Med mal is essestial component to reform.
No to government run insurance plan.
Increase fees to doctors.
Decrease cost of med. school or help with cost of education.
Fix only what is broken not total restructure.
Allow doctors to make all medical decisions--not health care plan.
No rationing expecially for seniors.
Congress should be included in any plan that his enacted. Good enough for us---good enough for all.

The de-coupling of health benefits from employment might represent a major step in the direction of progress, although I'm not sure Senator Coburn is promoting that element.

I don't understand how "making it illegal" not to have health insurance and taxing those that don't is going to work or help. Most people want health insurance and either it is too expensive or they have preexisting conditions and can't get it privately. There should be some type of guaranteed health insurance and those that choose to go the private route can. I would hope there would be some incentive/encouragement for employers/businesses to continue to help fund insurance for their employees as exists now (this would keep many of those people out of the "guaranteed" health insurance pool). But it is ridiculous that a person who is most at risk for using the health care system because of an unfortunate roll of the dice with a serious diagnosis is financially ruined for the rest of their lives for an inability to obtain insurance due to pre-existing conditions. This is most commonly seen in those persons who become unable to work because of their condition and so are forced to seek insurance privately (and then can't obtain it due to preexisting condition).

We need Health Saving Accounts and have the patient directly involved with decisions. SHH

I have contacted Sen. Coburn's office about this on multiple occasions. Each time his answer has been. Thank you for contacting me, but I disagree with you and this is why. None of his correspondence indicated that my input was being considered in his decision making. This is a very finely crafted survey designed to support his position.

1. Have the goverment take over the malpractice insurance and have all doctors and specialities pay the same price across the country. Or give us the oppertunity to buy malpractice across state lines. (since most states only have 1-3 carriers per state.)
2. There needs to be more transparency in the cost of care so the patient and the physicians know what the true cost of their treatment will be.
3. There needs to be some affordable medical insurance for the patients, people cannot afford $900 month premiums, thus there has to be a new option. whether this is created by allowing patients to get insurance acrosss state lines or by the goverment creating a new program something has to be done.
4. There should be some type to triage clinic next to the ERs so somebody with a sore toe can be seen there without the expense of a er visit. Thus allowing the ER to get back to true emergencies not a expensive family practice clinic
5. There needs to be true tort reform.
6. If the goverment is so interested in preventive care why does medicare and medicade not pay for preventrive visits? They only pay for problem visits.
7. The patients need to pay more than $1.00 for an office visit.

Sen. Coburn:
What do you mean by "the positive aspects of our system"? If it's choice of physician or hospital, a publicly-financed National Health Insurance plan, modeled after Medicare, would preserve this. Despite what many say otherwise, the most popular insurance program in the US (as judged by those who use it - the patients) is Medicare, a universal, portable, administratively-efficient, automatic enrollment, non-employer-linked, single-payer program that's available in all states. I see no reason why we cannot, over time, lower the age of Medicare eligibility and give more Americans the OPTION of enrolling in this program. And here's a bonus: enrolling younger (and healthier) Americans would expand Medicare's risk pool, raise revenue for the Medicare Trust Fund, and thus prevent its looming insolvency.

Sen.Coburn:
Consider this..
1) Dollar value limited, catastrophic health care for all with taxpayer funds. This should involve no pre-certification, no pre-authorization, no bean counting, NO BS to waste doctor's time etc. It is strictly crisis care. Family should also be supported during crisis. Care offered in this setting should be completely indemnified with no trial lawyers in picture.
2) Allow Private insurers to offer health insurance(optional) to the rest. Remove all restrictions including interstate commerce restrictions to give consumers the best choice. There should be no restriction on care that people who want to pay out of their pocket can get. Multi-tiered health care is appropriate for the US..This is because of wide variations in incomes and willingness to spend money in this country. ( Mayo clinic for all)
3) Uncouple employment from health care. Why should it be an employer's responsibility to offer healthcare?
4) Keep in mind small Biz with 10-12 employees in picture when making policy. These are the largest employers..not GM, AIG or Ford.
5) Abolish tax breaks for community hospitals and let them compete in open market for business.
6) Immediate institution of "NO FAULT" medical indemnity for medical professionals. It is impossible to reduce costs without removing the threat of bankruptcy and humiliation for doctors. Doctors do NOT cause intentional harm. that is why 80% of lawsuits are tossed out and of the rest, ararely is justice served for the maimed but supports lifestyle of people like former Sen. John Edwards. The costs can drop as much as 50% very quickly if trial lawyers are removed from "medical litigation" criminal negligence can still be prosecuted as criminal act.

I am a small biz owner with 10 employees. I cannot afford to pay a penny over $150/m/person for the health care of my employees. I myself have a $10,000 deductible combined with HSA and still pay $550 for family of four. Many of my employees do not want to pay anything from their own pocket to offset my costs and some choose to not be covered. Most healthy young people will NOT buy $250/m policies. Obama talks about high risk pools in the same tone as public option. High risk pools charge as much as $750/m for covering people. High risk can mean people with No known illness but Body mass index of 35 or more. . No easy solution here. Why not tag a 2% health care tax to all financial transaction activity and provide catastrophic care for all legal citizens ( not legal visitors..). When there is a cost to the society, people will make rational choices.

Do nothing this congressional season. Give the public a reasonable opportunity to research and discuss health care issues with the individual members of both houses.
No fines levies or taxes for nonparticipation in system. Control of health care to remain with patient and physcian.

Keep Marxist/socialist/redistributionist big government the hell out of fundamental issues such as health care insurance which have traditionally been the province of and reserved to the individual states.

Reject the false and false analogies to automobile insurance. Health care insures *the insured* against the risk of injury and illness. The mandated portion of automobile *liability* insurance is to protect *third parties* against the negligent acts of *the insured*.

Do not lie about the tremendous tax burden that mandated insurance for all will impose.

Do not lie about the inclusion of coverage of illegal immigrants that will be provided on the backs of taxpayers.

Do not lie about the taxation of insurance benefits that is part and parcel of this improvident, ill-conceived government plan/fiasco.

Do not expect that "tort reform" will decrease the cost of care and solve all coverage issues.

Do not falsely proclaim the existence of a manufactured "health care *CRISIS*".

Do not lie about the de facto rationing that will ensue.

Do not lie about the throwing of the older population under the bus by decreasing funding for oncology, cardiology and imaging services.

Mandate that the federal lawmakers and their families, *including Obama*, receive a level of care NO BETTER THAN that they will impose on the ordinary unprivileged American taxpayer.

Finally, DO NOT DESTROY THE BEST HEALTH CARE SYSTEM the world has every known and DO NOT REPLACE IT with the legion of disasters predictably and actually flowing from denial and rationing of care found in Canada and in the UK.

Hi Tom from your classmate from OU '83

I may be outdated by events but I am still stuck on the issue of people voting to help themselves to a chunk of other people's money to pay for their benefits. Charitable decisions are the purview of the donor, not the recepients. Alexis de Tocqueville stated more than a century ago that this great experiment in self governing which we call the United States would survive only until the American People discovered they could vote themselves largess from the public purse.
If i can be taxed to pay for other peoples benefits, such as health care etc, where does it stop? Dental? Groceries? Houses? -oh wait...

Do I really own anything I have earned, or do I only own it if no-one else with more votes decides they need it more than I do? If the grasshoppers are going to take my stuff away by force of law whenever they want it , this little ant will eventually decide it is better to join the grasshoppers rather than to work my life away to provide for them.

And the government IS NOT ALLOWED to tell me I have to buy health insurance or punish me if i decide not to do so. I already have health insurance due to military service but this overweening intrusion into my personal right to self-determination is insulting in the exrteme. This proposal is a violation of my freedom and will be resisted very strenously by myself and almost all the folks I talk to.

Please help us save our country from people who think that that sort of behavior by the government is OK. This isn't China. Let's keep it that way.

The senate committee has essentially killed any public option, unless someone adds an option for co-ops. In theory, a co-op insurance has many benefits for both patients and physicians and keeps insurance companies from making obscene profits at the expense of practicing medicine and patients getting adequate care. I have had 4 medication refill denials this week and 2 denied imaging studies to rule out brain tumors. These are not defense medicine scans, but critical in determining the cause of acute findings in these patients. Unfortunately, co-ops are basically doomed to fail from the start unless they receive huge influx of cash to start the process. If the gov't is stingy on a co-op option, then nothing will really have changed and no real competition for insurance companies will have been created.

The insurance companies need to be held accountable to two things (1) excessive profits from patients and providers and (2) inappropriate denial of care (meds, procedures, studies, etc). The Congress needs to take insurance companies to task, but the current bills seem to do little to alter the status quo.

As for the mandates, the current bills still allow for some people to be exempt from health insurance, so it is really not universal coverage, although it may be improved coverage.

As for tort reform, there should be some assistance from the federal government on this issue. The frivolous lawsuits should be addressed through health care courts, similar to other sectors in law, and caps should be implemented.

There is also a gross discrepancy between what Medicare and Medicaid pay for the same procedure. Congress needs to address the negative cost discrepancy associated with Medicaid for pediatricians and pediatric subspecialists in order to account for the additional time and effort involved in caring for children. The Kilroy subspecialty payment letter addresses these concerns from the American Academy of Pediatrics.

Lastly, whatever plan is initiated, patients must hold a financial interest in improving the quality of their care or incur additional expense in their insurance costs for failing to meet physician recommendations. Under P4P, if a patient does not follow our advice and a bad outcome occurs, the physicians are the one's who will be penalized in reduced reimbursements. That is fundamentally unfair and unjust.

1) Require insurers to provide at least one "all-comer" plan similar to Medicare Part A with true emergency coverage with $100/day hospital and $100/visit ER copays. No exclusions for pre-existing, no maximum benefit, portability and guaranteed acceptance and renewal. Mandatory federal audits so that at least 80% goes to patient care and necessary reserves

2) Encourage and expand availability of medical HSA's

3) Free physician fees from anti-trust and "Medicare pays the lowest fee." This will encourage competition and greatly reduce paperwork. Physician fees are artificial numbers driven up by desire for Medicare and Private Insurers to raise fees annually.
Puts medical decisions back in the hands of physicians and patients and automatically saves the 30% administrative fees and increased overhead caused by all payments being filtered through insurers.

Medicaid expansion should fill in the gaps.

4) cap non-economic damages in medical liability cases (the "tests" have been done in CA and TX.

5) have the IRS aggressively pursue employers of illegal aliens, charge them for payroll taxes avoided and fine them an "illegal alien healthcare tax" which goes to fund unreimbursed care

OU '79

As a practicing anesthesiologist, I am very concerned with the possibility that a public option or coop will tie reimbursement for anesthesia services to medicare rates, which are currently undervalued. An expansion of this unsustainable payment system to a larger population would have serious ramifications for the medical specialty of anesthesiology, and the patients who receive our care.

In a 2007 report (GAO-07-463), the Government Accountability Office confirmed the payment disparity between Medicare and commercial payments for anesthesia services. The GAO concluded that Medicare paid an average of 33 percent of what private insurers pay for anesthesia services. (Meanwhile, for most other medical specialties, Medicare has paid an average of 80 percent of what is paid by private insurers, according to the Medicare Payment Advisory Commission (MedPAC) in its March 2009 report to Congress). The 33 percent rate simply does not cover the costs of providing anesthesiology medical care.

As highly trained physicians, anesthesiologists are uniquely qualified to make medical judgments and oversee the broad practice of anesthesiology and other medical care. Our medical expertise provides the leadership and skilled care patients need when they are most vulnerable. Indeed, in the past decade, the Institute of Medicine has singled-out anesthesiologists alone as the leaders in quality and patient safety. And today, our efforts to advance quality and ensure patient safety continue unabated. Certainly, without adequate reimbursement for anesthesia services, hospitals, departments and patients will lose out.

Our Battle Cry must be: "NO HEALTH CARE REFORM WITHOUT TORT REFORM"

I agree with Sermo Doc 1.
In addition, I do not think more insurance coverage equals better access to health care. Most primary care providers are not accepting new pts, and many don't take Tricare or medicaid.
I see hundreds of government insured pts, (tricare), in my civilian ER for non emergent conditions. Their chief complaint is that they 'called and can't get an appointment for weeks.' Incentives for primary care providers are needed.
Better funding for Level I trauma centers.

I believe the individual should buy there own insurance so they are more fully aware of the costs and benefits and can pick the amount of coverage they desire.

I like the idea of making a mandate for insurance but do not understand what consequences you can enforce to those individuals who do not get the insurance.

I would really like to see more reimbursement in primary care, and more growth in the number of medical school graduates pursuing this career. Those countries with more of an emphasis in this field also seem to be more resourceful in medicine costs.

I would like to drug screen individuals applying for assistance with medicaid and if they are testing positive then they should not be given full medicaid benefits. I would also limit benefits to those who are here illegal. I believe these individuals should be with a very limited accident or emergency plan until they can get it together and be a part of the system like the rest of us.

This is simple.....allow us to purchase insurance across state lines..make the companies compete...use HSA big time so WE are responsible for our health care decisions and finally major tort reform....quite frankly I'd give blanket immunity to all MDs and let the chips fall as they may!! You'll see the cost of health care drop precipitously then.

The problems in all this (medical practice and healthcare reform) are that politicians, CEOs, health epidemiologists, other bureaucrats, in essence people who know next to nothing about the daily practice of medicine are the ones concocting healthcare reform. The people who know best what works and what doesn't, i.e., physicians are not being asked. What good is to have "insurance" and everybody "insured" if when the time comes, the doctors are just not going to be there to see the patients? Being "insured" does not mean much at all if your medical care and your doctor are not being paid. This is now what Medicare, and YES, the private insures that this Senator loves so much are doing. Let me tell you. Unless something radical happens, and these are changes for the better, a lot of physicians are just going to work on a fee-for-service basis, or leave the professsion altogether. No more Medicare, and no more private insurers. People will be left with nurses and nurse practitioners. A lot of problems like the daily denials of reimbursements, medications, and tests, the mountains of paper work, the overburdensome Medicare regulations, the lack of federal tort reform, etc will have to be fixed first before healthcare reform is even addressed. For healthcare reform to stand a chance, we need to create a much more physician-friendly practice climate. Need I say more?

I cannot envision a scenario where any insurance reform is not going to hurt the health care provider. When Obama says this plan will be funded by eliminating the "waste" from medicare, I cant help but to cringe at the number of cancers that will not be detected because a CT was denied, and the number of heart attacks that could have been prevented because a stress test was denied (or no longer feasable).

While our medical system in this country is not perfect, it is pretty damm good. I do not really see a crisis. Despite the popular mantra, nobody is dying from access to care.

While I despise the profits insurance carriers make, we must realize that this is a free market society, and as such a government takeover cannot exist within a capitalistic society. The entire system will crumble, and the doctors will be the ones paying for it in the end. Why the AMA and AARP are supporting this bill is beyond me. The money to pay for this system is going to come from somewhere, and as usual, it is the doctors that are going to be pushed around (because they can) and yet, we are the most creative and skilled participants in the health care relationship.

Tort Reform is a must to decrease the cost of defensive medicine. Availability of primary care physicians, meaning help defray cost of medical school and reimburse those physicians who are in the front lines. We must emphasize preventative care for patients. (BCBS who administers our state health plan will pay for 150 glucometer test strips in a 90 day period. My pregnant diabetic patients need to check sugars 4x a day) Insurance companies have NO incentive to take on sick patients and high risk conditions. Insurance companies have to be part of the solution otherwise we will end up with a government run program for these uninsurable patients. They will still need healthcare even if they are not covered and will come in sicker than if they had regular care.

put decision makers in same pool of care as the rest of the country.

crude recapitulation of republican talking points... not impressed. represent us by pushing for tort reform (and no, caps aren't the answer, but special malpractice panels to weed out the frivolous stuff are) but i'm frankly disgusted by what in essence is a push-poll in the wording of the options. no doubt you'll tout this as some sort of representative sampling of physician opinion, when the available options are loaded and misleading.
"Do you support Sen Coburn, even though he "may" eat small children" or, B, do you like freedom and apple pie.
shame on you

Fix med mal.
Fix medicare (specifically the reimbursement piece)

It is my understanding that as of this morning the vote in comittee was a resounding "NO" vote on the public option.

Develop legislation that a) does not deny coverage on pre-existing b) does not run out of benefits in the middle of treatment c) does not force providers to continue to play games up the "denied" chain d) forces insurers to actually pay for the work done.

Do not punish people for not purchasing insurance. But make it very clear that if you use medical services without having insurance, you are going to be required to pay at rates higher than if you had insurance, and that may include wage garnishment.

People need to have a higher stake in paying for their own health care.

1. Allow insurance to cross state lines
2. Mandate a percentage of insurance premiums/other insurance company income that must be paid in direct patient care.
3. Have a national catastrophe reimbursement system to cover everyone without insurance who suffers a major catastrophic event. Include illegal aliens unless you plan to deport them.
4. Enforce prompt pay laws.
5. End preauthorization/certification.
6. Limit requests for "additional documentation."
7. Simplify the e/m cpt codes and stop wasting our time with endless threats of fraud and abuse.
8. Get rid of Stark laws.

We promised to care for patients. Insurers promised to pay. We are upholding our end of the bargain. Let's focus on the others who are not holding up their end of the deal.

develop a co op plan , number of uninsured person X cost of service = premium X number of person and develop 5 year plan . see if this works . most likely this will boost productivity GDP.

OR

make us urance company sharehoders ????? CEO Dr. Mcguire of United health worth 1 billion dollars , don't you think we should be part of this ???? his seems that as person goes higher up ethics and moral goes in reverse direction there are so many examples are like this , Which made GM broke to bankruptcy.!!!

I agree in the separation of work and insurance, and that insurance is a right. I see too often people not working at their potential to keep their families qualifying for medicaid. And why wouldn't they, seriously. It is carte blanche insurance, far better than I can afford for my own family.

I believe in personal accountability, thus decreased premiums for people who work to keep themselves healthy (keep Aic under 7, keep BP in control, keep BMI under 30 or so)--or tax benefits for healthy behaviors, accountability for use of medical care (ie. some level of co-pay for all), and insurance for all.

But at the bottom line, I don't believe we need to put families into bankrupcy for illnesses that they don't request. I believe we owe it to each other as human beings to make sure that care is available to all. A public option seems to me the least we can do, if we are actually calling this "reform."

1. First, as a republican I would like to see some straight talking about the goals of each bill. Your description of the current plan is misleading, and it may work for the uneducated masses that view all of this as entertainment, but what Americans need is HONEST debate. A government option should cost less than private insurance. If it does not, then it is not designed properly. I cannot access your link without a subscription, but that is a statement that decreases the amount of trust I have in what you have to say.

Additionally, you lump all "businesses" into your statement about who would be taxed for not providing health benefits. I agree that employers should be taken out of the insurance issue. it should once again be a BENEFIT offerred, to help employ and maintain good workers. Small businesses would not be affected, and your misleading statement is actually embarrassing to me as an educated Republican.

Do you understand why some states offer lower cost insurance? State mandates...I'm all for state mandates for coverage, from patient standpoint, but once you start requiring coverage of chiropractic manipulations, accupuncture, herbal medicine, drug dependency, infertility, etc., cost goes up. Healthy people buy siimple plans, if any at all. Does the federal government then need to regulate what is covered?

And I would much rather have an appointed group of individuals deciding what is covered rather than a corporate committee of business people whose goal is to cut costs and increase profitj, which is the current method of deciding coverage. Teh government at least is accountable to me as a voter and tax-payer...insurance companies can simply say "then our patients can't come see you if you don't accept our terms."

Please don't distort the signficant issues facing reforms of the current health care payment system. Don't try to pull the wool over our eyes too...most of us are on your side. Most physicians are very good at determining whether someone is telling the truth or not.

Care and management of every pt. needs to be according and within a paradigm designed to achieve proven results of excellence in regard to clinical outcomes and efficiency in the use of resources. The emphasis of the paradigm should be resting on clinical diagnosis. The performance of every physician, and hospital needs to be automatically assessed in a national computerized register. Such periodical evaluation would allow compensation rewards according to the results. In other words the entire system needs to be brought under objective, scientifically regulated and manageable controls. Any less would fail any attempt to bring Health Care to its contemporaneous immense potential.
German Gonzalo, M.D.

