We are close to a 1 to 2 trillion increase in spending with new expansion of government control of the health care. All the bills were basically the same in form and provisions---big hoopla.
And, as President Obama promised, he will pay for the expansion from "savings" from spending on health care during the last year of life. And other "savings; good luck finding out where they will come from.
Except: we know the doctors will suck it up and accept worse payment. And so will nursing homes, hospitals and others because HHS and the governemnt run insurance will pay less. In fact, they will pay less whether the new laws pass or not. But, hey, we can all learn to deal with that. Don't we all think doctors are overpaid, and hospitals wasteful, and nursing homes beds of luxury? You will all learn to understand foreign language doctors who will work cheap.
Poor medicare. It will be hit with 500 billion or so in cuts. And as a bonus included in that, or added, is the amount of cuts in the medicare hospice program, a model of medicare financial management, where the current length of care is down to around 13 days in Carle's program, if my friends are accurate. Not far different from the national average. The example of hospice is ever tighter close monitoring and restrictions from the feds, and the understandable reactions of doctors and staff trying to adjust. They simply refer late in the game, to stay clear of trouble with the overmasters. So, even as hospice care increased overall, the amount of services declined. Shorter days of care means less care, in civilian terms. Never mind that patients and families are deprived of wonderfully beneficial care and and society benefits, the government can say they cut "costs" and covered more people.
Same pattern more or less under the insurance companies, who tend to follow the medicare lead where ever possible. After all, what is a prudent insurance company going to do when employers complain about costs of premiums.
So, the new bill fixes all this, right? Not at all. In fact, we get even worse financial management and more spending. Here's how it will work. We get massive increases again in Medicaid, as the states get hit with a mandated expansion, although some, like Illinois already expanded coverage. Never mind that they cannot pay for it.
The feds, who also are deeply in debt, will increase their share, even take over medicaid in Ben Nelson's state. Medicaid is the fasted growing sector of spending in health care, far beyond the private insurance sector. Has been over the years, but at the same time, Medicaid reimbursements to hospitals, doctors, and nursing homes have declined. Again, same pattern---cover more people, but pay less per service. My friends tell me that now medicaid reimbursement is at about 20-25% of costs, more or less. Want to know more about what to do when you get only 20% of a bill paid. Ask Champaign County Nursing Home. You shift costs. You increase the volume of private pay.You up your charges to insurance.
Ask Union Hospital, Illinois what happens. Oh, nobody answers there. Because, they went out of business in the '90s when they ran out of their UAW endowment fund in an effort to cover their shortfalls. They had reached the dead zone of 85% plus medicare/medicaid paid patients, and could not survive with so much goverment largess.
That is the future of American health care. Plenty of other examples abound. There are two terrible losses we face in America, following our trends in health care. With the domination of insurance and government to meet our demands to have more, and control more, we have increasingly eroded the all important patient-doctor connection. Not just doctors. Try taking good nursing care of 6-8 patients during 4 days of 12 hour shifts on a med-sugical floor. Ordinary business.
The liberal and Democrat wing of politics will have their way---but we will all be the worse off. Face time with doctors is a major source of good quality care and treatment. The research proves that. The doctor patient relationship cannot be freely treated as a commodity---medical care and treatment is a service and less of it costs dearly.
Secondly. America is not Europe, or Russia, or Canada. We lose the chance for innovation and creative health care solutions in this growing monstrosity when we add another massive layer of government and insurance company overlay. Government run "pilots" cannot be freely innovative, and are never turned loose. If the government puts in a 5 cent share, they will control the dollar show. Instead of real innovations we get such pilots as "evidence based" practice. Standardized, by the book medical care results. Never mind that another government agency's research found more dying and illness result from the "follow the numbers" evidence based care. That is the style of innovation we will get.
Already, we have a 50% overburden of regulation, financial management and oversight on health care. All this new spending is not just to give more coverage. Any available intern's, politician's, and staffer's old and new idea to manage your care is shoved into these new plans. Commissions, new powers of the Secretary of HHS, bureaus, potentates, czars, all abound.
And, by the way, so sad, the poorest and sickest will not get more care or better treatment, witness the history of government run programs everywhere in the world. The disparate health of poor and less educated compared to better off abounds. With government run care, they still get sicker more, use treatment less in every country. Why will we be different?
Dr. Gonsa Megilla
