, you seem to think it’s totally and completely impossible to do anything ever to increase the number of primary care doctors. Instead, you recommend… well, nothing. You recommend killing Medicare and Medicaid, thereby denying health care to an additional >50 million people.

        Good plan. I wish your letter-writing plan to Congress the best.

  8. TG says:

    Doesn’t the biggest part of this plan consist of providing federal subsidies to individuals so that they can buy policies from private insurers? As Max pointed out, if it wasn’t for the evil government plans, the hospitals would have even more patients who didn’t pay anything.

  9. Dan Bledsoe says:

    Matt makes some interesting points. Why have we been fighting the malpractice issue so hard? It’s a smokescreen. Every year, Congress makes us fight for the sustinance of the SGR (sustainable growth rate) exception that keeps us from getting a 20% pay cut. Every year, the AMA, state medical societies, specialty societies, etc. all beg us to call our Congressmen. Then they give us a one year exception, and we say we won…. only to start the CRISIS fight nine months later.

    Malpractice and SGR are foils and distractions. With doctors’ energy focused on those two things, we lack the energy and unity to battle for our patients and permanent security.

  10. Doc99 says:

    Somewhat off-topic but certainly germane: Voters favor tort reform by two to one margin.

    Fifty-seven percent (57%) of voters nationwide favor limiting the amount of money a jury can award a plaintiff in a medical malpractice lawsuit. The latest Rasmussen Reports national telephone survey finds that only 29% disagree and 14% are not sure.

    Forty-seven percent (47%) believe that restricting jury awards for medical malpractice lawsuits will significantly reduce the cost of health care in the United States. Twenty-eight percent (28%) disagree, and 25% are not sure.

    • Matt says:

      Well, if the polls say we should do something, it must be a good thing. And it must be true.

      http://www.npr.org/templates/story/story.php?storyId=112818960

      According to the above story, a poll of physicians found “nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options,”

      • Doc99 says:

        Wow … and here I thought no one paid attention to what doctors thought. Go figure. Does that mean we’ll get tort reform now?

      • Matt says:

        I bet you get it in conjunction with single payer. Think it will be a good trade?

      • TG says:

        Ahh….the tort reform solution. Here in Michigan, we have had tort reform, including damage caps, since 1994. Hospitals continue to close and malpractice premiums are still high. Obviously that’s just anecdotal evidence, but it’s hardly the only state where that has occurred. According to the CBO, tort reform measures would save about 50-60 billion over the next 10 years. Why the myopic focus on such a tiny piece of the pie? Although I do love hearing conservatives call for the national government to tell every state in the country how much each and every jury can give out in non-economic damages. It’s such a refreshing example of their view of small government.

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