SOLUTION Expand Medicaire in ALL COUNTIES for AMERICANS . and if they do NOT go there let them know that their assests WILL be taken from them .. easiest to do as part of social services in all counties or put GREAT Triages in ER and funnel uninsured to Medicaid clinic next door.. or in churches.. or county buildings..

Legal REFORM is now critical... IT USED TO BE that when a family membe had a CATASTROPIC event YOU COULD talk to the docs and Hospitals... NOW THEY ALL CLAMP UP!!

My STEPSON DIED in Guth Med center and they REFUSED TO TALK TO US.. there was NO COMPASSION.. WHAT have Hospitals become if they can not talk to you when a member dies.. UNEXPECTEDLY? this is a SICKNESS WHEN LITIGATION priority to HUMANITY

Any plan which is mandatory for everyone but exempts Congress from participation, is unacceptable. If it is good enough for the people, it is good enough for Congress. If the plan is not acceptable enough for congressional participation, then it is a bad plan. I am tired of Congress forcing regulation on us while exempting themselves. Our elected representatives need to be reminded who they work for.

Senator Coburn,
Reforming the health care system must be comprehensive, whether it be done immediately or over several years. Our political representatives must distance themselves from the influence of entities that are subject to this reform and seek to negate or minimize it's importance. That is your responsibility. Further, you must put political gamesmenship aside. Your portrayal of the reform proposals being considered is laced with language that incites negativity and fear.
We all understand that insurance companies have a mandate to make money for their shareholders. That being said it is very clear to me that they by this mandate they cannot and will not put the best interest of patients ahead of their shareholders. This ethical dilemma necessitates that health insurance be taken out of the hands of private companies. I believe we can create a single payer system that is comprhensive, fair and fiscally sound. Consider the achievements that we as a country have made through the years such as finding cures for diseases, dilineating the human genome, putting a man on the moon. We can create a health care system that works and is financially feasable. And by this creation we can fully and effectively utilize the tremendous medical infrastructure we have developed and the talent that makes this infrastructure work.
As physicians we need to recognize our responsibility and accept our role in meaningful change. I believe we can remain autonomous; but we also need to be reasonable and responsible in delivering health care, both in terms of what we order and what we charge. We have not committed to that in the last 40 years.
I challenge you and your colleagues to put aside your fears and political agendas and look at this issue with a mindset of making the United States fully capable of its potential for its people and its medical system

john Cianca, M.D.

Americans tend to be generous people. The uninsured and the underinsured will be cared for somewhere in the health care system-and the hospitals will recoup their money by sending the costs on to the insured and to the insurance companies, who in turn, increase the premiums for their insured. Plus, anyone who has anything like a "preexisting" is now a captive audience. So, what happens if everyone has some form of insurance? Then the hospital has less to pass on and so does the insurance company.
And since when have American companies been afraid to compete? It seems that the main argument is that named insurers want to secure their customers and not compete in the marketplace.

"The current health care reform proposal before Congress, if passed, would have wide-ranging impacts on Americans. It would threaten the insurance coverage that millions of citizens rely on, increase government control over the health care decisions of Americans, and add to the already out-of-control spending in Washington. I agree that this plan is wrong for America.
Many in Washington believe that the answer to America's health care problems is to let the government take over our health care system. I firmly oppose H.R. 3200 in its current form, which would create a government-run insurance plan, and require all but the smallest businesses to provide coverage for their employees. The government-run plan would compete against private insurance plans in a market governed by the federal government. Over time, such a model could threaten existing insurance coverage or access to care for patients, and may ultimately lead to rationing of care. Among its many other provisions, the bill empowers the federal government to force physicians not to accept patients with private insurance as a condition of participation in the government-run plan. In addition, it would also create a federal committee to determine what health care coverage is essential for patients under the government-run and other plans.
I am also troubled that this bill will expand the government role in health care without making health care more affordable for taxpayers. The director of the nonpartisan Congressional Budget Office (CBO), Douglas Elmendorf, noted, "In the legislation . we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount." The CBO estimates that H.R. 3200 would cost $1.3 trillion, increase taxes, and add $239 billion to the national debt that will be passed on to our children and grandchildren.
I also have concerns that H.R. 3200 simply expands a broken health care system and does little to improve the quality of care for our patients, ourselves and families. Officials at the Mayo Clinic in Minnesota - widely regarded as an exceptional model of health care delivery in America - have said, ".the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients."
I believe the challenges we face today can be addressed without jeopardizing the coverage of those who like the insurance they have."

1) You CANNOT MANDATE that everyone have insurance WITHOUT A PUBLIC OPTION. Talk about a handout to the health insurance companies! 50 million new customers that are FORCED to pay the ridiculous rates that have given the health insurance companies a 428% increase in profits from 2000-2007. The public option will ONLY lead to a single payer system if the health insurance companies decide they need to continue with their incredible profits and do nothing to offer an acceptable product.

2) THERE IS NO FREE MARKET IN HEALTH INSURANCE. 1,300 health insurance companies?? I can only name about 5. Most of the 1,300 use the major 5 health insurance networks. I just recently found out that insurance companies are EXEMPT FROM FEDERAL ANTI-TRUST LAWS! What is up with this. This is why there is NO COMPETITION IN THE HEALTH INSURANCE MARKETPLACE!

3) How about passing a law that mandates any company involved in providing health insurance must be NOT-FOR-PROFIT?

ALLOW insurance to CROSS STATE LINES.. this is the ONLY way a stupid (to borrow a word used by someone very big) States that constantly run UP COSTS FOR INSURNCE , as in NY ., would have to finaly STOP running their Insurance co out of business.. In NY state, the cost of Med Insurance is FOUR TIMES MORE !!! the cost of MEDICAL CARE IS Twice.. the cost of Nursing Homes is FOUR TIMES MORE because they are Democrat controlled and ONLY Know to Increase CRAZY RULES that FORCE UP COSTs and PROFIT THE NY GOV only..
allowing INsurance to COMPETE across state borders would FORCE an end to this stupidity

30% OF ALL HEALTHCARE DOLLARS IN THE PRIVATE SECTOR GO FOR ADMINISTRATION AND PROFITS - THIS AMOUNTS TO $300,000,000,000 - $400,000,000,000 PER YEAR! AT THIS RATE, WE COULD BAIL OUT OUR ENTIRE FINANCIAL SYSTEM EVERY OTHER YEAR!

Might consider a Flexner-type of commission for health care reform with a straight up or down vote by Congress like in base closings. Need to try and remove politics from this.

The Flexner Report is a book-length study of medical education in the United States and Canada, written by the professional educator Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Many aspects of the present-day American medical profession stem from the Flexner Report and its aftermath.

Expanding Medicare, a single payor program, is the only logical choice, combined with supplemental insurance policies provided by the public sector. The other proposals only feed more money to insurance companies who do not look out for the best interests of patients or physicians.

It is up to the conservatives to argue why "government run" health care is a bad idea when majorities polled, even in places like Arkansas and Montana, want a government option. Seniors like Medicare, though many of them are dumb enounh to believe it isn't "government run" health care. Even Bill Kristol was forced to admit our own "socialized medicine" program--the VA and military health care systems--work well and provide, as he put it, "world class care."

Americans don't need health INSURANCE they need health CARE. The more "insurance" is addressed the more middle men we have in the picture dictating how physicians practice medicine. (Obviously physicians still need check and balances as well. ) The only plans which really need addressing include serious tort reform/malpractice coverage, and basic coverage for Evidence Based basic care for everyone. Preventive care/well care should be covered for everyone as it should make sense both financially and medically. Major catastrophic coverage needs to have a risk pool that involves everyone, so incurance companies can't cherry pick etc. Some one who hopefully can be impartial needs to decide what we can and can't afford as a nation. To require "insurance for everyone" is essentially a tax, which is called insurance. Call it what it is, increase taxes to fund basic health care for everyone who pays taxes. (If one is an illegal alien who doesn't pay taxes, you don't get covered.... ) For health care beyond the basic and catastrophic above, people may purchase additional health insurance for non-covered catastrophic needs to routine daily expenses, if desired, with policies available through the government or private sources and let the market decide where the deals are.

•    The current federal poverty level is $22,050 for a family of four. The bills would expand Medicaid eligibility to families earning an annual income up to 133% or 150% of the federal poverty level, or about $29,325 and $33,075 respectively.
    ⁃    That sounds like a good entry point for those needing extra assistance in affording medical insurance. $33k in a dual income family is $8/hr per worker. With a family of 4 that is tough to survive on.
•    Create a new government-run health insurance program (co-op or otherwise) to "compete" with the 1,300 existing insurance companies in the U.S., which could mean American families who have private insurance could pay $3,000 to $4,000 more in health insurance premiums if it is arranged similarly to Medicare
    ⁃    Of course they can likely keep their health insurance, and would only need to switch if their employer chooses to stop offering health insurance, but this is a reality that businesses face every day due to the staggering increases in health care costs. Whether they lose their private insurance and have a fall back plan in a government provided insurance, or lose it in a year when the cost to the employer becomes unsustainable is a matter of debate.
•    Make it illegal for Americans to go without health insurance and tax those who do not comply (an "individual mandate")
    ⁃    Fantastic idea, you can't drive a car without insurance and it is in the best interest of the government to ensure a healthy, productive working population.
•    Make it mandatory for businesses to offer federally-defined health insurance plans to all their full-time and part-time employees, or face a federal tax for noncompliance (a "employer mandate")
•    Move the regulation of health insurance from the state level (where it is currently) to the federal level in Washington, DC.
    ⁃    Essential to good reform.
•    Allow an appointed (unelected) panel of individuals make decisions about reimbursement and coverage decisions for Medicare
    ⁃    Excellent, these members should come from the healthcare community - doctors, nurses, community lay people - and it should be regional, as well.
•    Allow federal appointees in Washington, DC to decide the details ("essential benefit package") about what would be included in the federally-required health insurance each American would have to buy.
    ⁃    Agreed, as well. There needs to be an agreement as to what constitutes minimal coverage.
•    Levy new taxes on insurers, medical device companies, businesses, or Americans to pay for federal subsidies to Americans under certain income levels, to help them purchase health insurance
    ⁃    Taxes are the price we pay to live in a civilized world, there is no need to demonize them. And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me. Matthew 25:40

In addition I want to address this: "And, so far, no bill provides any med malpractice reform or addresses the practice of defensive medicine, which adds an estimated $1,700 or so to the price of insurance per family each year."
- Don't misunderstand me, by and large 99.9% of physicians are good, honest hard working people who have sacrificed much for their professional and position of privilege in the US. In addition the bar for malpractice should be exceptionally high, and all malpractice cases should be reviewed for their merit by a panel made up of doctors and lay people alike, much like ethics boards, with only the true cases of "improper, illegal, or negligent professional activity or treatment" being heard by court. But the link you provide concludes with "So -- however intuitive the argument may seem to be that the risk of malpractice suits might lead a doctor to perform an otherwise unnecessary test, it doesn't seem to be born out in practice." Which were the finding of the CBO who stated there was "no evidence that restrictions on tort liability reduce medical spending." (2004). They concluded that "the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect , either positive or negative, on economic efficiency."

Also, please bring back the counseling about advanced directives, and living wills. As a critical care provider there is nothing worse then putting patient's families on the spot, essentially demanding they provide me with their loved one's wishes. One thing we know from the literature is that whatever you do as an intervention in ICU medicine, it is better when you do it sooner, rather than later. There are many mixes feelings of guilt, family members who didn't get to say goodbye, who didn't visit as much as they could have, and in that split second the answer is almost uniformly "do everything." This may not be what the patient wanted, and I have had several patients wake up and immediately express their desire to not be resuscitated. Patient's wishes need to be documented early and readdressed often, likely at their yearly checkup. No one should have to guess or feel responsible for the "on the spot" life and death decisions of a loved one. There is no death panel. Just doctors, the patient, and their family making a decision that we will all have to make in our lives, however uncomfortable it may be.

Finally, as we all are well aware of, the "competition" in the health care industry is an illusion. I would refer you to this excellent paper in Health Affairs on Competition by James Robinson. (http://content.healthaffairs.org/cgi/reprint/23/6/11.pdf). The consolidation, as is frequent in all aspects of business, has lead to the illusion of competition, but with the same 3 players behind most of the 1,300 companies.

I commend you for your attention to perhaps the most important, and yet to date neglected voice in this health care debate, and look forward to continually working with you.

Jon Steuernagle

I agree completely with nsmurali, and Sermo Doc 7.

The first priority as I see it is getting everyone access, regardless of health condition and employment status, for life-threatening conditions.

Rationing is a dirty word, but everyone cannot have everything all the time. Examples:

1. You get 1 free gun shot wound repair, the 2nd you have to pay cash up front for.
2. You get 1 free preterm crack baby, the 2nd you have to pay for
3. You get admitted and dialyzed twice free from skipping your outpt appts because you were drunk/ high, but after that you have to pay for it.
4. You get 1 free year of hypertension/ diabetes, sleep apnea care, and after that you have to pay for it if you haven't gotten down to a normal body weight. No joint replacements or back surgeries on the morbidly obese.
5. Families have to pay for long-term ventilator care
6. If 3 doctors agree the patient is terminal with no hope of survival, the family has to pay for subsequent ICU care.

Senator Coburn,

There must be a decouplng of employer-provided insurance, and insurer contracts with providers. These mechanisms, in combination, allow insurers to control, as either oligopolies or oligopsonies, the entire end-to-end financial transactions involved in health care. They exercise far more power than their counterparties in these transactions, and exercise that power in ways calculated to maximize their profit regardless of the costs of care.

Insurers have no incentive to reduce the costs of care; instead, their incentives are focused on ensuring that they erect formidable barriers to entry by competitors, and to ensure that their processes are so convoluted and obtuse that only a dedicated few will even consider challenging the way they do business.

Eliminating the two mechanisms named above will cause insurers to change the nature of their competition from delay and denial to patients, and from oligopoly to efficiency for people seeking insurance. Shifting the present tax incentives from employers to individuals will help smooth the transition, continuing and even strengthening the HSA concept will limit costs and reduce the demand for questionable services, and allowing the sale of insurance across state lines would complete the transition.

If one replaced the words "financial scheme" with "health insurance" in any bill or article and thought of it that way, we would think about this issue very differently. Insurance really is a financial scheme where everyone who wants to put in money to pool risk can do so and experience a benefit should they need it. We've just seen another financial scheme called a mortgage backfire on us, so the focus should be how to regulate the financial scheme to give the most benefit to the most people who want to participate.

Agree to extend coverage to a higher "low income bracket", but I disagree with any mandated coverage. If I want to pay for my own house with cash, why would I want to get a mortgage? If I had a million dollars and was in good health, why would I want to buy health insurance if I could consider myself to be self-insured? I plan to cancel my life insurance once I get enough cash why mandate participation in a new scheme when we are already participating in several (medicare taxes and social security taxes).

I think one needs to talk about healthcare delivery reform and stop trying to create new financial schemes because financial schemes have loopholes, will be exploited, and eventually will go bust. There is no real value in a health insurance scheme except for the investors and employees of the company -- health insurance does not see patients and does not provide any real services. They try to limit cost and act as an intermediary between physicians and patients, often getting in the way of real care.

I think the real solution is reforming how the financial scheme works and who is held accountable for the financial outcomes of it. Patients who want coverage should be offered it and everyone should have a basic catastrophic plan because no one really wants to suffer catastrophic losses. This should be available to everyone. Those who want a more complex financial scheme can choose to participate in it, but requiring them to do so violates our individual rights. A fair model would be a health savings account where the balance rolls over year to year so that you can save up enough for the increasing cost of health care with age and you can reap the benefit if you continue to keep yourself healthy. We should not be sponsoring, as a country, obesity and preventable illnesses.

Once everyone has an HSA, physicians can charge what they think is fair and the payment system would be more clear -- cash for services. If it was your money, then you would have a reason to want to save it or manage it wisely and you would ask the physician how much things cost, negotiate a lower price, or not undergo unnecessary procedures. It would force medical school to teach doctors what their services and tests cost and give each patient the accountability needed to keep costs down.

With the current financial schemes in place, no one knows how much a service costs. Also, no one regulates the profit potential of the financial scheme and so much of the surplus money goes to the corporate officers and shareholders and does not benefit anyone with a medical problem. The insurance financial scheme needs regulation to make it a boring, low profit, real outcomes driven industry, but this will be hard with all the lobbies in the wallets of the politicians.

Q.. Dr COBURN, my simple question (you dont need to be a doc to figure it out)... thanks for willing to hear from the docs voices!!!!

Are the docs of yester years so dumb,stupid, untru$$$tworthy that they FAILED miserably in health care which is why govenment/insurance/pharmaceutical should
RUN HEALTH CARE?????

I hate to be the voice of cynicism here, but I just don't believe that Coburn actually reads ANY of these comments himself. I think this is just a publicity stunt.

He could make me a believer by introducing and sponsoring a bill that contains the important suggestions, policies, and protocols that have been brought up here by practicing physicians who really do know what they are talking about. Put the doctors back in charge.

Any proposal that does not decrease the frequency of lawsuits is not serious about cost containment! It really is that simple.

willingness

After careful study, I just don't see the Constitutional warrant for the federal government to be involved in health reform. If any of this passes, can't we use the 10th Amendment to take this to the Supreme Court?

Dr. Coburn: Make Health Savings Accounts universally available as Dr. Sermo Doc 4 has suggested above.

Instead of taking employer-provided health care insurance, as is done now, individuals could ask employers to give them the same amount of money the employers now spend on their insurance coverage. This would not be cash in hand, but money deposited into each individual's Health Savings Account.
Like the health benefits insurance employees now receive, this money would be tax-free. It could be spent only for health care - say with a debit card that taps into the tax-free Health Savings Account. People would use this money for ordinary expenses - visits to the doctor, immunizations, routine tests, most prescriptions, and so on. Docs would bill the Patient, no one else. Bill the Patient and collect now; the Patient pays from his HSA with a debit card and then he deals with the Govt., Insurance Co., or whoever, not the Doc!

What about big expenses, like a stay in the hospital or a CAT scan ? The Health Savings Account probably couldn't cover those.
But it could cover the low cost of a high-deductible catastrophic insurance plan, which would kick in whenever you incur a large medical expense.
For most people, these events don't occur very often, which is why such coverage is affordable.

The higher the deductible, the cheaper the insurance policy - just like auto insurance. If you want a plan with a low deductible that covers routine medical expenses, you'd pay a lot more.

But that would be the Patient's decision, not a government bureaucrat's decision.

The Senate has an Amendment to remove HSA's...wonder why?
Perhaps because the HSA would remove Health Care from Government control?!

Add a new Amendment to provide Universal Private HSA's!

md.sermo.com

md.sermo.com

I agree with everyone, we should allow people to purchase health insurance across state lines, just like auto insurance. That WILL foster competition. I still don't understand how having a public option will increase competition, it's gov't run, costs the taxpayers money, and is a default mechanism when people can't purchase insurance on their own. The insurance companies will love having people in the public option and not on their plans, and if they have to take people that have increased moral hazard or risk, they just increase the premiums for the healthy people or the young.

The so called "public option" seems to be quite reasonable. The fact it frightens the insurance companies makes me consider it to be a serious threat to the excess profits presently garnered by insurance companies. I have no problem with profit, it makes us all more motivated, competition usually controls prices. The existing government run systems including the VA, medicare and medicaide seem to be offering reasonable care to most consumers. I do clinics at a VA hospital, in subspeciality care for retina problems, I hear complaints from the veterans. Despite the complaints, most of the I see given is excellent care for people in very poor health with little motivation to change 60 years of poor choices on the patients part. Those who are diabetic are a poster child for bad choices, over weight by 100 plus pounds, no home testing of blood sugar, no attention to the concept of diet control and continued smoking despite loss of one or more limbs. I can not condone abandoning those members of our society who have been on the front lines in many conflicts. Their choices many years ago to serve in battle cost them more than they ever thought possible. Part of a democratic society is paying attention to those who lack the ability to look after themselves when weakened by age, ill health and abandonment by family. In summary controlling cost by the insurance companies is the essential point of health reform. We already have in place one of the most sophisticated medical systems in the world. I spent several years practicing in Canada as an eye surgeon. The most debilitating aspect of that system is the inability to keep up with technological advances, the cost of the "next better thing"is out of reach due to strict controls on the overall dollars devoted to the system. Governments are experts at exerting controls vis legislation and budgets for equipment in hospitals. Doctors who make enough profit to continue purchase of the best technological advances will always be there to protect and serve the patient. Remember we all are potential patients.

