Monday, May 31, 2010

No One Is Above The Fray

Jennifer, my lovely daughter, had a wonderful orthodontist. He was the dental equivalent of Mr. Rogers. Gentle. Caring. The kids loved him. The parents respected him. We, the parents, just hated going to his office.

Jen and her fellow patients were all in middle school. They would check in and find their way back to an open room and an array of colored rubber bands. The parents would sit and wait, hoping to not be noticed by the doctor’s office manager, a young woman who had a habit of standing in the doorway and calling out to us.

“Mr. Cunix.” Uh oh. “Doctor says that Jenny should do a better job brushing her teeth.”

“Mrs. Smith.” It was someone else’s turn. “Your insurance wasn’t approved.”

I began waiting for Jen in the building’s atrium. I was not alone.

Great dentist. Happy kid. All was right in the world right up till my insurance got screwed up. I had to go in. Ms. Noisy was sure that I had a problem. I quickly determined what she had done wrong. Now she was both loud and unhappy. It was time to meet with the doctor.

With childlike innocence, the orthodontist explained to me that he only dealt with the teeth. He didn’t know anything about the paperwork. He didn’t touch it. I looked him in the eye and reminded him that he owned a business. He couldn’t divorce himself from the hard part. He couldn’t keep his hands clean.

The paperwork got better and the consultations with the parents became private.

I was reminded of this long ago confrontation by Dr. Johnathan Ross’s rant in this past Sunday’s Plain Dealer. Dr. Ross is identified as the past president of Physicians for a National Health Plan and a leader of Single Payer Action Network in Ohio. I have provided the links. Take a moment to read the article and research the groups.

Dr. Ross is positive that our health care delivery system’s only problem is our method of payment. It’s the insurance companies. If only we had a single payer system. Our costs would plummet and all would be right in the world.

“So what's the alternative? It's building on the solid foundation of our tax-financed, low-overhead Medicare system, and extending it to cover everyone without exception. The administrative savings from such a streamlined system would amount to $400 billion per year, enough to provide comprehensive coverage to all with no significant out-of-pocket expenses and with complete choice of doctor and hospital.
A single-payer system would also have the clout to negotiate drug prices and provider fees, and to allocate resources efficiently and wisely. It would possess powerful tools for improving quality and controlling costs.”

At the risk of sounding like a Saturday Night Live Skit, REALLY?

We would save $400 billion a year?

Comprehensive coverage to all with no significant out of pocket expenses?

Clout to negotiate drug prices and provider fees?

Allocate resources efficiently and wisely?

Somehow our federal government would suddenly repair its abysmal record of fraud prevention, negotiate drug prices and provider fees, and reorganize our entire health care delivery system with no increase in administration costs or personnel. G-d knows, when I think efficiency, I think Washington.

Is this all a lot of hooey? Not quite. Dr. Ross is hoping that we, like my daughter’s orthodontist, will forget that medicine is a business. Big business. Dr. Ross, and physicians like him, are offended that the insurance industry is part of their business. A large part. I don’t take it personally. Sometimes I’m offended that the doctors are a part of mine.

Dr. Ross wants to be paid better, faster, and with less paperwork and oversight. Can we take the risk out of being a business owner? Can we just guarantee him a steady, predictable income free of hassle and concern? Give him that and he promises to check the blood pressure and pulse of little old ladies for years to come.

It doesn’t work that way, at least not yet. Administrative costs are probably higher than they need to be. But we should also check out the building costs for the new doctors’ offices and hospital palaces popping up all over Greater Cleveland. All those TV commercials for the newest drugs cost lots and lots of money. The system is also fueled, in part, with unnecessary tests and expensive, futile procedures.

Attack all or attack none.


Wednesday, May 26, 2010

The Resurrection Post

Health Insurance Issues With Dave may have run its course. My April post was designed to have been my last. I had called my shot. I had made my prediction for the delivery and payment of health care in the United States. Short of a major U-turn, the changes I have described seem inevitable. So having said what I had to say, it was time to sit back and monitor the conversation.

Published Comments – O! Don’t get me wrong, the post was well read and generated lots and lots of feedback. Sadly, the phone conversations and emails were all private. Thoughtful. Concerned. Interesting. Private. No one wanted to go on record. No one wanted to have his/her ideas examined, the conclusions challenged.

We, all of us, need to continue talking, and even occasionally listening. Well, listening may be just pie in the sky, but I will provide the opportunity for further communication.

In other words, I’m back.

I received an email from a client last week. Janet (name changed to make my attorney happy) is a member of a grassroots organization called The Ohio Project. Would I sign their petition? Did I want to participate? Their goal is to pass an amendment to the Ohio Constitution that would give Ohioans the right to opt our of health insurance, especially government mandated coverage.

I went to the site and read all of it, the amendment, the petition, even the training material. I DID NOT SIGN THE PETITION and I can not participate.

My problem was that I could not find any solutions on the Ohio Project’s website. There is a focus on being “forced” to participate in the system as a responsible player. My perspective has always been that our system won’t ever work if people can opt out up until the moment they need care. This blog has consistently delivered that message, most notably in the August 21, 2009 post. We need everyone to participate, the sick and the healthy, the young and the old.

My client’s concern, first and foremost, was to stop the government from forcing her to buy insurance. I asked Janet what plans The Ohio Project had to fix the system. She told me that they don’t have any solutions and that solutions aren’t their problem. The Ohio Project views the requirement to purchase insurance invasive and unconstitutional. I should note that Janet is well insured. Always has been. Always will be. This is a battle built on principle. Janet, and many like her, have drawn a line in the sand. This is where they have chosen to take a stand.

I strongly disagree with the members of The Ohio Project, but I welcome their participation. There is a natural progression from objecting to a government program or policy, to actively challenging said program or policy, to thinking about a more functional solution. And that is what we need. It has been said that the opposite of love isn’t hate. It is apathy. I am thrilled to have the members of The Ohio Project out and about. I am hoping that their energy will generate new ideas.

So I’m back. Let’s ride out this storm together.