I forgot to add that even the poor patients should pay a small co-pay to decrease the chance of overuse for trivial clinical items. I have had MediCal patients come in for a medical visit, just to get a free bandaid and antibiotic ointment for their small knee abrasion. I have had MediCal patients who call the ambulance because they did not want to come in to the office for an hour to refill their asthma meds (They did not want to wait their turn and wanted to get immediate service at the ER instead at their convenience)

Frist of all thanks for invitingyour fellow docs into the health care reform discussion. I don't think any meaningful discussion about any reform will be effectve w/o our participation or input. THe AMA, AOA and the like do not speak for most of us.Doc's who are salried employees will not have the same view as those of us in the trenches of pvt. practice.
There can be no meaningful health care reform w/o malpractice reform.We need to have malpractice reform first plain and simple.The next step should aimed at preventing insusurance companies form comming between docs and patients- this happens all of the time, everyday. Insurance cos restrict the no. of visits, type of visit, procedures, and medications that they will allow. Isn't a lot of what happens to all of us in life looked at by them as a pre-exisiting condition?... then we need to look at fee for service monolopy practices of the insurace cos and federal govt(can you say RICO?)The rembursment rates that insurance companies pay are pitiful, and the govt. insurance is the worst! If I had to depend upon pvt insurance and Medicare/medicade paymets to run my practice I would be bankrupt.
Sorry for typos- I have more ideas , but I have to run-pts are here.
God Bless to all!

As an Ob/Gyn, I find malpractice reform essential to the healthcare debate. I think our specialty is one of the worst about practicing defensive medicine, but when I can be sued 18 years after a child is born because they weren't the valedictorian of their class, it forces us to do everything possible to cover our tails.
The other key point is medicare/medicaid reimbursement. The majority of our patients are covered by these types of plans and getting less money each year does not seem appropriate.

Motives can be misrepresented from both sides !!!

I do propose the following: ( considering breathing air is also not free!! AND you cannot go to WAL MART and not pay your bill)

1. Every individual must contribute to his/herhealth insurance.
2. A person below the poverty line does make income to look after his day to day expenses and so why should they not contribute towards health care. I think it should be 20 % of his SSI/SSDI which should go towards payments of premiums to Medicaid or disabled on Medicare. A person who gets an average of $680.00 social security should contribute at least $150.00 towards his health insurance monthly. The benefits of this insurance plan should be laid out and should not be a "Rolls Royce plan". I am sure that food stamps are included with SSI for their groceries.

3. All health insurances should have specific designated/ stipulated services and this should be clarified at the time of contracting for the plan.

4. All health insurance premia should be TAX DEDUCTIBLE and expenses should also be TAX DEDUCTIBLE to a percentage of the total expenditure.

5. All insurance companies should have a mandated single procedure for billing and evaluation of services. All payment procedures ,deductibles and copayments should be standadized. At present a company like Blue Cross has as many procedures as it has plans. IT MUST BE SIMPLIFIED. Drs. are getting killed with the utter confusion, availability of trained personnell who hold them to RANSOM. There are enough horror stories about this.

6. Medical Malpraxis denotes a criminal involvement and the very concept of a Doctor being criminally motivated towards his patient is an abhorrent concept. The lay public has been brainwashed to believe that a doctor's only incentive is to make as much money from his hapless patients and bring obout his financial ruin. I wish there was a study to re-visit the actuals of Physician earnings compared to other services paid out of the health dollar. DOCTORS EARN MORE BECAUSE THEY WORK THEIR ASS OFF and a very few can actually have time to enjoy the fruits of their labors.

I do not wish to miss the forest for the trees but a few of the "BAD" trees need to be weeded out of this confusing forest.

1. The Medicaid system is directed toward children and women with children. If it were directed at "poverty" instead, others could be made eligible:
a. Unemployed, including men and women without children or other "able to work"
b. Part-time and minimum wage employees

2. It would not be unreasonable to have a "tax" or a payroll deduction of 7% on all incomes earned, no ceiling, to offset healthcare costs. This would be on anyone earing an income, not just those above a certain level. Countries like France, with their socialized medicine programs, do not exempt the working poor from contributing their share.

Mandating that employers provide health insurance for their employees will only lead to a greater reliance on a government/public health plan. With the rising cost of private insurance, employers will opt to pay the tax instead of providing insurance. Then there really is no choice - can't afford private insurance on my own and my job won't provide it, so what's left, especially if it's "illegal" to not have insurance. So, then the majority of the country will have a health plan that resembles Medicare (a sorry but only example of the way a government can run healthcare.).
As Physicians, we chose to provide health care to people for a living and unfortunately the way in which that is done has had to become objectified, scrutinized, and governed by others so that we can't hardly do our job. They tell us not to consider reimbursement and litigation when treating a patient, but when it comes down to our paycheck and our career/reputation, how can we not? We provide a service that will always be needed - health care for our country's people. We were trained to do this job to the best of our ability, and we are paying for that expensive training. It doesn't seem right that those who know healthcare the best, who have chosen their career in providing it day in and day out are not the ones making the decisions. We're not even allowed to make the decisions, the insurance companies/government tell us what to think and how to do our job. (who did the training and who is paying for it?)
Asking physicians for their opinion is noble, but are we really heard? Give the doctors the ability to do their job and get paid for it - Wow, what an original concept!

Just in case ALZHEIMER has set in....

INVOLVE the doctors NOT AMA in any health care REFORM ...

this country needs if we claim to be the GREATEST (hopefully not paranoid as Muhammad Ali!!) claims...

I can assure you DOCTORS ONLY ... this represent ALL of the ABOVE correct answers to health care reform!

this statement of his is finely crafted, assumption filled bull. i don't think it really belongs on this site.

If there is no mandate for health insurance, people will continue to avoid paying for it, and continue to get free care, which will cause cost shifting and, you guessed it, YOU will be paying for the public option without there even being one. If we're going to pay for it indirectly anyways, let's at least get universal health care coverage on the books so doctors can get reimbursed for a change.

To the people who say this is America, and we can't be force to buy insurance, I say, why are we forced to take care of you when you need care? That doesn't add up. Insurance or no, we will have to take care of you and you will get it for free because someone else will pay for it. Back to the starting point...

The real problem is paying managed care 38% overhead and their CEOs untold millions to ration care. You're worried about rationing care to the elderly, being denied necessary medicine and surgery under the Obama plan? WAKE UP AND SMELL THE COFFEE PEOPLE!! It's happening right now under BC/BS. They take your money, deny care, and pocket the savings. And they have you all fooled into thinking change is risky....

Of all the above comments, I agree with John Cianca MD, well put.

Why is there such a push to protect insurance companies? In my state the medicaid programs are run by private companies with a profit motive, and it is a big mess. At least, with one single payer, there's only one mess to have to deal with.

For all you who are against any government intervention, think of what would happen if the government left medicine altogether. No more NIH grants, a stop to federally funded cancer research, a lot fewer residency slots, fewer state-supported medical schools, and, no more VA, medicaid, or medicare.

I disagree with the above comment that access isn't a problem in this country. It is a huge issue and death/disability does result.

Seeing my medicaid patients abuse the system drives me crazy. Bringing their 3 little kids in with mild colds just so they can get tylenol paid for by medicaid is a huge waste, especially so when they go to the ER. It's also a waste to fly out any little kid with any minor ailment to the nearest children's hospital just to cover myself against a potential lawsuit. Our system has flaws and waste. But, I went into this business to take care of kids. Rich or poor, legal or illegal, I don't care. Sick children deserve care. I hope any health care reform improves my ability to do my job.

The health care system in the U.S. is terminal and med mal, which is being proposed on Sermo as some form of panacea, won't even touch the problem.

There are actually 2 huge issues:
1. Lack of universal coverage
2. Out of control costs

The only solution to both of these is a single payer system. In lieu of that, as I realize that insurance companies among others won't let this happen, is that there

ABSOLUTELY HAS TO BE A PUBLIC OPTION!!!

If not, we are just collectively fiddling while Rome burns, and the insurance companies, hospitals, PHARMA, Device makers, and specialists get rich in the process.

Thank you,

Bert Bieler MD

Sen. Coburn,

I don't imagine that you will ever read this, but you cannot tie payment to anesthesiologists to the pathetically low Medicare rate of reimbursement, which is only one notch above "no-pay", We are unique as a specialty in that we would never sign a contract with an insurance carrier unless it were a multiple (>4x) rather than a percentage of Medicare rates! Any plan to do this will decimate the specialty of Anesthesiology and force me to consider going to law school as I haven't heard any plans to limit their compensation. In my state, I receive almost twice as much if the patient does not have any insurance or Medicare!! How's that for a slap in the face? Medicare recipients will have no one to care for them.

A Public Option is Death for any Health Program...Medicare is underfunded and dying!

Doctors will quit or opt out of Govt Health Care!

So will it be with all other new socialist Govt. Programs!

History repeats itself!

I would like to see you support a bill that has the following:

1. A mandate to obtain insurance
2. A robust public option that actively competes with the private insurance companies
3. Research into effectiveness of treatments and interventions
4. Tort reform that limits punitive damages preferably through the creation of health courts

You can do this by supporting one of the Democratic sponsored bills that include these features and stop impeding progress on this matter.

The private health insurance industry needs MAJOR renovations to curb its absolutely astronomical profits!! We need a plan that not just ensures every American has health insurance, but also a plan that CUTS the profits of private insurance companies currently making BILLIONS of dollars without providing a single penny's worth of care for that pure profit! Pumping more money into private insurance to get more people covered without ALSO limiting insurance industry profits is plain foolish. I want to see every American covered. I strongly believe we need a government-run plan, the benefits of which to be overseen by real practicing physicians, to compete with the private insurance industry. However, I don't believe this will be enough to bring down their profit margins and ensure that more health care dollars paid to private insurance will result in better care or care for more people. There need to be profit caps, period. As the article below points out: "Within the context of companies' revenues, insurers skim off 15-20 percent of premium dollars for administrative costs and profits. In fact, an examination of insurers' medical loss ratio — the fraction of revenue from a plan's premiums that goes to pay for medical services- suggests that within the last 10 years, insurers have been spending less on medical care and more on administrative costs or profits." An even better plan would be to force private insurance into not-for-profit status, but I doubt you'll be refusing the insurance industry's lobby money, will you?

See: wonkroom.thinkprogress.org

I also believe we need to rid the system completely of any pre-existing condition clauses, AND everyone with a pre-existing condition must not be charged a higher premium as a result of it.

A cost shift of $1800 (if your figures are correct) would be virtually cancelled out by the cost savings of $1700, if med mal reforms were included in the ultimate reform bill. Med mal reform is obviously absolutely necessary. It not only wastes our money--it wastes our time.

Finally, there needs to be a cost shift toward PRIMARY CARE MDs. We are the front line. If anyone should achieve higher reimbursement as a result of reform it should be the underpaid pedatricians, internists, family medicine docs, and cognitive-based subspecialties who are financially disadvantaged relative to procedure-based subspecialties like surgery, cardiology, etc. Those on SERMO who seem to whine the loudest about "socialist" health care reform are those paid the highest in medicine right now. Isn't that a sad state of affairs? Greed isn't very attractive.

Let's reform medicine to benefit patients while maintaining the autonomy of the physician. And we can do that by ensuring whatever health insurance vehicle we choose to keep or modify puts the most dollars back into real health care--not profits, not administractive costs. Thanks for listening.

The only way to curb the run away costs of medical insurance is to reign in both the lawyers and the administrators. Imagine that your car was broken and driven into a lake. Would you put on scuba gear and fix the engine without removing the car from the lake? That is what congress is currently attempting by not addressing tort reform.

As for the 'public option' that is the worst possible scenario. The current public option systems, Medicare and Medicaid, are woefully top heavy (administrative burden) and laden with extra duties for the physician that are not reimbursed. How can the President claim to be for preventative care when Medicare does not cover the cost of preventative health care codes currently?

I agree with eliminating preexisting conditions, caps on services, and portability of insurance. These are steps in the right direction.

Finally, a word as a Family Physician. There is going to be a marked shortage of primary care physicians in the future. Very few people are choosing these specialities because of the relatively low reimbursement. Who is going to provide all this primary care that Congress is emphasizing?

Len Raucher, MD

I agree, we either have a capitalist country with market driven services or we have a government controlling more and more of our daily needs. There are video clips of Bill Clinton declaring that the people are like children and the government must take care of them. That is the democratic position in a nutshell.

Senator Coburn has crafted questionnaires to support his position, other Senators and Congressmen do the same and many if not most seem to back the position that this must be rammed through the legislature with no regard to opposition.

Our only recourse is to get the voters informed and make this a voters issue not a doctors issue. Senator Coburn is irrelevant. He will accomplish nothing on our behalf. We must have Madison Avenue work for us to convince the voters to put pressure on the Coburns, Franks, Waxmans and Baucus' to stop screwing around with their lives.

P. Jakobson, MD

1- Med malpractice reform
2- Med malpractice reform
3- Med malpractice reform
4- allow cross state health insurance competition
5- Physicians make med decision, with a physician elected panel to oversee.
6- Increase reimbursement to MDs. Lowering reimbursement will drive good MD's out and will not attract future MDs. If not, govt can pay our overhead. If you are going to salary or limit my earnings, then govt pays my office bills.
7- Pts need to be accountable- increase tax, insurance premiums etc if you are overweight, smoke, drugs etc. I feel the people who take care of themselves shouldn't pay for those who don't.
8- Public option ---> socialized medicine. If that is the goal behind the scenes in Washington, you can expect rationing of care etc. If you have this which is essentially the VA system, you must have #1, 2 and 3. Cannot expect physicians to be delivering care based on govt rules, yet be liable because the govt limited our ability to deliver care.

I guess people will be now flying to India to get their health care instead of the good ol' US of A...

Oh, forgot
9- Will bronch for food!!!

As one other poster mentioned, I too contacted Senator Coburn's office along with many other senators of his ilk. None had any interest in ideas that did not jibe with the Republican non-plan for health care reform. I don't want to see health insurance reform but health care reform. Putting a Bandaid on Medicare doesn't really do much for anyone, least of all physicians. Are they going to change the poor rate of reimbursement from Medicaid. Are they going to give real tort reform. Are they going to subsidize medical education to get more doctors into the system. Haven't seen it so far.

Qui prodest?
US spends >$7000 / person (#1 in the world) yet US health care ranked #32 by OEDC
Insurance related cost 6.9% while physician fees 7% of health care cost.
Insurance companies profit = missing money from health care
No-one protests again mandatory (universal) auto insurance
No one speaks about goverment take-over in elementary and high school education or in the postal service

Insurance companies are obviously are afraid of loosing their profits, so spend o lot on lobbying against the public option.

By the way aslaaz, we already have private rationing of health care by "death panels" from the insurance industry. You must not order many MRI's or much in the way of other procedures. Our office has one person to whom we pay a good salary that does only authorizations for services and that work is not reimbursable by anyone least of all the insurers. And when a medication is denied payment and the patient can't afford the more expensive medicine so they just get sicker, who pays when they end up in the emergency room or the hospital with no coverage? I see this at least once a week.

Sermo Doc 20 - the way I understand it, is that the AMA and AARP, as well as the AAP, support the "principles" which PrezBO is basing the healthcare reform - ie no pre-existing conditions, affordable health insurance, etc. Back in my idealistic days with AMSA, we called these "flower resolutions" -ie "resolved: We like flowers", because, who doesn't like flowers. The trouble is that these assn's are not refuting that PrezBO represents their approval of principle as approval for the actual plan. Pres Obama is an excellent speaker. He makes it sound like what he says is true, but lots of folks besides Joe Wilkins know the truth behind the speechifying. We are having a crisis in truth as the mainstream media reports news according to its agenda, and ignores anything contrary, and doesn't have the kahones to do investigating anymore.

A lot of good points have been made here already. I just want to say I second the motion on increasing the role of HSA's, creating medical arbitration courts, no mandate on carrying healthcare insurance, and more support from the powers-that-be that doctors are not the enemy; in fact they are the savior in the whole healthcare equation. Doctors need to be shown more respect (and adequate payments) or they will cease to accept low-paying insurance plans.

Confiscate all Lobbyist money and fund Medicaid/Medicare!

One significant change would be to drop the bans on balance billing, especially for Medicare. That is the reason why so many doctors are dropping out of Medicare completely. Balance billing is illegal so they resign and treat Medicare patients for cash. The pre-existing condition situation is very difficult without some sort of mandatory insurance. A mandatory catastrophic plan would be a possibility but no one I know trusts the Democrats to enact this without adding lobbyist-drafted mandates that will make the plan a monstrosity. Those who want single payer, like the commenter above, will try to prevent anything short of their ideal command economy model.

use the constitution which lets the president set tarriffs. Tell the companies they have 60 days to begin producing 50% of the product they sell in the US here or the tarriffs will be so high they will not be able to compete in the US market. That brings millions of jobs back to the US. Tell the companies they are required to offer health insurance to any employee regardless of hours worked. That gives millions back insurance. Make the hospitals and HMO's give up ownership of the doctors and practices they own and control and that will restore the free market of office charges and lower medical costs dramatically. Cap malpractice to lower the rates as many doctors pay hundreds of thousands per year in premiums. Stops all benefits to illegals so the states will not be bankrupt after you get the illegals a 6 month grace period to apply for citizenship since they are already here. Do all that then lets see who is left over to need insurance.

Decrease paperwork:
I currently on average sign 15 Medicaid forms a day at considerable time to my staff. This has to be costing the governement as well, just in hourly wages used to generate and review forms.
Endless preauthorizations for prescriptions.

Allow purchase of insurance across state lines. He in San Antonio our choices are very limited if you want a quality policy.

Do not tax "luxury policies". This shows a total lack of knowledge by Congress and The White House of what really is going on in the real world. Only the politicians in Washington have "luxury" policies. President Clinton spent 5 days a Bethesda for a sprained ankle. In the real world we would get a script for Tylenol # 3 in the ER and sent on our way. The fact that some people are paying 10,000.00 or more for a family policy is NOT because it is a luxury policy. In my case it is because I have hypertension and an employee with lymphoma, so our rates have gone up an average of 20% a year because of this. But our coverage is quite basic, with high deductibles.

Limit the amount a policy can cost and how much they can increase every year.

Malpractice goes without saying.

Finally, keep in mind that a huge number of physicians are over 50 and may well retire or work part time if we are starined any further. Then you will clearly see the waiting times increase which in turn will send more "insured" people to the ER. No savings in the end.

As the population ages and technology advances, cost will incease and I think Washington has a responsability to admit this. There is no way to save money unless you ration. And if you ration, that should include everyone, including the President.

Finally, accept the fact that when it comes to medical care you can only pick 2 out of 3:
Cheap, Fast, or Good. There is now way you will ever get all 3. Washington needs the courage to accept this, and then live with the consequences. From my standpoint, all my political contributions are going to ANY challenger and NO incumbent. Enough is enough.

Sermo Doc 39... excellent, well stated...

... health care in the hands of lay people (patient representation) under docs, medical counsel (medical representation!) ' for ethical, economic,. apolitical, medicolegal decisions ... both regional, federal levels...

"all malpractice cases should be reviewed for their merit by a panel made up of doctors and lay people alike, much like ethics boards, with only the true cases of "improper, illegal, or negligent professional activity or treatment" being heard by court. But the link you provide concludes with "So -- however intuitive the argument may seem to be that the risk of malpractice suits might lead a doctor to perform an otherwise unnecessary test, it doesn't seem to be born out in practice."

I haven't heard any viable alternatives to:

1) removal of the profit motive from the financing of health care
2) a no-fault system of compensation for bad medical outcomes
3) rationing

So we might as well get started.

"You can always count on Americans to do the right thing -
after they've tried everything else." ----Winston Churchill

We mandate, by law, that Physicians see and treat patients regardless of their ability to pay when they present to the ER. Why don't we mandate that insurance companies provide coverage to the uninsured, in proportion to the percentage of market share the company has in a given geographic area, for each ER visit and /or hospitilization of the uninsured. Physicians have borne the brunt of providing free care for decades, now make the insurance companies bear some of the burdon. Or we could just regulate the insurance industry like we do the electric industry. People do not go without electricity, and the profits by the companies covering them are tightly regulated. Yet people still invest in their stocks and everyone is happy.

Malpractice/liability reform should be central to heatlhcare reform. Without it, we'll have a very bumpy road, even if all the other elements favorable to true reform were in place.

We need to stop financially threatening physicians. They currently take home less than 10% of healthcare dollars. We also need to strengthen our primary care infrastructure, without which we'll have continuing fragmentation of care and therefore increasing costs.

A simple idea to explore is this: let doctors be doctors. Don't get in their way and shift focus to where the real inefficiencies lie, i.e., our bloated third party system.

For Medical Liability Reform,
If we could have "Malpracrice Comp" to be like "Workman's Comp" the heavy litigation would go away.

In Workman's Comp there are Employer, worker and injury.
In Medical Comp there would be Doctor, Patient and injury.

Substitute the words and make everything else the same. The employer would be the doctor and the worker would be the patient. Now you have the same relationships as workman's comp. Everything is reduced to a simple claim, rather than a bruital lawsuit. If you have many claims then your rates go up. if you have few claims your rates go down. If you do not want to get this incredibly cheap MEd comp, then self insure like some businesses do.

In workman's comp they deal with complex medical injury and problems with the assignment of liabiltiy. This is the same with medical liability. The difference is that now all Medica liability compensation starts with a full blown law suit, not a simple Workman's comp type claim.

I have passed this idea past lawyers, physicians and people alike and tt has seemed reasonable. The only group that does not like it is the offfensive lawyers who file law suits. I suspect this is because they are the only ones who get hurt by this model.

Many will criticize Workman's Comp, but it is still 10 times better than the alternative. Workman's comp has been around for decades. It is relatively efficient and eliminates millions of lawsuits. If there is a problem with a dangerous doctor, then that is a matter for the state medical board and should be addressed there.

Please consider introducting thsi new approach in congress.

Triple the reimbursements for primary care. In no time there will be no shortage.

Mandate that women who have 1 child requiring government-assistance (i.e. WIC, Medicaid, etc) be required to get a Depo-Provera shot q3months to continue enjoying their taxpayer-funded assistance. Once you get your shot, you get your check. It would be a lot less expensive for Joe Taxpayer to pay for a depo shot every few months than to continue paying for labor/delivery, NICU, ER visits and well-baby care for the next 18yrs. It is a completely reversible birth control strategy that doesn't depend on anyone taking a pill at the same time every day. If you want to have more babies...fine...you'll just have to pay for the expenses yourself.
I just cringe when I see a baby born to a 21 yr old G5P4 mom who has never worked a day in her life, dad is in prison, and the mom has a +tox screen for marijuana...but yet she gets her 5 kids all expenses paid! Drives me nuts.

Senator,
I believe that in order to reform our health care, we will need to adapt a free market model, where REAL competition is allowed. As you know, that will include getting rid of State-line regulations, that do not allow the insurance companies to compete freely in between States. It also means, that we get rid of the CPT codes, and start charging patients for the entire episode of care, rather than by procedures. Medicare, as well as private insurance should be allowed to choose among health care organizations that offer the best value for the care of the patients. Patients who do not have the ability to afford their insurance, should received a subsidy from the government so they can also get insurance. Primary Care services need to be beef up, so that we pay for preventive medicine rather than curative medicine. In summary, we need a complete overhall of our health care system, rather than just patchy strategist that do not contribute to the improvement of the Health Care for our citizens.

Here's what needs to be done. Keep the government the hell out of our personal lives. Hands off. You work for us, the US citizens. If this garbage gets crammed down our throats in 2009, I guarantee you that the voters will stick it up your a$$ in 2010. Get the point, "senator" ? Quit fabricating "crises". Penalize people who don't have insurance?! They can't afford it, or they would have it! Government option? Thank God that got killed in the finance committee. Just compare the USPS to FedEx and UPS. FedEx and UPS make millions every year, the USPS LOSES millions every year. The US government would screw up a one car funeral. Quit handcuffing the physicians with more red tape. Quit letting frivolous lawsuits move ahead. Keep non-physicians out of the healthcare decision making process. It should be between the doctor and the patient. I take care of anyone who walks in the door. I never ask how they will pay, and have worked that way for 20 +years. Keep your grubby, filthy senatorial hands off of healthcare, and go do something useful. You politicians all make me sick, regardless of your party affiliation.

Dear Senator Corbin:

Here is my plan -- it is VERY SIMPLE: OUTLAW ANY AND ALL TYPES OF HEALTH INSURANCE. Then, everyone is COVERED -- i.e. everyone is self-insured. Those who do not have the means to pay, well I am sorry, but, as harsh as this may sound, you have to do something to get those means. After all, if you do not have a roof over you head or food on your table (or the table itself, I might add), no one is going to provide you these things for free -- and these things clearly come way before your cholesterol level check or MRI or Botox (whether for therapeutic or cosmetic purposes). See how this approach is going drive the costs DOWN (because providers must geuinely COMPETE) and the health status of the population UP (because people must genuinely be CONCERNED about their health for they pay CASH if they don't).

Dear Senator Coburn,
This plan takes the best ideas from both parties. The number one problem is costs. Address costs by putting patients more in charge of the money and by making prices public. Fix Medicare by using a new payment scheme, something like this:

75% - of charges will be automatically paid for when you see the doctor, undergo a treatment, or get a medication.
up to 10% more - will be paid for if your last check-up showed normal blood pressure, normal blood sugar, non-smoking, and reasonable attempts at weight control. These are the Safeway ideas, which proved very successful in controlling costs.
up to 10% more - will be paid for depending on the science behind what is done. If lower quality studies support the test or treatment action, less is reimbursed. If high quality studies, such as randomized controlled studies, support the action, test, or medication, the entire 10% will be reimbursed. Social networking of physicians, nurses, and allied health care professionals, will be the cornerstone of deciding how this 10% of the reimbursement is done, but patients, epidemiologists, and statisticians must also be involved. All this information will be public, visible to you, at all times. All physicians must be involved, not just a government panel.
5% will be paid out of pocket by the patient. This will be the starting co-pay for everything - this is the out of pocket cost that will keep demand for medical services from getting out of control. This co-pay will also have a ceiling, or will graduate downwards, to prevent patients from going bankrupt, or will be forgiven for the poor, working poor, veterans, or elderly as needed.

The percentages are adjustable. Once a working scheme has been introduced and it is mandated that all prices must be told to the patient ahead of time, except in emergencies, turn seniors lose on the health care system with the directive to get the most care they can for their money. This will drive all medical costs down.

This way no care will ever be completely denied. Everyone will care about prevention. And everyone will care about the science of medicine again.

Seniors, instead of driving all over town to save $2 on lunch will start driving all over town for the best deal on a CBC, x-ray, medication, or MRI.

Then do the same for VA care. Then do the same for Medicaid.

Then do the same for private insurance reimbursement.

Whatever you do, do not expand government health care. The worst care I have seen all over the world is government health care. Government health care cannot innovate or keep up with health care changes. Government health care leads to artificial shortages, rationing, and death.

Take power away from the Government and away from private insurance companies and put it back into the hands of patients, doctors, and nurses as much as possible.

Mandate risk pools of 1 million or more so that pre-existing conditions won't matter in the private health care system and make all insurance completely portable.

Thank you for trying to help with health care reform.

The frist thing I would like to point out is that there really is no logical reason why all of this has to be in one big bill. You could break it down into components and tackle one thing at a time to give a better chance of some success and allow for progress on some fronts while fighting others.

1) Med Mal - the problem with this debate is that people usually want to take the easy way out and just cap the max pay out. This intuitively makes sense and I think should be done but it is not enough. The numbers are just not there and ample reasearch shows that it will have very little effect. The real problem is that the docs don't want to get sued int he firs tpalce for any amount. The way to make docs feel more secure and so not order un-needed things is to give them a more clear idea what will keep them out of court. More consistent standards rather than local standards would make it possible to be more judicious and also to more rapidly adopt new thinking and so improve care. Also, decreased reliance on a jury of peers (all of whom have been selected based on a lack of knowledge of medicine) and more reliance on professional jurists would help to have a mre streamlined and consistent process. SImply changing from one local standard of care (as if that ever exists) to any reasonable standard would make things much better and stil protect the patients who have not had reasonable care.




2) Reimbursement. I hate to turn this into an us vs them type of debate but he sad truth is that all docs are fighting for a piece of a pie that is probably going to shrink and certainly is not going be much bigger. Virtually every efficient healhcare system in the world relies more heavily on primary care and less heavily on specialists than the US does. Currently we are moving in the other direction as far as medical school grad choices. Some would like to bolster the primary care with "mid-levels" but even if you agree that they can handle it (which I don't - and the rest of the world doesn't either) their numbers also are not there. Things need to be made better for primary care. The good news is that I don't think that means markedly more money (and so not markedly less for the "proceduralists") but it should mean fewer hassles and getting paid for more of what we do.

I would suggest having a scale of complexity that varies more than the current so you actually get paid for managing more than 2 problems at a single visit (currently we don't), less bundling of services so I can get paid for a minor procedure and other things, and actually getting paid for things like filling out forms and talking to people (patient sand otherwise) on the phone. The coding should rely less on documentation and more on what you actually do and they should drop the requirement for face to face encounters. Maybe they should only look at the decision making and scrap the counting bullets of PE and history all together and allow us to bill for time including time filling out forms and on the phone.

Lastly, just as it is in every other facet of the insurance industry, the burden of gathering needed data to settle claims (ie. authorisations) should be on the insurance company, not the vendor (doctor). If the insurer chooses to use the doctor rather than pay an adjuster (as the home and auto insurers do) then that should be at a reasonable rate outside of the fees for providing healthcare. Ditto schools, sports teams, Boyscouts, etc.



3) Mandates: I am torn about the mandates. I intuitively don't like them but agree that pre-existing conditions must be covered and am not sure how to do that and be fair to the insurers without more of an individual mandate. I would be open to other solutions.



4) Competition: I agree that competition is good. I therefore think that a "public option" (or co-op) is only needed where there is insuffiicent competition. In many, if not most, places it is not an issue. Why not only bring it in where it is needed and let the free market go where not? I don't like the idea of cross state insuring unless the federal government also regulates the companies. If you let the state do the regulating but then let them operate nationally then everythingwill quickly contract to a few insurers running in just a few especially lax states where the regulations are set locally and the rest of us have to live with it. It would be a new incarnationof taxation without represenation.

First, although I believe tort reform, which should occur at the STATE level, is a useful component of health care reform, I do not believe it will solve the financing problem. Even if we factor in defensive medicine, and assume that suddenly all physicians stop practicing defensively, savings is likely to be < 20%, probably quite a bit less.

People will consume an unlimited amount of anything they don't pay for. They will even consume "pregnancies" as was pointed out above, when the the child-rearing is cost-free. Therefore, an essential philosophical reform is to make the patient spend the first dollars out of his / her own MSA. Perhaps this MSA is funded by the employer to a certain extent, but we have to create a "make a budget" mentality towards health care consumption or no reform to the financial structure will have any useful effect (unless it imposes absolute rationing).

The more capitalist elements you can inject into the reform, the better. Open competition across state lines among health insurers - throw it wide open, anything goes. Plans with low premiums and restrictive pre-certs can compete with plans with higher premiums and no pre-certs. These plans would be competing for patients and ALSO for doctor participation. Patients need doctors. We (docs) can vote with our feet and the patients will follow.

Balance billing is essential. We aren't having a dental crisis.

Gotta go see a patient or my staff will swat me, more thoughts later. If you're reading. Which you probably aren't. But see you on the Mall tomorrow, Senator.

I agree with Sermo Doc 35. Biggest problem with costs is 30% of health care dollars spent on administrative costs. Should be 15% at most. Large part is excessive insurance profits. This is also biggest hassle factor, burnout causing dissatisfier. Waste, fraud, abuse, defensive medicine also on the list.

Congress must address administrative costs and waste to have any real chance of "bending down" the cost spiral.

I'll make my comments brief: we need Tort Reform and a single payer system. If all are created equal under our Constitution, we should all have the same healthcare. Societies are judged by how well they take care of their children, their elderly, and the overall well being of people. No more preexisting conditions, gaps in coverage when changing jobs, no more COBRA. MDs should be on a competitive salary, have student loans repaid, not worry about being sued, and have the freedom to use their own judgment when practicing medicine. I know there are those who feel the government can't run anything. If this is the case, why does everyone want government jobs and benefits? This would not be socialized medicine. It would be socialized insurance. Make it illegal for insurance companies to profit from the sick while making people go bankrupt with unpayable bills.

Any changes in the system have to include malpractice/tort reform. In addition, med school costs need to be adjusted to our income potential. Less pay and higher school costs.... not a good combination. I predict that soon we will have many more foreign physicians in the U.S. due to our U.S. med school costs. Bright students will not enter the medical profession. We also need tax breaks for our student loan interest. Our loans are more than most home mortgages. Why shouldn't we be able to claim tax relief? I wish I was old enough to retire. I can't take any more regulation by the govt.

1. Everyone should be insured. Those who are poor should have real insurance, not Medicaid, which pays so poorly most doctors won't take it. If we have to raise taxes to cover the uninsured, then do so. We are the only developed country that doesn't.
2. Medicare payments should be restructured to pay more for E&M and less for procedures.
3. Insurance companies should be heavily regulated. They should be non-profit only, without huge salaries for their executives, either. They should be told what they have to cover so they can't weasel out of it. Payments to doctors and hospitals should be made within 7 days, like in Switzerland. They should have to cover pre-existing conditions. Insurance companies have done far more to ruin the practice of medicine in this country than the government ever did.
4. Medical school should be subsidized like it is in all other developed countries so students don't have to choose high paying specialties.
5. People injured in the health care system should be compensated sufficiently through a system that doesn't involve trial lawyers and having to prove malpractice. This is what is done in the UK.

As one of Senator Coburn's constituents I am saddened and alarmed by his stance on health care. Dont we already pay the price for those who are uninsured in many different ways! He of all people as a physician knows this. PLEASE consider changing your stance to a more rational one and please listen to what physicians are saying in this. You of all people should be there for us!
A fellow Oklahoma physician.

Do away with the "bullet points" for E & M codes. I am not a criminal, but God Forbid I only collect 9 review of systems instead of 10 and bill out a level 5 consult.

My biggest criticism of the current debate is that it centers on health INSURANCE reform, not health care reform. Until we start talking about changing the care delivery system and the payment system, we won't achieve menaningful reform or cost savings. Expanding insurance coverage is important. Tort reform will be helpful ,although I think the benefits have been overstated. We must address the fact that the economic incentives of the system are perverse and that the system is geared toward treatment of acute episodes, while our countery is facing a tsunami of chronic conditions. We msut begin to reddesign a patient centered system of care, that pays physicians for maintaining health. Wev need robust outcoems measures taht will ennable value based payment for health care services. We physicians have allowed ourselves to becoem piece workers, not unlike someone in Soutesat Asia, making sneakers for a few pennies a piece. How did we, the best and the brightest, come to this?
We can influence the conversation. We need to be the vanguard in an effort to focus the discussion on how we can really transform health care, not just expand insurance coverage. Michael Porter and Elizabeth Teisberg have written a wonderful book entitled, "Redefining Health Care" that puts forth soem provocative proposals for doing just thta. Clayton Christenen has written "The Innovator's Prescription", which also proposes transformational change, albeit quite different from that proffered by Porter and Teisberg. If we won't help frame the conversation, then who will? Certianly not Congress!

I'm not sure how to do it, but the profit motive for large corporations needs to be removed. Indeed, people should be appropriately compensated for what they do, but as long as for-profit large corporations are driving the health care bus, people who work in the health care industry and patients are going to suffer. This is because large for-profit corporations ( pharmaceutical companies, insurance companies and hospital chains ) are in business to make money. They are run by businessmen. Making money is their primary goal. Providing care to people who are ill and distressed is just one hoop they have to jump through in order to make money. They make money by collecting the maximum amount for their services, and minimizing the care they provide. If you don't believe me, I invite you to work at a hospital run by a large, for-profit corporation for a few days. Some of the people running these companies are simply, ( and I'm trying to be kind here ) greedy thugs. Their primary obligation is to their shareholders, not their patients. And they are compensated according to how happy they make their shareholders. The employees are overworked and patient care is compromised. Providing health care should not be about making profits. It should be about providing the most care at the lowest possible cost. Until for-profit corporation are removed from the picture, pharmaceutical corporations will continue to spend more on marketing than they do on research and development, and fat cat insurance and hospital executives will continue to make obscene amounts of money in the form of exorbitant salaries and stock options. Physicians, other health care workers, and patients will continue to suffer, and the price of health care will continue to rise.

On second thought I would add to Senator Coburn: listen to what your fellow physicians are saying and leave big business out. Making money from the sick and poor is not a prlmary concern. This is a conversation between patients and health care providers! If we did not teach you this as a medical student and resident in Oklahoma I am sorry but please hear it now.

None of the bills take into account those who abuse the system. In one government study the lower 50% of patients accounted for only 3% of health care costs while the top 5% accounted for 49% of healthcare expenditures.

www.ahrq.gov

Drug addiction is becoming a cash cow for hospitals and healthcare. States can get a waiver to put addicts onto Medicaid then treat them for years (a lifetime problem) with Methadone.

There needs to be limits on healthcare usage by the uninsured and poor. The middle class is limited by co-pays, and work hours.

I would like to see a two-tier system. First, a "decent minimum" entitlement (yes, entitlement) that would guarantee immunizations, USPTF screenings, generic meds, "normal" procedures, etc.
For those who can afford it, a second tier of insurance and/or private pay could cover elective things like rhinoplasty, bariatric surgery, ED meds, etc. Why should those of us who don't want the latest/greatest meds, or "everything possible" at the end of life, subsidize those who do?

Health care reform without tort reform is useless.
45 million poeple do not have health insurance
9 million of those are illegal immigrants
30 million make between 50-75K and choose not to get it or are college students.
That leaves 6 million. Put them on Medicaid and leave everything else alone.
The new plan would tax the 50-75 K level and is just a ruse for Govt to take control of 1/6th of the US economy

Send illegal immigrants home.Enforce immigration laws...after all these are Federal Lwas that are being broken. COntract rather than expand government.
Vote for term limits and get the dead wood out of Washington

First of all, there is not a health care crisis; there is a health cost crisis. We have the best health care in the world period.

The largest issues I see with any attempt to deal with the health care cost crisis are meaningful tort reform and futile care issues. Without both, any attempts at reform will miserably fail.

If the costs of end of life care alone could be brought under control, there would not be a health care cost crisis and Medicare would not be going bankrupt. It is that simple.

Unfortunately, the Republicans are supported by the religious right wing which would precludes a real discussion on end of life issues, and the Democrats are funded by the trial attorneys which precludes a real discussion on tort reform.

We need politicians in Washington to step out of their party lines and get their heads out of the sand and do what is right for our country. If not, we are doomed for a financial crisis that will make 2008 look like a year of prosperity

Thanks for asking our point of view.

I honestly believe that we have to have a public option. It is important to have the bargain power of a federally funded option. This would bring prices down like is does in other developped countries.

As a family doctor I am way more concerned about my community and their ability to access health care than how I am going to get paid.

The insurance companies and Big Pharma have to loose ground on this.

Let's make a law for the PEOPLE OF THIS COUNTRY and not for the INDUSTRY THAT MAKES MONEY FROM THE SICK.

Senator,

I sincerely hope that your question to this community is an honest attempt to get a fresh perspective from our community. If so, thank you.

The only point I would like to make is that all of your discussion points pertain to health insurance and none to the actual access to and provision of medical services. As the state of MA has sadly discovered, there is a gulf between the two. Primary care physicians are leaving practice as fast as their finances or other opportunities allow and hardly any are coming out to replace them. It has been clearly shown that patients with access to primary care have better outcomes at less expense. If nothing is done to support access to primary care, costs will continue to escalate as our outcomes continue to be some of the worst in the developed world.

The incentives to providers as well as insurers are not geared towards effective care (quality-wise or cost-wise). The free market has driven everyone to the top line. We have MRI's, vein centers and spine clinics to excess because that is where the money is. Our community of 150,000 is short about 57 primary care doctors. When providers are enabled to financially benefit from making good medical decisions and not from providing more care, the system will start to have the outcomes we all want to see.

The Republican proposals of allowing insurers to compete across state lines as a way of reducing costs will not have any beneficial impact on costs or quality. In fact, it will drive more doctors out of the profession and encourage others to simply seek out loopholes in order to maintain their revenue stream.

I do believe tort reform is essential, but don't think it is going to adequately change behavior on its own.

The focus on illegal immigrants possibly getting care on the government's dime is pure distraction. We all pay for that regardless.

I wish you the best of luck with this complex issue. I hope you listen and are open to alternative view points from what your party has espoused.

Senator Coburn
Thanks so much for opening a dialogue with us and GOD BLESS YOU for listening!
I know you are going to get an angry earful here, but as practitioners we are in a special position to talk about the burden of health care from the providers perspective.

All of us entered the doctoring workforce at different times. Older docs will remember 'how it was'. I have not been in practice more than 18 years, but have been subject to alot of the worst of it. I don't know why anyone with insurance would want to keep the plan they have, except for those who get it free via Medicare/Caid, and even there it's covered by taxes. Fraud is a smaller part of the problem, mismanagement another, fraudulent disability another, and greed by insurance companies and Pharma another. Malpractice issues abound. The recent addition of Part-D by congress is an example of the travesty of elected officials, supported by lobbyists trying to do something and failing miserably.

It doesnt matter if you make a public option or not, if you dont find ways to fix ongoing problems like denial and delay of care and waste of money, things will never work correctly. You cannot create another beaurocratic mismanaged plan designed to help people but go belly up like Social Security. You must exert control over the marketplace and yet encourage competition without third parties becoming fat off the hog by taking money that was intended to treat and heal.

I know it's a big task but we shouldnt act quickly. No dish cooked quickly is cooked well. Let's not work on health care REFORM but health care that CONFORMS to the needs of the people of the nation from birth to death.

Thanks for listening.

Tort reform is important, but not the root of our problems. "Uninsured" taking up ED space and even illegal immigration is not the root either.
Government cannot run Medicare (nor states Medicaid programs) well, these should not be sacred cows. Really should be dismantled ultimately.

Employers are the only ones getting tax breaks for health care (prepayment) plans, so "reform" that fails to address this is doomed. Health Savings Accounts are a good example of creating "competition," but the discussion is focused on competition at an institutional level rather than at the level of the patient. Allow the patient to spend the money on ANY health plan they want (or spend it directly as they need to, or invest it in HSAs, etc) and you have real competition.
What if your employer got a deal on 5 different computers and offered those to you as the "only" ones you could own? You wouldn't have the hundreds of choices available to you now, nor could you piece together your own computer over time...
Health insurance (prepayment plans) over-pay for health care that's not used in the majority of patients during most of their lives. If we ceased buying into these, the cost of health care and medicines (and devices, etc) would go down. Why are we talking about "reforming" by creating another health prepayment plan or differently regulating the existing structure that does nothing to promote patient-level decision-making?

I'm scared that no one's listening to this kind of reasoning.

Once you start an entitlement, it isn't easy to stop.

Senator Coburn,

I do feel that all the above ideas can be possibilities, howver if there is a system that passes where health insurance is universal or run by a gov't program, would there be loan forgiveness. There are a lot of residents like myself who took out loans to pay for medical school and undergraduate degrees. I'm concerned with our healthcare system and how it is currently run, but more afraid of not being able to payback the borrowed government loans I'm starting to pay as a 3rd year resident.

1. HSA for all
2. Separate 3rd party coverage from employers.
3. Implement Sermo Doc 40' plan above!
4. Stop talking about how physicians have to focus on prevention (which we do) when people come to see us AFTER they have acquired their chronic diseases which now have to be treated! Start focusing on how people start taking responsibility for themselves - which leads us back to HSA for all...

To paraphrase Willie Sutton: Why do I rob banks?; 'Cause that's where the money is.' "Reforming Healthcare & Managed Care" is the name of my blog on MDNG.com and it tells the 'rest of the story'- the three stool that needs stability from its three legs--quality, cost and access; the target of unwarranted variation; the costly use of E.R.s for want of a medical home or the under-supply of primary care doctors; defensive medicine and the need for a safety net as we struggle with unfair insurance company practices and great disparaties in how we treat our citizens. [Please also google: "Kaplan" and "managed care" for elaboration]

1. We don't need to throw out the entire system and start over - Not many of us would want our families or ourselves cared for in any other country in the world.
2. Fix the egregious problems first
a. tort reform - penalties for frivolous suits, expert panels, loser pays; benefits are
obvious (see Texas)
b. curb insurance company outrageous profits - our incomes are limited (see 'usual
and customary') and we actually provide a SERVICE.
3. Someone needs to have the courage to admit the enormous cost of the
proposed unfunded mandates on the table. I may be a doctor but I know that if you
throw 46 million more patients onto my schedule along with the 100 million admini-
strative personnel to go with them, it MIGHT cost me some some money. Perhaps
even a lot of money.
4, To answer your last question. I'm 46 and have finally paid off my student loans. If
HR3200 were to pass, I'd quit. (and I'm not alone)

For right now, I would settle for the CDC and media to stop scaring the hell out of the general public with this H1N1 nonsense. Our volume has overwhelmed our states EDs. Many patients are simply walking-well that need re-assurance for concerns created by the government and media. This is driving up costs and breaking the system, not to mention preventing real emergency cases from being seen as quickly as normal. We are now having to triage which patients to triage first.

1) Universal access
2) Universal participation
3) Eliminate exclusions
4) Eliminate the 20% profit private insurance companies make and use the money for medical care.
5) Rework compensation to favor primary care - the "thinkers" - which will encourage docs to go into primary care, so we can deliver on the first two.
6) Tort reform - this is not exclusively a medical problem - our whole country abuses the liability lottery in every concievable application.

I think the government option is essential, especially if congress is unwilling to outlaw private insurance profit. Note: no other industrialized country in the world allows insurance companies to make a profit off health care premiums. Duh - how dumb is that!
Also, WHY do stubborn Americans always think they have a better idea, when everyone else has already figured it out, and we're the last ones to acknowledge the problem! We were still poisoning our workers with lead and silica when Germany had eliminated the problem (1919). And WHY do we make it so complicated - Medicare part D - what a fiasco! Get the drug companies under the thumb, like other industrialized countries do.

If we are unable to have a single payer (the best idea), then at the very least we need a very strong public option. And we need to take care of everyone who lives in the United States or who is visiting it.

How about attacking one problem at a time- a specific thing to try and address. Incremental reform is what is needed. And figure out why insurance premiums have increased 400% in recent times. Who let them all go for profit anyway??? That's when the big problems with their costs and behavior started.

Why are we focusing on "sick-care" instead of "healthcare?" Providing everyone with insurance will ultimately increase costs. Can't lower cost without healthier Americans . . . period. It doesn't matter who is paying for it. America will only be healthy when individuals are accountable and responsible for their choices. A sound government will create incentives for healthy choices. Unless the bill that is passed helps people to lose weight, stop drinking, stop doing drugs, stop being promiscuous, stop smoking, exercise during the day, sleep at night, drive slower, stop working 24 hours a day to make an extra buck, etc . . . we are wasting our time.

Socialized medicine that is cost-effective, cost-contained & 'universal ' (for the general population) must inevitably imply 'sovietization', to wit:
1. Relentless centralized rationing of health consumer demand & health care providership supply;
2. Permanently higher taxes & levies for all income groups (not just 'the rich');
3. Indefatigable cost containment (e.g.: abolition of med mal tort awards as it now exists; suppression of labor union autonomy in matters of collective bargaining & partisan politics; health care provider remuneration correlated only with cost-of-living & provider productivity);
4. Ruthless enforcement of #1, #2 & #3, inclusive of anti-libertarian practices such as nati'l identity cards (with biomarkers) & omnibus, lifetime databanks (with bio-markers) for each identified person in the US & a true national police force (as already exists in most areas of the world anyway) with pluripotent powers of investigation & enforcement.

When you think about it there's really no other way to pay for affordable 'health care for all--no matter what'. Only sovietization would allow a country of this size & diversity to pay for the health care it needs with some guarantee that the money is going where it should.

Let the leftists answer that!

PS Here's a joke for Prez Obama (in order to make him feel better) which I generated from a Sermo comment:
One Sermoan commented that Obama had as much control over the prevailing liberal left Democratic Establishment as 'Mickey Mouse has over Disney Corporation'. I would remind all that MAD magazine (in the late 1970s, I think) had a skit called "The Peanuts Gang Grows Up" in which Charlie Brown (as CEO) declaimed (apparently regarding a planned corporate merger): "Don't tell me Schultz is fighting the deal..he works for me now!..."

Senator Coburn: you forgot HR 676, which would dramatically reduce administrative costs which are wasting the tax-payer's health care dollar.

The party of NO would like nothing more than to see real health care reform fail. They have suddenly become the defender of Medicare. Can anyone recall the name of any of the NOP that voted for the Bill? They were also against Soc Security. They were against Schip that gives children basic health care. They spout family values without any reference to the fact that health care is a family value. Sen.Coburn , come up with a proposal that really reforms rather than supports the profiteers.

1) Insurance reform must involve competition between plans without proliferation in plans. There should definitely be a Public Option to spur competition, especially with regard to administrative overhead costs. Only diversified insurance companies (ie, those with a wide variety of insurance plans - life, disability, car....etc should be encouraged to offer a health insurance plan, as in Switzerland. The health insurance arm of the insurance company must be able to guarantee payment to the physician within three days of the visit or experience a severe penalty. The insurance companies and government must come up with an EMR/EHR/HIE that is distributed to all physicians cost-free and has Clinical Decision Support, Personal Health Record keeping, e-prescribing, one billing mechanism, codng support that detects fradulent claims, links to other programs (eg, to differential diagnosis programs such as DxPlain and Isabel), conceptual clarity with a paser that recognizes and files concepts correctly (eg., problem into the Problem List, medication into the Medication List, allergy into the Allergy List, observation into an Observation List, cohort into a Cohort List, intervention into an Intervention List....etc), semi-automated linkings of lists (eg, linking of evidence-based interventions to timed and dated annotations of the Problem List), synonym thesaurus, animated help, informed consent, semi-automated validated claim filling, evidence-based form fill hypertext, topic mapping, concept mapping, argument mapping, mind mapping capabilities

2) "Malpractice Reform" should be along the no-fault approaches taken in Sweden and New Zealand where there are local government sponsored entities that do not include any lawyers but do include physicians in the democratic, objective, transparent adjudication of health care injury claims. Patients can file claims of injury with and without assertions of negligance. There will be no cap on awards. Supported local governments foster an uniform system of adjudicating claims completely separate from the Tort System. All claims are reviewed objectively for cause, effect, prevention potential, lessons learned, dissemination and implementation of system wide continuous quality improvement, assurance of democratic access to claim adjudication, complilation of statistics of all claims with forwarding on to the State Medical Board for decisions about physician feedback. Continuous Quality Improvement of the no-fault health care claim adjudication process would be facilitated by a non-profit corporation founded by the sum total of the medical schools in each state. A process for appealing awards would be worked out to a Heatth Court. Physician participation with critique of physician performance would be developed to facilitate enthusiastic physician participation. Public gevernment (local,k state and national) participation would be expected with soft drink taxes supporting, in part, the financing of the system.

3) Public self-care and duty to facilitate the public's health would be fostered by creating a new slogan: "Every Person is a Community Health Worker" who facilitates a system of secondary care. Physical Education and the Science of Sports, Public Health Biology, and courses leading to certification as a Medical Assistant or Community Health Worker would begin in the ninth grade and culminate in achievement of a Certificate as a health care professional at the end of high school Those who achieve this certification have advantages in "tracking" to become a nurse, physician, phjysician assistant and nurse practitioner in primary care at minimal cost to the future graduate of a residency training program.

So Insurance Reform, "Malpractice Reform" and Education Reform and expectations of self-care of the populace go together to make for high quality / cost effective care in a reformed health care system.

Financing of the helath care system would, in part, be based on getting the middleman out of the health care trough and shifting dollars from middlemen to support the essences of the doctor - patient interaction and relationship.

Senator Coburn, the following are health reform proposals of America's Physicians (Sermo). I hope that they are given serious consideration as health reform will not succeed without the active and willing participation of physicians.

1. Redefine the scope of practice of the primary care physician in improving quality and cost of healthcare.

The primary care physician is the centerpiece of the healthcare delivery system. In a reformed healthcare system, the primary care physician should have an expanded role in the diagnosis and management of diseases. The primary care physician therefore needs immediate and easy access to diagnostic services that increase diagnostic acumen including xrays, sonography, laboratory and other services on site. This means that primary care physicians should have the opportunity for additional training in the performance and interpretation of these procedures. Access to financing for such expansions should therefore be facilitated. The savings from early diagnosis and treatment, from reducing time lost during referrals and follow up and from potentially lower costs of these services when provided by primary care physicians would be enormous.

2. Physician Cooperatives.

Healthcare reform will not be meaningful unless physicians organize effectively. Physicians bear ultimate responsibility for providing necessary medical care cost-effectively to everyone in the United States, and the government must play a role in developing the infrastructure for an integrated physician-based healthcare delivery system of medical practices if effective healthcare reform is to be achieved. Community-based physician organizations that streamline the care of patients by providing access to patient data by multiple providers will result in greater efficiency and better coordination of care, especially for individuals with multiple healthcare needs. A Physician Cooperative is the affiliation of multiple physician organizations and other healthcare facilities over a wide geographic area that then manages the health risk of this population. Physician Cooperatives may compete in any geographic area. The entire population then becomes the "risk pool", and everyone contributes equally to this "insurance pool" that pays for services. The cost of this care may be apportioned by law (Medicare, Medicaid, Private Insurance, Tax Funded, or "Charity" pro bono) spreading the risk over the entire population. This nationwide risk pool will lower costs and re-align market forces

3. Health Insurance reforms.

Currently, 80% of insurance plans are constituted under the ERISA statute which grants a trustee fiduciary authority to manage the benefits of plan members according to a Summary Plan Description (SPD), which is created and promulgated by the trustee. The statute outlines a claims management procedure with specific guidelines to be followed for the resolution of claims disputes that are brought by plan members only. Plan members may assign these benefits to physicians as payment, but physicians have little or no legal authority over these benefits as compared to the broad discretionary authority of the plan administrator, granted by the SPD. Contracts with direct payment arrangements are even worse for physicians, as physicians have absolutely no legal standing under ERISA without a prior written assignment of the benefits in dispute, the only basis on which such a dispute may be heard by the federal courts. Additionally, contract disputes involving federally constituted entities such as these are not heard by State courts. So physicians have no viable legal mechanism to challenge unfair reimbursements and unpaid claims. This has caused increased abuses by insurers and extreme frustration and declining morale of physicians. This must change if physicians are expected to meet the increased demands of a system of universal healthcare for all Americans. New federal and State laws that govern compensation of physicians and other healthcare providers, and a dedicated 'health court' that may also handle tort cases will be needed.

4. Expand Health Savings Accounts (HSA)

The public in general and patients need to accept some responsibility for their medical care and their behaviors. One of the fundamental problems that we face in health care purchasing is the almost total disconnect of the patient with the real cost of the service being purchased. Health insurance, like homeowners insurance should be there for truly catastrophic events, not for day to day purchases. Some outpatient services, to a certain maximum dollar amount each year, should therefore be out of pocket expenses.

Health Savings Accounts is one such way for employees to bear greater responsibility for their healthcare costs and decision-making, while reducing the cost to their employers and encouraging long term savings. A system of HSAs for low-income citizens could completely eliminate Medicaid as it currently exists and put the purchasing power and decision directly in the hands of the patients.

5. Establish a Universal Healthcare Pricing Index.

The rapid rise in healthcare costs is partially due to the rapid introduction to the market of new technologies and treatments. It is therefore important that the pricing of products such as these with wide public application be tied to an index that is determined by the buyers' purchasing power. Thus a purchasing Exchange for healthcare products and services is necessary to control the inflationary tendencies that are inherent in the healthcare market.

6. Tort Reform.

America's Physicians are pleased that the Obama administration is finally giving consideration to tort reform. Every physician knows that excessive jury awards are driving the cost of malpractice insurance. In a revamped healthcare system of Physician Cooperatives that demands greater accountability of physicians and provides the tools for physicians to preemptively fight disease, jury awards will need to be controlled to satisfy specific criteria, and costs due to the practice of defensive medicine would diminish. Health Courts, with specially trained judges and expert witnesses, are best suited for this exercise.


7. Anti-trust Regulations.

Physician organizations and Physician Cooperatives must negotiate with insurance companies on multiple levels, including fee negotiations. Justice Department and Federal Trade Commission regulations forbidding fee negotiations by physicians must therefore be rescinded if physicians are to participate fully in the health reform process.

Unless Lobbying Congress is stopped and the Insurance Industry reformed (no Anti-Trust Exemption & Free Interstate Competition),this will continue:

$1,000,000:
The estimated amount of donations by Denise Rich, wife of
fugitive Marc Rich, to Democrat interests and the William
J. Clinton Foundation in an apparent quid pro quo deal that
resulted in a pardon for Mr. Rich. The pardon was reviewed
and blessed by Obama Attorney General and then Deputy AG
Eric Holder, despite numerous requests by government
officials to turn it down.
True: articles.latimes.com

$12,000,000:
The amount of TARP money provided to community bank
OneUnited despite the fact that it did not qualify for
funds, and was "under attack from its regulators for
allegations of poor lending practices and executive-pay
abuses." It turns out that Rep. Maxine Waters (D-CA), a key
contributor to the Fannie Mae meltdown, just happens to be
married to one of the bank's former directors.
True: online.wsj.com Wall Street Journal

$23,500,000:
The upper range of net worth Rep. Allan Mollohan (D-WV)
accumulated in four years time according to The Washington
Post through earmarks of "tens of millions of dollars to
groups associated with his own business partners."
True: www.washingtonpost.com Washington Post

$2,000,000,000:
($2 billion) the approximate amount of money that House
Appropriations Chairman David Obey (D-WI) is earmarking
related to his son's lobbying efforts. The son, Craig Obey,
is "a top lobbyist for the nonprofit group" that would
receive a roughly $2 billion component of the "Stimulus"
package.
True: www.newwest.net
and this as a list of these related stories:
search.yahoo.com

$3,700,000,000:
($3.7 billion) not to be outdone, this is the estimated
value of various defense contracts awarded to a company
controlled by the husband of Rep. Diane Feinstein (D-CA).
Despite an obvious conflict-of-interest as "a member of
the Military Construction Appropriations subcommittee, Sen.
Feinstein voted for appropriations worth billions to her
husband's firms."
True: www.sfgate.com

$4,190,000,000:
($4.19 billion) the amount of money in the so-called
"Stimulus" package devoted to fraudulent voter
registration ACORN group under the auspices of "Community
Stabilization Activities." ACORN is currently the subject
of a RICO suit in Ohio.
True: www.ocregister.com

$1,646,000,000,000 ($1.646 trillion):
The approximate amount of annual United States exports
endangered by the "Stimulus" package, which provides a "Buy
American" stricture. According to international trade
experts, a "US-EU trade war looms" which could result in
a worldwide economic depression reminiscent of that touched
off by the protectionist Smoot-Hawley Act.

Can we confiscate this money for Medicare/Medicaid?

I, too, doubt that S. Coburn is going to read or pay attention to this - after listening to the "debate" on the Ryan amendment, I believe that most of you all are making this fuss just to cover your backside and get re-elected, not so much to make things better for Americans.

Fundamental rule: YOU CAN HAVE IT GOOD, FAST, OR FREE. PICK ANY 2.

To "fix" the current system, you have to stop the insatiable appetite people have for anything they don't pay for.

1) If you're on Medicaid, you get a depo or lupron shot every time you pick up a check.

2) ALL medical visits require some reasonable copay to get in the door - unless you're exsanginating on the doorstep.

3) Transportation is not part of medical care. Bus passes are cheap.

4) You have to pay to play - no insurance (and, 'scuse me, DSHS and Medicare don't really count, nor would some gloriously crappy Unified Socialist Healthcare Policy) and no ability to file a lawsuit.

5) Tort reform - no claims against damages beyond provable lost wages. Oh, and laywers are paid a MAX of 10% of charges ONLY on the cases they WIN. That way, they'll get a taste of what it's like to be paid on the basis of your collected earnings, like the rest of us. I also get tax credits for all the zillions of dollars of free care I provide to our country.

6) All of congress is on the same plan the rest of us are. They get the same care, and we are allowed to balance bill for care given to medicare/medicaid patients.

7) If you AREN'T morbidly obese, smoke, use drugs, or have more than 1 visit to an ER per year, your copays are halved or eliminated.

Finally,

8) You have to purchase some type of catastrophic, de-regulated health care insurance that is NOT linked to your work, and NOT provided by the govenrnment. Nobody forces anyone to own a car, but most people do, right? No license without proof of insurance, right? This is no different.

If you think the govenrment is going to improve the quality or efficiency of our system by meddling in it, you're wrong. It'll only increase the cost.

Oh, and if you don't curb the appetite - not only will you drive our country to financial ruin, you'll make 100% sure there won't be physicians around to take care of the next generation of folks as the youngsters out there won't buy into this ridiculous plan. Then you'll have it free, good (maybe), but not fast at all.

Pick two.

You have heard it all, so I will not repeat ideas already posted. I would like to suggest that in order to help cover the uninsured that you (the govt) allow physicians to write off the bad debt owed to them by patients. Currently, we are unable to do this, with the type of accounting system used being the oft=stated reason. I say forget accounting rules. The truth is, we provide millions of dollars of service and get no credit. Let me, and especially my colleagues who spend so much time taking care of the uninsured through our ERs, take a tax credit for the bad debt, and the burden of caring for these folks, many of whom are illegals, can be at least somewhat mitigated.

The cats getting fat from American illness are the insurance companies and drug manufacturers. Your proposals don't meet these head on.
I personally had to retire from practice before I had planned because the insurance companies paid so little for my patient care activities that at the end of the month ... after I had paid my bills ... there was nothing left to take home. At least I was supporting my nurse and secretary. My wife made me quit.

Dear Senator Coburn,

Thank you for soliciting this feedback.

I would simply add a very basic request that any government involvement (new or revised) should *not* serve corporations as a primary interest.

The reason I say that is this: Healthcare is not a "normal" economic good. There is great need, more than supply, and far more than the public seems willing to truly pay for.
We, as a nation, cannot afford to have corporate welfare also subsidized in this manner. This is, unfortunately, some component of most of the plans.

Paying more taxes, being paid less for my services, leaving my children a bigger deficit, all so that insurance companies can profit, is unacceptable.

Respectfully, sir, you and the remainder of our government have no idea of the depth of anger at all the corporate bailouts and poor fiscal management the government has shown.

That, is the downside of "mandated insurance".

Thank you,
David Kim MD

If patients had the right to change insurance companies rather than employers the insurance companies' profit margins would naturally reduce as they would need to keep their customers satisfied before they left in droves. Patients would not tolerate some of the denials that are negotiated by employer representatives or by bargaining agreements.

It would be good to form A COMMISSION TO STUDY THE HEALTHCARE SYSTEMS IN THE REST OF THE DEVELOPED WORLD, with the mandate to select which model would work best in the US and then implement that model here. All of these systems provide universal healthcare, with better health outcomes, better overall societal acceptance, and lower cost than what we have in the US.

Thank you for coming to listen.

I will not add more to the posts above at this time.

I think all physicians would like to think that we have the most intimate understanding of the problems of providing care in America, and would genuinely like to be invited to the table to help Congress and the President address these problems.

Thank you for the post, Dr. Coburn!

I hope to see you tomorrow at the Million Med March here in Washington.

Richard A. Armstrong MD FACS

Claims forms have to be made uniform throughout the whole business, although the address of the insurance company could be different (obviously) on the form. Email info on the card with the electronic billing address on the insurance card would help. More high deductible plans and medical savings accounts might actually get the patients to care what their care costs. Try walking into a hospital and asking how much a test costs. Except in emergencies, it would make sense to be able to get an estimate for the "repairs" or "servicing" from a medical provider, just like from a mechanic.

I think the comment by Sermo Doc 41 hits the nail on the head. We do not need regulation of healthcare as much as we need regulation of insurance companies. Bluecross/BS of Maryland gets tax incentives because it is a non profit. It has stashed away a billion dollars while cutting reimbursement to us the physicians while simultaneously raising premiums. They control every aspect of healthcare with monopolies while it is illegal for us to organize. I am paying $100,000/yr for malpractice with no claims. It is insane. Who is going to pursue a career in medicine spending all their time and money to work for the government for less than a plumber or electrician?

We need real health care reform and part of this will be a true public option. The private insurers have caused so many of the problems we are in now; it is wishful thinking that a solution based entirely in the private arena can fix the problems with health care. There is no free market in either health care or in health insurance. Free market "solutions" are just bandaids. No American should have to go without insurance because he/she cannot afford it, has a preexisting condition and is denied coverage, or has gotten too sick and accumulated too many expensive claims and is then canceled. An illness should never force any American into bankruptcy. We need meaningful health care reform in this country with a real public option.

We need free market reforms, not more government interference in medicine. The Baucus plan based on individual mandates and more regulations has been a disaster in Massachusetts.

Please see my OpEd in today's Christian Science Monitor for more information:
"Health care in Massachusetts: A warning for America"
www.csmonitor.com

Paul Hsieh, MD
Freedom and Individual Rights in Medicine (FIRM)
www.WeStandFIRM.org

Sen. Coburn, please do not use the derisive term "individual mandate" to criticize the notion that everyone should be required to purchase health insurance. Sharing of the collective risk is a fundamental of insurance, isn't it? I bet your state of OK requires drivers to have liability insurance in order to own and drive a car, I know Texas does. I guess that's an individual mandate too, but it is one that has been made law for the common good. Similarly, we need to have everyone's health insured in the U.S. also.

Please do not mistake us all for teabaggers, deathers, czarers, 9/12 ers, etc, etc, just because we are physicians. We don't all think that way.

In theory I am for a public option. However physician should be paid an amount comparable to that of other white collar workers with a similar level of responsibility (such as bankers?!). They should not be threatened by recurring reimbursement cuts from the government and ever increasing bureaucratic intrusion. I am afraid this is not going to happen and a public option would only curtail the present benefits provided by Medicaid and Medicare. Physicians are already opting out resulting in the paradox that more people in the more vulnerable age groups are left without insurance.
I like to point out that I am not in private practice, thus I don't think I a have a vested interest

Why not look at the big problem.
GOVERMENT,GOVERMENT,GOVERMENT.
THEY HAVE NOT CONCEPT OF OUR
CONSTITUTION.
IT IS ALL ABOUT FREEDOM.
NEVER WAS AND SHOULD NEVER BE ABOUT
GOVERMENT CONTROLL.
THE GOVERNMENT DOES NOT OWE ME
HEALTH INSURANCE NO MORE THAN THEY
OWE ME A LUXURY AUTOMOBILE .
STOP UNECESSARY GOVERNMENT REGULATION
AND INTRUSION INTO OUR LIVES.
START LOOKING FOR WAYS TO SUPPORT AND
ENCOURAGE AMERICAN INGENUITY.
SUPPORT FREE ENTERPRISE AND SURVIVAL
OF BUISNESS LARGE AND SMALL WHICH PROVIDE
OUR JOBS AND FEED OUR FAMILIES.
OF COURSE WE NEED LAWS TO PROTECT AGAINST
UNFAIRNESS AND HUMAN GREED BUT SUPPORT
HONEST BUISNESSES BY NOT OVERTAXING THEM.
HOW SIMPLE IS THAT?
HOW MANY OF US COULD HAVE ALREADY HIRED
SOMEONE ELSE AND OFFERED HEALTH INSURANCE
IF ALL THE EXTRA CASH RESERVE WAS NOT STOLEN
BY UNECESSARY TAXES,COST OF MALPRATICE INSURANCE,
COST OF BUILDING INSURANCE ETC.

IF ANYONE WANTS SOCIALIZED HEALTHCARE AND
GOVERNMENT CONTROLL OF THERE LIVES WE CAN
GIVE THEM A DIRECTORY OF PLACES TO MOVE.
CANADA,ENGLAND,RUSSIA,CHINA,CUBA(JUST BE
SURE TO TAKE A LIFETIME SUPPLY OF TOLIET PAPER
AS I HEARD THERE IS A SHORTAGE.)
GOD BLESS AMERICA
AT LEAST WHILE IT IS STILL FREE.

Sermo Doc 122
did you mean;
No American should have to go without healthcare

instead of
No American should have to go without insurance ??

just curious

The notes of keratos and Sermo Doc 12 aptly describe my feelings. Everyone is equal to receive benefits but only those who work hard and earn are mandated to pay for the indolent, unfortunate and indigent. These sounds like communism each contribute to their might but only consume to their basic needs. The only real beneficiary is the politician who enjoys power and money at the expense of the tax payers. The charity recipient mandates how much tax paying person has to donate by law and the middleman politician takes all the credit for universal health care. The legalized high way robbery by the legalized mafia called government. The former trial lawyer and current president Obama extorted $950,000 from Citibank under the pretense of racial discrimination for bank loan of an African American who received just $60,000 is an example why the pseudo liberal hypocrite president does only show pretense for support of tort reform. The trial lawyers spend on advertisements sky rocketed from 3 billions odd to about 45 billions odd in few years, only goes to show how confident and aggressive the medical malpractice trial lawyers are in destroying physicians. The payments to doctors are cut progressively to the bare bone level and it is truly amputation of limbs when it comes to paying surgeons. The senator Rockefeller who keeps his wealth securely in foundation but wants to be generous with the tax payers money, so he can clear his guilt and feel good for stealing public money by his family.Do the Tort reform, Provide Medicaid for needy with better physician payment and fix the insurance industry exploitation.

Government control of economy is in essence vicarious ownership and monopoly by the government with public investment and hard work. The government the blood sucking parasite feeds on tax paying citizens depriving them of the oxygen. The zeal of Obama for health care reform is only to get reelected and to leave a legacy of saviour of american heath care. His delusions of grandeur and obsessions of illusions are mere mirage when we find ourself in the desert of dispair. His radical approch to health care reform may end up in collapse of the the health care system and drive the dollar currency to new lows with the astronomical deficit spending and huge national debt. Obama preaches one thing but practices some thing different to help his selfish goals.

Let us decide for our health care and not mandated by the government for this is America , Land of the Free.

There must be some tort reform in the current plan. The success is set forth in Texas and California. There also must be reform in the insurance industry. Insurance plans declining authorization of neccesary tests and care and having no responsibilty for the impact on the patient is criminal!!!! Why should a physician be paid less for same procedure/test now as compared to 10 years ago. All expenses (gas, oil, phone, car, employees health insurance, etc.) has gone up. (Average reimburstment for angioplasty in 1999 (Medicare MD fee's $2500) (now $987)). How is it that a MD can render a service and then an insurance company deny payment for no appropriate reason. If I walked into Mc Donalds, ate a hamburger and then complained about it not tasting right and did not pay for it, I would be arrested for stealing!!!!!! This is what insurance companies do!!!!!!!! This has to change.

Med-Mal. Reform: Those who have been injured by negligent care should be compensated.Yet,we need Tort Reform Elderly, disabled, poor need coverage from State and Fed. No coverage for illegal immigrants and dependents not paid into the system. Identify fraud and waste in Health-care. Private insurance Cos. are juggernauts who make their own rules. They have 25% stake in health-care $--can translate in Trillions. Yet, they can handle the business better than Govt.bureaucracy which will swell by geometric proportion and add billions. ED care for emergency. Encourage private clinics. Hospitals compete to higher new Grads with salaries and benefits that Pvt. practitioners can't afford, even half of it, for themselves. I suspect that in the next decade we will be employees of Fed. or Sears financial network. Temporary migrant med. professionals from overseas will be employed for disease specific/specific surg. procedures at fourth of average physicians earning in USA with minimum benefits. Insurance companies will encourage and promote overseas medical tourism. We will see the demise of the best health care in the world. This will be another GM in making.

The only problem in our system is greed; the system is set up to transfer money from average Americans to investors. There is ample money in the system if we reduce fees to simply cover the costs of the services, not pad the wallets of the fat cats. Ways to do this:

1. Cap the incomes on executives in the insurance, health system, and pharmaceutical industries. Nobody is worth more than a million dollars a year.
2. Eliminate DTC ads.
3. "Loser pays" med mal reform, using panels of impartial physicians who are in a position to differentiate real negligence from bad outcomes.
4. No health care corporation can be publicly held. Taking health care premium dollars from blue collar Americans and using them to pay dividends to investors is insane.
5. Reestablish the Certificate of Need. Free market forces works when selling widgets, but not in health care - competition means duplication of services. In Milwaukee, there are SEVEN hospitals newly constructed or under construction simply to compete with other hospital systems - in an area where there are more than enough beds.
6. Although it is a dirty word, regulate the insurance industry. The competition that the various Congressional plans intend to set up to control costs will result in decreased salaries for physicians and other employees, while the administrators preserve their incomes - until the physicians are driven out of practice.
7. Established evidence-based guidelines for emergency care that can be utilized in med mal cases, which will drastically reduce the costs of defensive medicine.
8. Trimming this waste will reduce costs to the point that medical decisions can finally return to the hands of the physician - what we order and what we prescribe will be available to the patient, no questions asked. This will free up so much of the physician's and staff's time that we will have the resources to see most of the increase in patient volume that will arise from universal coverage, at least until more favorable reimbursement rates will increase the ranks of primary care physicians.

I have heard Coburn speak and respond on any number of occasions; he lacks credibility, logic, reason, common sense, compassion, decency, and would serve us better on whichever is his planet, Klingon, I presume.
Nothing short of a public option will give needed care to everyone, and avoid bankruptcy and premature death.
He does not want a public option, yet he is willing to tell people they need to plead charity from neighbors, bake cakes and sell lemonade, go to Medicaid, go to the county hospitals. He claims the government cannot function properly or do anything right. As a government employee voted in by the bozos of OK, he should resign immediately and re-start his laxed CMEs. The pencil pushing geek.
Hundreds of billions go to the corporations screwing our arses, 1 of 3 dollars is in CEOs pockets. There is the money. And the public option will cost less and go to medical care.
Coburn does not want a government between us and our patients? Who in the bloody hell does he think is massively between us now? and lacks legal liability for their dictates to us? In Medicare, who decides? We do.
You want your fees increased? okay, tort reform, I am all for it, and I am all for doctors getting back to being doctors, not academicians or technicians or cya idiots treating lab tests. I refer to the fine art of clinical common sense, go back to school and learn to talk with patients and to your senses to figure out what is happening. Learn to know what your are examining with your eyes, hands, ears, nose. Learn clinical medicine. A slew of labs do not treat patients; they only show what an idiot you are. Earn your fat fees.
Furthermore, an efficient average medical practice should have an overhead around 30%, surgical and diagnostic and imaging is higher. Most of youall bitch and moan over 3 weeks per month never in your pocket before taxes since you have overheads hitting 70%. And thanks to the present medical insurance crap we have in place, we have to hire at least another full timer just to handle the billing and insurance BS and plead every 3-6 months, or 12, to remain on their 'approved' provider list.
A public plan levels the field and allows us to hang out our shingles and be practitioners of medicine and surgery without the gargantuan 3rd body of those blood-sucking insurance/capitation companies.
Coburn reminds me of an old Groucho Marx film and song-Whatever it is, I'm against it. And so they are, whatever it is, they are in opposition without anything constructive to add to the discussion. And the millions in bribes, excuse me, lobbying, is disgusting and revolting, so don't get me started. May the Force be with you.

Sermo Doc 128 wrote: "Let us decide for our health care and not mandated by the government for this is America , Land of the Free."

Let me add, "Little pink houses for you and me." (Apologies to J. Mellencamp)

Sermo Doc 132, You are oh so right in what you say about Coburn. Thanks for posting.

orlandoc wrote: "Sermo Doc 122
did you mean;
No American should have to go without healthcare

instead of
No American should have to go without insurance ??"


In reality there is no difference between these two. No American should have to go without health insurance and the health care it enables him to obtain.

Before we can begin to make the necessary changes, we must get a foot-in-the-door and speak clearly with a unified voice for our patients.

Join us here in Washington DC at John Marshall park TODAY at noon.

We need change that American physicians and their patients can believe in...we can start the change.

Thanks, thanks, thanks.. and WE NEED to SHOUT IT TO THE ROOFTOPS!

''This is because large for-profit corporations ( pharmaceutical companies, insurance companies and hospital chains ) are in business to make money. They are run by businessmen.

MAKING $$$$$$$$$$$$$$$$$$$$$$$ is their primary goal."

WE NEED TRUMPET IT till the TSUNAMI HEALTH CRISIS will eventually submerge us ALL regardless of WH/CONGRESS and comrades rides the big elephant $$$$$ !!!

... it wont be long when the righteousness and goodness of His chosen and called of the profession will be vindicated... in the name of the ALMIGHTY $$$!

STOP the partisan fighting
1. State Goal of the legislation ie to cover all citizens
2. the decide how to get there
3. decide what you want to do ie fix "health care" or fix health care cost
4. stop taking MONEY from lobbist to influence your choices (Called bribes anywhere else)



Stop the fear mongering - "death panels"
"we can stop the President"
Stop playing games with the political system and get about your job of fixing what is wrong with the health care system

STOP THE BS and get to work fix the system but tell us what your real goals are.
ALL I hear is it COST TOO MUCH - this sounds like cost control not health care reform

"Reform" with reforming the underlying problems--malpractice abuse, and the lack of personal responsibility for health (i.e. smoking, obesity) is useless. The costs will continue to skyrocket and the government and we the tax-payers will pay the price. Address these FIRST.

Govt. control of Health Care is about Money and Power (Control of People)...it is a mix of Marxism, Fascism, and Socialism.

Whatever the Plan, it should not be controlled by Congress,Insurance, Lobbyists, and Trial Lawyers.

I'm not a cynic but doubt we can do much with the Great Elephant and Big Donkey eating all the grass and feed in D.C.

RATIONING is the only way. The debate is not IF but HOW MUCH and WHAT.

I only buy a car I can afford. I would like to work three days a week. I can do so but I will have to make significant sacrifices to do so. On a macro scale like health care, public funds should go toward the greatest good for the greatest number of people.

We Americans CAN go on with our consumption of health care which is our right, but it will be on one's personal nickel when it is outside the pale of the basic "rights." This could mean that my 86 year old grandmother would not have gotten a valve replacement and bypass--maybe that is the right thing. Nobody wants to be denied understandably, but THIS IS THE ONLY WAY OUT.

Diverting some of the STIMULUS, TARP, CLUNKER, AUTOS, CAP/TRADE, ENERGY/WARMING, LOBBYING, TORT, etc., money to Health Care would eliminate any need for rationing Care.

Greetings from anothe OU grad:
I see lots of other good responses above, but :
real med mal reform (caps, penalities for frivolous suits) take away the impetus for lawyers to "win the lottery"
Portability, no refusals for pre-existing conditions, take away their profit motive-does the CEO deserve 100 millions in salary when they don't pay the providers adequately, and continue to increase premiums while cutting coverage to their subscribers
reform medicare to make it more of what it is supposed to be--Those who pay into the system should benefit--not the hordes of people who currently recieve benefits, but never contributed.
Make it known that while dysfunctional, the US system does not need decapitation--It has good points, and the Left-liberals like to tell only half of the statistics--like infant mortality has to be taken into account of the fact of survival of preemies who all used to die, are not counted elsewhere, etc. That cancer survivals in the US IS the best in the world (tho not cheap)
It does seem congress makes decisions in the bubble-because they wont have to live with the consequences--I think that you all should have the same coverage you vote in for the citizens

Here's what CATO Institute says about the Required Insurance Individual Mandate:

"Simply making health insurance compulsory gives
government as much control over healthcare as
would a compulsory government program."

More of a "Public Option" all over or worse!

Tongue and cheek response to your friend and classmate, Sermo Doc 11-"I don't have any children. Why do my taxes pay for other kids schools?
I never travel further than ten miles. Why should my taxes go to pay for roads and trains and airports and air traffic controllers and guards who check some one else's shoes?
I'm not the slightest bit worried that Russia may attack Germany, so why do I have to pay for a battalian of soldiers in Germany? Ditto for Korea and Iraq. And I don't think think Al Queda is going to blow up my farm, so why do I have to pay to try to catch him ... and where did that multi-million dollar reward for his capture come from? New Yorkers, I hope.
If I get sick, my good friend Mac is a vet and he prescribes me some meds. Me and the family get up early, eat lots of veggies, do lots of physical labor and no one weighs more than 160 pounds. We don't need any more health care. Why sould I pay for medicare or the county hospital where obese smokers use up all the beds? If I want to add on a room, me and the kids do it. I don't want a licensed plumber or electrician and no inspector telling me it ain't to some code. I don't want to pay for no inspectors I don't need. If Sam, next farm over wants to raise smelly ol' hogs, well, me, my sons and other neighbors will have a little chat with Sam and convince him it's not such a good idea. Don't need no guvment tellin' him he can't do it."

Government:

1*"You cannot legislate the poor into prosperity by legislating the wealthy out of prosperity."

2*"What one person receives without working for, another person must work for without receiving."

3*The government cannot give to anybody anything that the government does not first take from somebody else."

4*When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is the beginning of the end of any nation."

5*You cannot multiply wealth by dividing it..."

Adrian Rogers, 1931

Sermo Doc 46,

1. The biggest corporations and some of the most wealthy individuals in the U.S. "owe" their existence to the government--loopholes, tax breaks, credits, special legislation legalizing corrupt practices, no oversight, etc.

2. Corporate giants, overpaid CEOs etc. are the classic example of receiving without working.

3. The government took plenty from us and gave to Halliburton, KBR, military industrial complex, etc, etc.

4. Do you remember when marginal tax rates were as high as 90%? Did very many rich people and businesses cease to work because of this?

5. Big pharm, big healthcare, big insurance, bid BIDDNESS does a pretty good job at multiplying their wealth. I don't see that changing.

sgmorr, 2009

Nothing will work without med mal reforms period!

All insurance plans must be community rated. All variations of coverage must be offered to all comers at the same rate. A $5 per person per month discount for billing to a group rather than an individual should be allowed.
That way you don't need one more level of bureaucracy with "Exchanges" and there would be no need for COBRA since anyone could choose the plan they want and buy it at the same price.
To avoid adverse selection, it might be reasonable to give a 6 month delay in any added coverage over a previous plan.

Has anyone had the following idea of a simple way to bring competition to insurance? Have all insurers have the same policies so you can compare apples to apples. Plan A covers certain procedures, Plan B a little more, Plan Z covers any procedure (cadillac plan). Then you could compare the price of insurance company A to B and competition would ensue. Make it illegal to charge individuals or small businesses more than large businesses for each life covered. Thanks

1. The medical liability system needs to be changed to a no-fault indemnity system with direct compensation to the injured (no lawyers). Competency of physicians needs to be controlled by medical boards, not fear of lawsuits.
2. A for profit health insurance system will always try to reduce payouts for care and raises premiums. That's the whole point of a for-profit business. Health insurance should be about risk sharing and should be non-profit (and no outrageous compensation for CEOs etc of these non-profits).
3. Catastrophic coverage for all.
4. Patients need to have a stake in the costs.
5. Reduce administrative costs and burdens.

Tort Reform, private HSA's and Insurance Reform...no govt. involvement.

Regulate the insurance companies.
1 get rid of pre existing conditions
2 get rid of maxed out benefits
3 limit the amount premiums can go up
4 limit the amount they can increase deductibles and copays
The inurance will cry they are not going to be able to make a profit, but if they get rid of those employees that are there to deny claims, limit coverage and try not cover others because of pre existing conditions and put that money back into the system that will help the bottom line. So instead of the CEO making 70 million, they will make a million or a half a million.

Don't forget about tort reform

To the Honorable Senator Coburn, I would like to make a few simple suggestions. First of all, due to the severity of the current healthcare crisis in this country and a universal overall perception among health care workers including more than 90% of practicing physicians that for profit insurance companies are the problem, law makers need to pay attention to this. Immediate legislation should be passed barring all legislators from receiving campaign funds or kickbacks of any kind from insurance companies. This needs to go into effect immediately especially among congress members who are participating directly in health care reform. Insurance companies profit when care is denied and politicians are directly profitting from healthcare legislation that includes insurance companies. By the way, putting more people into medicaid has not worked in my state because the state is broke and cannot afford to implement expansions to medicaid already enacted about 1 and 1/2 years ago.

I live and work in one of the poorest areas of the country - the central San Joaquin Valley. The residents of Appalachia are much more finacially secure and have better acces to public services including health care ( CRS Report for Congress "California's San Joaquin Valley: A Region in Transition", December 12, 2005). Under Sen. Baucus' bill this area of the country, which already has one of the country's lowest reimbursement rates for Medicare patients will have its' reimbursements slashed an additional 33%. As a physician I know that you are aware that all commercial carriers use Medicare rates as the standard on which they base their physician reimburement. My practice's margin is 10%. That is what I get to take home in salary. There is no place to cost shift to. I will not be able to afford to keep my practice open with even a 10% cut in reimbursmenrs much less a 33% cut. . I am one of the few gynecologists who will see Meicare/Medi-cal patients. Where will they go?

cyn, they'll go to midwifes and unregulated quacks, who'll be well-paid, just like the good old days!

There are currently two problems with US health care, cost and accesibility. Both are easily fixed thusly:

1)Cost- freeze all Medicare payments at their current rates for ten years, but get rid of the balanced billing restrictions. Allow physicians to bill over the Medicare allowable if the patient is made aware of the excess cost and is willing to pay the difference in advance. This can be done by requiring any charges over the Medicare allowable to have been documented in advance by having the patient sign an "Advanced Beneficiary Notice. These already exist for non covered services. As it stands now, the reimbursement by Medicare is getting below the cost of delivering care for many services. Medicare patients are increasingly finding it more difficult to get access to care because of the low reimbiursement rates by Medicare.
2) accessibility- allow us to get a tax write off for the labor we give in treating the indigent. We could have those applying for charity status undergo financial evaluation through county health departments (such as the already existent "We Care" programs). Then, treating physicians could "bill" the certifying agency for the patients care at the Medicare allowable rate. A voucher would then be sent back to the physician and this voucher could be used to deduct the same dollar for dollar amount from that physicians taxable income. Such a system could be expanded to include hospitals and drug manufactures. If such a system was created, healthcare providers would be fighting over the indigents to get that tax write off. And the US would get coverage for the indigent uninsured at 1/3 the cost of paying us the full price!

There is one urgent pressing issue. As of Jan 1, 2010, the Obama administration and CMS has plans to change the reimbursement for cardiology and oncology, as well as to eliminate consult codes. No new code has been introduced. That would mean that the reimbursement for a complex consult would drop from about $186 to $76. I can not get a plumber, maid, or yard man to my house for $76. It is absurd to think that the US will be able to get physicians into a hospital or ER afterhours for such a small amount. Obama is finding his "$500 billion in Medicare waste" by cutting services to Medicare recipients by under-reimbursing Medicare services, predominantly in specialty areas. YOU NEED TO POINT THIS OUT AND MAKE IT PART OF THE NATIONAL DEBATE ON HEALTHCARE.

I don't have time to read all the above, sp here goes.

Private insurors exist for one reason, and one reason only...to divert as much of the health premium dollar to their own pockets as possible. They take BILLIONS OF DOLLARS out of the health care system. It doesn't matter whether they are for profit or not......look at the bonuses of the non profits execs, and their "reserves"...they're absurd.

Fed/State/public run insurance will be cumbersome, and, at times, incompetent, BUT it will actually mean well, and try to do it right.

SO....I have a choice, be screwed by the greedy bastards running the private insurors, or go nuts with the probable idiocy of the "public sector"..............

I would prefer the bumblers to the crooks.......

The solution is simple.
Pass a bill that outlaws sickness.
I am sure it will work as well as
cap and trade on climate change.

Sir, I thank you to coming to this forum. Much of how I feel has been eloquently addressed. Tort pressures and worries have created a generation of doctors many of whom order extra tests and procedures and consults and admissions for reasons of insecurity, self protection, and sometimes laziness or lack of practicing clinical, hands-on medicine. Medical students and residents have been learning this wrong and expensive way of practicing medicine because they learn from their over-testing instructors and attendings. It will take at least a generation of teaching to shift back to pure medical reasoning as a basis of testing in the setting of the best malpractice and tort reform.
Get the illegal aliens out of my emergency department, please.
Get the Michigan and other phony drivers licenses and ID's out of circulation by having new ones issued.
Permit balance billing and opting out.
Stop witch hunt records reviewing.
Get rid of Joint Commission accreditation requirement.

Thank you for your terrific feedback and candid and thoughtful opinions.

Let me respond to a couple of points that were raised.

Several of you effectively pointed out that merely having health insurance does not guarantee high quality health care. Several others broke down the demographics ( keithhennessey.com ) of the "more than 45 million Americans" without health insurance. Still others argued we have excellent medical care, but the "crisis" in health care is really costs.

Yet, too often policymakers look at the issue of cost in isolation. The deeper problem is the absence of a transparent, competitive and rational market. For instance, many of you explained how low reimbursement rates negatively impact delivery of care. Several of you pointed to CMS's low reimbursement rate to anesthesiologists and the negative impact that low reimbursement rates have on the practice of medicine. When only 2% of med school students went into primary care last year, I believe payment reform is the structural change that is the key to realigning incentives and rewarding physicians for helping their patients achieve healthy outcomes and manage chronic disease. Unfortunately, Congress is not considering this as part of "reform."

There are many things that disappoint me about the current proposals in Congress which I outlined in my post. Back in May, I introduced my own health reform bill: the Patients' Choice Act ( coburn.senate.gov ), S.1099 ( coburn.senate.gov ). This bill would equalize the tax treatment of health insurance, and create transparent state-based Health Exchanges, where consumers could shop for plans that meet their needs. Most families making under $250,000 would save money, and nine in 10 households would see a tax cut. With auto-enrollment ( coburn.senate.gov ) (with an opt out), most of the uninsured would be covered and not end up in ERs. Fraud ( www.realclearpolitics.com ) in Medicare and Medicaid ( www.usatoday.com ) would be addressed in a serious manner. My plan would transform Medicaid for 45 million moms and kids by enrolling them in private health insurance plans, giving them real choices in health decisions.

Again, I appreciate this opportunity to continue our dialogue. I look forward to our next discussion.

Tom Coburn, M.D.
U.S. Senator, Oklahoma

Senator Tom Coburn has directly recieved from health care and pharma over $272,000
in the last 4 years.
Medicare has an administrative cost of less than 4% compared to 32% for private insurers.
This means: "Medicare is much more efficient, and economically cost effective for the country as a whole than private insurers can possibly be, since they pocket or give to the pigs in our congress more than 27cents from every dollar they collect. This is why we spend more per person on health care than any other country and are still just #31 in world overall health ratings.

The health care lobby has spent (given to Congressional pigs) more than $500 million in the past 6 months.
Get rid of the Congressional greed and get rid of the lobbyists and we can have the finest health care in the world.

1. No discussion at all, unless there is good and comprehensive tort reform and malpractice reform. Focus on that first. Then, once successful, we can talk about any healthcare reform. Doctors must be on board with the tort/malpractice reform. We are far more reasonable than the lawyers. We actually want our patients to do well and to be taken care of when things do not go well. We do not work on commission like trial malpractice lawyers, who have a tragedy-commission built in to their work, in addition to billing by the minute, which doctors do not do.
2. Less government regulation, not more is the answer to more competition. Identify the regulatory practices that have not been successful in improving anything and eliminate them. For example, paperwork created solely for government regulatory purposes should be eliminated. If pts want specific information, they can request it, but unnecessary confusing papers mailed incessantly has got to stop.
3. Being able to go across state lines to get insurance.
4. Allowing insurance companies to give discounts to healthy clients, who eat right, join a gym and demonstrate that they use it on a regular basis, get their check ups and preventive care, get their teeth cleaned twice per year, don't smoke, get educated on their disease states, etc.... Or make the ones that don't do this pay more. It's only fair. I agree that the government should do the same thing for those on Medicare-HMO plans. [Whenever I see a 30-something individual who is obese, smokes, eats unhealthy, etc., I see someone who may make it to 65 and suck up the system with their chronic illnesses... not fair to the rest of us healthy-conscious taxpayers].
5. Making employers who hire illegals liable for all healthcare costs of these employees. It is not fair that taxpayers should pay the bills of undocumented workers, when these people invariably come from countries with socialized medicine, and when they are here because of the employers who do not care about the consequences. It is also not fair for hospitals and doctors to be stuck with the financial loss of taking care of these people. So when a hospital realizes that the patient is an illegal alien (and everyone should be allowed to ask and request documentation without fear of political or legal repercusions), they should send the bill to the employer and make them liable. You will see how quickly we will resolve the illegal immigrant issue.
6. Increasing the age of retirement for Medicare benefits to 69. I know this is very unpopular and probably no politician will dare say it. However, it is necessary. We simply do not have the money. Medicare is in the hole for trillions of dollars and we need to start making hard decisions now, so that the "death panels" some fear won't become a reality. We need to swallow the bitter pill and accept this now. Otherwise there may be no Medicare in a few years.
7. Easing some regulations and relaxing on the church/state issue a bit so that more charitable work and programs are available to the indigent, not poor enough for Medicaid, or those young people who are chronically ill but not disabled enough for SS-disability.
8. Did I mention relaxing some insurance regulation? I guess everyone loves to hate the insurance industry, but they provide a tremendous service. Let insurance companies taylor plans to specific clients. Not everyone needs to have the fancy-fancy coverage. Many young people should be able to get cheap healthcare, at least the healthy ones.

Anyway, I have many other ideas but running out of space. No one with any power has ever asked me!

There can be no meaningful healthcare reform without addressing tort reform. This administration's approach to that is to do patient safety pilot projects. There is no question that we need to be involved in patient safety, but the message conveyed to physicians is this: "If you guys would just practice safe medicine, we wouldn't have to sue you." I believe the studies actually understate the costs incurred because of defensive medicine. Tort reform in the larger sense would do a lot to improve the business environment as well.
Regarding insurance reform:
No pre-existing condition exclusions
Prompt payment of claims
Universal electronic filing of claims
Expand competition across state lines, and let the market work.
Encourage HSAs.
Insurance education of the public. We should insure against what would be an intolerable loss, and not expect someone else to pay the tab for everything.

lantern314 is entirely correct. The questionnaire is crafted to merely support Coburn's position. And Sermo Doc 89, just above, is also correct. For profit hospitals should fade away into the sunset. Medicare is certainly not perfect, but I have spent hundreds and hundreds of hours arguing, haranguing, filling out paper work, facing threats from insurance companies to get my patients appropriate care. I have never done that with Medicare. I am certainly aware of the re-imbursement issues. Unfortunately, who else but the govt. can do certain things? The medical system, as pointed out by a Berkeley professor (?Robinson) several years ago, is the only economic system where competition drives UP costs. Hospital A builds a new wing, hosp. B builds a bigger one; new CT, a newer CT; new MRI, a faster, newer MRI. Rates go up at both hospitals. Drug A is a great drug - now Drug B is even better and, therefore, even more expensive. And, yes, malpractice reform is necessary and adds significantly to the cost of care. At least let's really talk about the problems and how to solve them; not rant at each other with catch phrases about death panels, socialized medicine, the govt. between you and your doctor, etc. In all my years in the office and ICU I was much more concerned with the insurance company between me and my patient.

I am retired. So my comments on insurance are general. Question: what happened to everyone getting Congress' health insurance?? Last year this was the pitch. Now it is avoided like the plaque. There are about 1/3 as many federal employees as there are Medicare patients. May be as many with families. There didn't seem to be much discount taking care of federal employees as with Medicare. I have never heard that the FEHBP is a huge strain on government finances. Wouldn't it be better to make FEHBP the choices for all?? They could even get some Medicare patients to transfer into it !
This seems like more of a Republican plan than any single plan I have seen.

Aren't you the legislator who told constituents who had difficulty with access or payment of medical care to see you in your office? I saw/heard this on a Frontline piece.

Stop being such an ostrich!

My husband, a retired personal injury (and med mal) lawyer, believes that non-economic damages should be capped at $350K. They did this in Missouri a few years ago, and it is proving to be successful at easing the liability for physicians and hospitals, because unless the ECONOMIC damages are SIGNIFICANT, the med mal attorneys won't represent the plaintiff -- too much risk is involved in chasing a case that has low economic damages and high (capped) non-economic damages (like pain and suffering). The plaintiff's lawyer only gets paid if he/she prevails... and MOST have to front the case ($40 - $60K) with their OWN money to prepare the case. So when the non-economic damages are capped, they lose interest in representing the plaintiff.. UNLESS significant ECONOMIC damages exist.

I believe that the issue is not health care reform, but health insurance reform. The current size and beurocacy of the private insurance system is so bloated that the costs of insurance to patients is guaranteed to go up just to feed the machine.

As a private practitioner and thus a small business owner I think that any proposal which forces employers to provide insurance to their employees will threaten the ability of many small businesses to even stay open. For my own office of 2 employees our mothly cost will be $2200 per month (up from $1700) if I choose to renew. And I am insured under a different policy! The rising cost of insurance takes away any chance my employees will have of getting a raise in their take home pay. It is either continue to provide insurance at the current pay level or stop insurance and give incremental pay raises instead.

As a young physician I am already frustrated and disillusioned with the business of medicine. I love my job and can think of nothing that I would rather do fo a living. Unfortunately, the business aspect takes much of the joy away from my work.

On Malpractice:
Hamurabi, more than three thousand years ago, established the principle of written laws, as opposed to the claim that the law is whatever I say it is-a la Stalin and Alice in wonderland.
If the standard of Care is whatever anyone says it is-then we have a system not of law but of larceny.
Review the protections gun-toting, drug-inebriated gangsters have under the bill of rights. Do physicians have the same protections?
Are we really innocent until proven guilty? or are we really guilty until proven innocent? How many settlements involve physicians settling (pleading guilty) in cases where there is proof positive they are innocent?
Malpractice is a system which is more akin to kidnapping or blackmail than any system of justice.
In the civil injury system, 50 years ago there were many protections that made it difficult for plaintiffs to succeed unless they had a truly legitimate case, convincing case.
Malpractice does not mean that you had a bad outcome. It means, or should mean, that you screwed up so bad that you caused the outcome yourself.
Over the past several decades, law professors have cooked up many new theories which have become the law of the land. In aggregate, these new theories have had this result: a completely corrupt set of rules. : Like a ten commandments that says murder is required, adultery is mandatory, honesty is prohibited.

We need to focus on, and discuss, and propagandize about how the current civil injury system is an industry of larceny. It is not a system of justice. In fact, for me to say it like that, is to elicit peals of laughter.

Those near or past retirement age remember OB malpractice as being about $7,000 a year. A brachial plexus injury would go for about $30,000. If the outcomes are the same or better, why are the verdicts, and settlements much more? If malpractice is now about 10-20 times what is was previously, and outcomes were the same or better, then the system has nothing to do with the quality of care.

The lawyers and judges are the enemies of justice and fairness.

Some say that defensive medicine has nothing to do with cost of care. This is wrong. In fact, the more the legal system is percieved as profoundly corrupt by physicians, the more ridiculous defensive medicine becomes.

The other nite I sent a multip in for induction of labor. The cervix was 2/80/-2. The nurse told me that the baby was Occiput posterior. She told me it was "too dangerous " to labor such a patient and the patient would have to be sectioned. I took the patient elsewhere for an easy vaginal delivery.


As many physicians in Los Angeles (with so-called reasonbable malpractice) feel the courts and arbitration panels have no hope of fairness, such idiocy is becoming porgressively more common. Many section babies thought to have estimated fetal weight > 4000 grams. One would have to perform >3500 sections, at a cost of 8.7 million dollars to prevent one brachial plexus injury. Yet if many are doing it, it means insanity has taken over.

It is pretty clear from reading standard textbooks, that cerebral palsy has nothing whatever to do with what obstetricians do or do not do in labor in delivery. According to what the scientific literature says, CP has nothing to do with the conduct of L+D. Yet, when there is a case of severe neurologic handicap, the malpractice companies never defend any case. What they think, is the chance for fairness is less than the chance for a snowball in hell.

Any honest and knowledgeable observer should conclude that enormous sums of money change hands based on theories which have little compelling factual basis.

For example, fetal distress would often be attributed to "uteroplacental insufficiency." This can be measured in an animal experiment if numerous catheters are placed in the uterine arteries and veins, the umbilical arties and veins, fetal carotids, etc. Has this ever been done clinically? I've never seen it.

I would suggest that "uteroplacental insufficiency is almost never demonstrated clinically. Like any malpractice issue, it flourishes where there is a lack of data, as malpractice allows "experts" to make up "opinions" and then testify to them under oath. It is probably about as scientific as the salem witch trials.

This is a profoundly corrupt industry. It needs to come clean. Very clean. Otherwise all vaginal deliveries will be done by C/S. Outcomes still will not change. And attorneys will then say the C/Ss should have been done a week earlier. But not premature.

In order for any proposition to be accepted in a medical or scientific journal, it must have a significant p value. This means the reliability of the conclusion is at least 95% correct. Why is this standard not used in court?

There are supposed to be limits of reasonableness for civil litigation. If one is not on trial for a violent crime, one is not susposed to lose one's entire savings and everything one owns. A verdict or judgement should not include one home or entire life savings.

Yet, I rent because I could not afford to own a home. My malpractice is four times higher than my rent. Even with LAs inflated property values, I buy a house for my malpractice carrier every few years, yet I've never had one myself.

Something really needs to be done about this industry of theives. If the US malpractice system is relatively unique in the world, then most lawyers and judges from other countries must conclude that US attorneys are thieves, and they operate with the encouragement and support of a judiciary that allows them to do whatever they want.

I hereby request that we have no further discussion with Senator Coburn as per the NY Times article documenting his involvement in Senator Ensign's mistress scandal and "The Family." He is not an honorable man.

Congress should consider smaller bites toward the large goal instead of trying to "fix" everything at once.
First, keep the population healthy. If vaccines are recommended simply provide them free of charge.
Second, catastrophic health events should not bankrupt families. Perhaps patients with overwhelming health costs should be covered by Medicare.

Consider a trial of govt hospitals available to all. Perhaps try it in one state first.

Or mandate that insurers covering more than, eg, 20,000 people be required to accept any applicants, AND be prohibited from charging those with pre-existing illnesses more than 300% of their avg premiums.

Allow the health system to have tiers.

Bottom tier could only cover accidental injuries, catastrophic costs, and generic medicines.

Individuals could purchase better insurance that would include a greater number of medicines, more PT vists per year, etc

Cadillac coverage could include dental, orthdontic work, glasses,etc.

That way businesses could offer better coverage as a perk.

Let the govt pay our malpractice bills in proportion to the number of Mcaid and Mcare patietns we see. If I see 20% Mcare and Mcaid, let the govt pay 20% of my premiums. In that situation, the govt would soon facilitate malpriactice reforms to save govt money.

Sen. Coburn,

It is a bit upsetting to see you present your points in such an obviously slanted manner. You are looking to validate your own preconceived ideas.You presented a set of carefully chosen points designed to manipulate people's opinions.
Most of us who have been in real-life practice of medicine appreciate how complex these issues and systems are. For you "outsiders" much more would be accomplished by humbly asking questions, then listening. Many of us REALLY know what has been going on in the world of medicine! But there has been little real input from currently practicing physicians.

IMO the most efficient form of insurance is self insurance with defined benefit plan that is negotiated by the members who have a stake in the costs. Services are covered or not covered based on medical necessity and concensus opinion of a broad group of physicians to include primary care and specialties. Want covage for chiropractors??Pay more. Require evaluation by a physician prior to ordering of big ticket items like mris. Investigate the conflict of employed "providers" ordering thousands of dollars of testing on patients in facilities that pay that "provider" way more than any independent physician is ever paid. Investigate the whole "not for profit" joke that many insurance and health care facilities work under. Get rid of high paid CEO's

Malpractice:

More than 3000 years ago the first written code of law was given by Hamurabi in Mesopotamia.

Prior to that, the law was whatever the King or judge said it was. It could be different things on different days. Thus there is no real law or fairness unless there is an agreed upon, written code of law wherein anyone can look it up and see what it is.

Yet in malpractice court, the standard of care is whatever anyone says it is. If the plaintiff's expert said the defendant practiced within the standard of care, then said expert is replaced by a different expert with a different standard.

For this reason, and for very many other reasons, malpractice is a profoundly corrupt system which resembles kidnapping or extortion much more than a form of "law".

What of bunch of horseshit. How much are the insurance companys paying you and the other Republicans, Coburn. to keep them in control of health care.

It is time to dump the present system entirely, create a totally non-profit, single payer system controlled by healthcare professionals and patients. All paid for taxes on the international corporate cartels, BIG vice taxes and a 90% tax on anyone making over $300,000 a year with no deductions and 50% capital gains taxes and tariffs. Etc Etc ETc

You politicians should stick to what you do best - make war and brown nose each other.

To: Sermo Doc 161 (& all leftists?);
CC: Senator Coburn;
Sermo Doc 161 is all well & fine until one asks how one is going to pay for 'universal care for all--no matter what'.

Sorry but 'tax (only) the rich' schemes have been tried & failed. In NYS, Tom Golisano (tycoon & sometime candidate for Governor) has threatened to relocate to Florida because of NYS tax burden. A similar & more widespread phenomenon seems underway in neighboring & hi-tax NJ. It takes little imagination to envision capital flight abroad--beginning with that of the very wealthy--out of USA (where the $ is needed) to anywhere else that it would be safely wecolmed.

Exorbitant 'sin' taxes would only mean that the 'sin' would continue underground--under the protection of the Mafia while losing the expected revenue (e.g. waterborne smuggling of already highly-taxed tobacco products is an apparently lucrative Mob racket in Italian ports).

High import tariffs are 19th century economics which helped cause the dismal trade wars of the 1930s &, if ever implemented under prevailing conditions, would hurt America's international trade (altho' we could use repeal of an archaic Constitutional amendment against export tariffs--the latter apparently useful to exporters).

For 'what is to be done' when it comes to 'universal care for all--no matter what', then, I say, 'Authoritarianism--or Chaos!', to wit:
Socialized medicine that is cost-effective, cost-contained & 'universal ' (for the general population) must inevitably imply 'sovietization', to wit:
1. Relentless centralized rationing of health consumer demand & health care providership supply;
2. Permanently higher taxes & levies for all income groups (not just 'the rich');
3. Indefatigable cost containment (e.g.: abolition of med mal tort awards as it now exists; suppression of labor union autonomy in matters of collective bargaining & partisan politics; health care provider remuneration correlated only with cost-of-living & provider productivity);
4. Ruthless enforcement of #1, #2 & #3, inclusive of anti-libertarian practices such as nati'l identity cards (with biomarkers) & omnibus, lifetime databanks (with bio-markers) for each identified person in the US & a true national police force (as already exists in most areas of the world anyway) with pluripotent powers of investigation & enforcement.
5. Miscellaneous nonsoviet reforms (for purposes of cultvating economic growth) might include: repeal of ban on export tariffs; line-item veto & impoundment empowerment for US presidents & all US governors; ending doctrinaire anti-trust laws; curbing 'class action' lawsuits, discerning & rigorously-enforced immigration laws (e.g. need nat'l identity card with pluripotent policing).

In essence, I say to the Left: yes to socialized medicine--but if & only if--you've got 'the guts' for it, for all of it!

The Dissident Voice website abhors these "robber barons" stating:

United Health CEO earned $124.8 million in 2005
February 14, 2006 in Current Events, Health Insurance

"William McGuire of UnitedHealth Group, the nation's leading insurer, was the third-highest paid CEO on the Forbes list. His pay of $124.8 million could cover the average health insurance premiums of nearly 34,000 people....

While workers are having a tougher time making ends meet, CEOs are getting perks worth more than worker paychecks. CEO freeloaders expect perks such as lifetime use of company jets, chauffeured cars, company apartments, club memberships, sports tickets, financial planning, personal assistants and more.

In CEO World, the more money you make, the less you should have to pay for."

And this is only one of the "Gang of Twenty".

As Sermo Doc 161 asked: "How much are the insurance companys paying you", Dr. Coburn?

The above discussion is one of the most intelligent and varied that I have seen in a long time. I don't agree with everything, but at least it appears to be a genuine attempt to reveal and discuss many of the options. Personally, I think Dr. Coburn's pl;an is facile and disingenuous. Its claims to do so much but is not supported by the fine (or even large) print. I agree that the discussion has become one of health insurance reform rather than healthcare reform. Many of the folks in Washington seem to want to ensure that the health insurance industry will survive if not flourish. Why? Could it possibly be that the insurance lobby is one of the largest in DC, and that they funnel countless millions into congressional candidate war chests. Need I remind us that their funds are deducted from healthcare dollars that otherwise might have been used for, wonder of wonder, healthcare. Exactly what positive effect has health insurance provided. How has healthcare been improved after they have removed the widely accepted 33% of every healthcare diverted to profits, CEO salaries and administrative costs. Many eschew "a government takeover of healthcare." First of all, no one has made that as a recommendation. Nonetheless, the VA consistently scores among the best healthcare delivery systems in our country. Medicare administrative costs are generally 3%+/- annually. The difference of approximately $30 of cost between the private and medicare insurance plans would fund healthcare for all of the currently uninsured in our country without adding a cent to the overall cost.
I have subscribed to medicare for the past year. I pay an extra premium to get a particularly good plan with full choice of medical providers, no doughnut hole for generic prescriptions, and reasonable co-pays. I don't feel that I have been a victim of a government "takeover." In fact, I am doing much better now than when I had private insurance which cost more than $14,400 annually for my wife and me.
We need to speak up as clinicians. The reason for excessive lab tests and diagnostic procedures has little to do with defensive medicine. In Texas, where there has been major tort reform, the level of testing continues unabated at pre-reform levels. The problem is that we don't have enough time to spend with patients listening to them, taking good histories and performing the physical exams that we all learned to do as third year medical students. If we could jettison much of our office staffs who contribute nothing but addressing coding and billing concerns, our overhead would be less and we would have to see fewer patients each hour and would feel less harried, more gratified, and we would continue to earn the same income. Also, we could train and hire additional clinical staff who could then augment and improve healthcare further. I think plowing more money into training and hiring medical personnel makes more sense than spending it on bloated administrative staffs.
Please contact your congressional representatives with constructive ideas about how to address well-articulated problem areas. Don't exaggerate or oversell controversial areas of self interest. Instead, keep patient care foremost in your thoughts and you are more likely to be heard. Good luck

Sermo Doc 162, the problem with all the efforts at tort reform around the country (including Texas) is that they are aimed at regulating dollar amounts. The type of tort reform needed is one that actually reduces the likelihood and frequency of lawsuits by making them more difficult (or impossible) to file, or severely penalizing those who file and lose.

Attorneys have a different viewpoint on lawsuits. They look at lawsuits as just normal business activity, an activity with which they are quite comfortable. Doctors look at lawsuits as evil: insulting, expensive, unnecessary, inconvenient, painful, scandalous, and even possibly ruinous. IRS audits are preferable.

To attorneys, lawsuits are just a game you win or lose, to doctors lawsuits are a personal attack. Winning and/or losing to a doctor are same thing and have the same result! For lawsuits to diminish in frequency, so that frivolous ones disappear entirely, we must make them PAINFUL for the attorneys. They must be made to suffer, so that they finally realize...THIS IS NOT A GAME!

Sermo Doc 44, I appreciate and agree with your point entirely. That is why I support tort reform. My point is that to say that it is THE overriding concern in providing better healthcare for all Americans is to far more prominent economic and clinical issues that apply to all of us as Americans rather than solely to us as physicians. Tort reform should be addressed. The sad reality is that most congress people are lawyers. Fat chance that they will join our bandwagon. The few physicians (save Jim McDermott) in congress are largely bought and paid for by insurance companies and behave accordingly. Tom Coburn is one of them. He also is being investigated for his role in trying to hush-hush Doug Hampton, whose wife was being boinked by Senator Ensign of Nevada and the good senator then orchestrated an illegal lobbying career for his erstwhile best friend. That was before Ensign's parents paid the Hamptons a cool $96,000. But that's another story. It just speaks to the level of sleaze in which Coburn participates.

All due respect to Senator Coburn; not all of us agree with your views no matter how carefully crafted the questions are. This is beginning to feel like a "when did you stop beating your wife?" conversation. Please listen more carefully.

The whole health reform issue is about out-of-control COSTS. And, there are very few ways to actually get a handle on this. None of the proposals in the current pending legislation address the REAL problems of cost containment. This is why we make such a big deal out of tort reform, because THAT actually does address the cost issue directly, as so few things do.

But, if tort reform is off the table, as apparently it is, it means that there is NO serious effort or desire to address the real underlying problems. The way costs CAN be reduced is to put the doctors in charge of decision-making, and allow us to make medical AND economic decisions by priority (with nominal risk assessment strategies) without the ever-present fear of litigation, punishment, backlash, or second-guessing.

Costs can be contained, but only with RATIONAL decision-making. The way that decisions are made now, is not rational.

And, I submit to you and everyone else, that bureaucrats cannot and will not make proper decisions. The ONLY people truly capable of proper prioritization of the use of valuable medical resources are the physicians, period.

Tom

I have completely lost faith that you or any other politician can improve things for physicians or their patients. The government has had decades to "fix" our health care system and has only succeeded in making it more complex and wasteful. There are too many companies making too much money paying too many politicians. Our government is composed almost entirely of lawyers,liars or both. Not surprisingly,most of my patients agree with my opinions.

Dear Senator Coburn,

It is refreshing to have someone ask for physician's opinions, even if it's just another physician. In general, the politicians from both parties couldn't care less what matters to physicians or what is actually required to provide medical care. Perhaps those issues are really too complicated and individual to ever be satisfactorily organized. I would suggest a somewhat different approach: Challenge the basic assumptions!

Let the government do what it seems to do well - collect the money. The IRS can do that at little additional cost. The question is, how much needs to be collected per person? Insurance company actuaries know those figures very well. Why can't the government access that data? That data can establish a budget for providing health care to everyone in the country, and that's money already getting paid somehow. Once the health care budget is established, collect and segregate those funds, with subsidies where necessary, then to pay for everyone's care, pay the people actually responsible for delivering that care, at rates appropriate to the economy, and an appropriate return on their investment of time, effort and capital. These rates can also be calculated with standard formulas, if anyone cares to do so. In this country, only medical care reimbursements are determined by third parties with significant financial incentives by subtracting from last years rate schedule, while the costs of providing care continue to go up.

Free the medical community from anti-trust regulations, just as the health insurance companies are exempt. Reform Tort laws to at least make the loser pay the prevailing parties costs and be liable for countersuit, if the cost can not be eliminated by experienced and skilled arbitration. Then let anyone who would provide medical services organize and compete for the available funds based upon the patient's preferences, and their choice of provider. That allows the operation of a free market, creates an opportunity for free enterprise, and will demand appropriate innovation, while making exorbitant, unproductive expenditures a thing of the past, especially the inflated bonuses given executives for not providing care. If an insurance company can pay bonuses in the millions of dollars, that money represents either care that was denied, of insurance premiums that were too high.

I sincerely hope this provides some useful basic ideas, along with the hundreds of personal suggestions expressed above, and elsewhere. We all know the system is broken, and certain basic assumptions must be clarified before there can be any logical or reasonable reform.

Eric S. Lichtenstein, MD, FACP, FACE

If anything is to be done, have it go into effect as soon as possible so that the current administration can accept the credit---or the blame--- for what happens afterwards. It is a CRISIS, isn't it? Doesn't it mean that we need change right away??

I have read very little about the effects this legislation will have on us(doctors) as small business owners. The employer mandate will increase our overhead by requiring part timers to receive that benefit-whether or not they need it, all of my part timers have insurance from their spouse's plan-truth be told they would rather put the money in their SIMPLE IRA or take it home. These bills will lower our reimbursement again raising overhead as it is a function of Revenue. That would likely cause length of visits to drop as we would need to see more lower paying patients to make ends meet-leading to more tests and referrals as it is easier to order things than taking a good history and talking to patients. Less time with patients hurts our doctor patient relationship which of course increases liability and increases waste. Lower reimbursement also hurts our ability to pay back loans we have for things like EMR's, in office testing and systems that help with practice management. Maybe we need to figure out a way to help primary care doc's spend more time with their patients like Mark Sklar MD penned in the WSJ, or the Mayo Clinic proposes on their web site.
Med Mal reform is needed if waste is to be eliminated you can't tell us to do more with less and have doc's hold all the risk.
If prevention is a priority and you want a public plan let's nationalize Pediatric Vaccine Administration. Pediatricians are drowning trying to finance these medicines that actually do decrease costs and yet no insurance companies want to provide reasonable reimbursement rates. Nationalization is not bad but let's be selective in what we chose to give to the government.
I hope someone reads these posts, because I have written to Pres. Obama, Rep. Jim Clyburn-SC, Rep. Joe Wilson-SC, Rep. Tom Price- GA, and now Rep. Coburn-none has written back with a direct answer on any of these issues or has it appeared that the letters were read throughly. The letters did get me numerous requests for campaign donations.
Frustration abounds and I have begun to look into how to get a work visa for Australia or New Zealand.

Sermo Doc 167, you are exactly right. They don't ever acknowledge or accept our well thought out advice, but they always have their hands out for cash. If they took our advice, they wouldn't need cash! No one would even bother to run against them.

Sermo Doc 44-Amen!!!

Sermo Doc 167 and Voyager5k, You both have made some good points. Still there are some ways in which you are inconsistent. The major issue about "health reform" isn't simply cost. It is access. It is so easy for those opposed to improving health care to invoke and hurl the Socialism epithet. Still it is an embarassment to see how despite the extraordinary potential of American medicine, there are many who never can receive even the most basic care. If we want to design a system that iis evidence and outcome based, how do the conservatives explain our number 31 ranking in healthcare, well-being and life expectancy among developed nations. Looking at our profession as a business, changes our approach. Is it surprising that those cardiologists who own echocardiogram machines order more echos than cardiologists who do not own those machines? You referred to the Mayo Clinic which regularly is cited for superior care at a below average cost. That is because they are all salaried, don't get a cut of the test fees that they order, and can leave the administrative concerns to others who are real pros in that regard. Last I heard, the staff there has a high morale and a lot of well-deserved self respect. If we all were a part of a truly integrated healthcare delivery system, we might all do similarly. True, there may be fewer Mercedes and Boxters in the doctors' parking lots, but no one would be going barefoot. Also, I'll bet that the Mayo Clinic has a lower than average rate of malpractice suits. I don't know that for a fact, but I'd be willing to bet good money on it. Let's stop worrying about how well we doctors are treated, and let's start worrying about how patients are treated. And..., let's get real upset whenever there are patients who are not treated at all.

johncrowl I agree access is a problem, one that is getting worse as our economy flounders. I think that in order for health care and insurance to be reformed one must look at the business end of things. To have a practice that is in the red and closes hurts access as well. I would gladly take a salary and put aside some of the challenges of a private practice like Mayo doc's do that is why Australia and New Zealand look good to me. As for owing equipment, I own a cbc machine which saves my patients from traveling to the lab for a draw and delivers timely results. I see 120-150 patients a week and I do 12-15 cbc's a month so some but not all use their machines for revenue enhancement. I also agree that people should get care that they need and I do feel for those who are not able to access the system. I do my share of uncompensated care for those who can't pay, but to ignore the numbers involved with reform is to proceed unwisely. I do believe that to take care of patients one must be a good steward of your patients care, your practice, and the system.

Swiss model, anyone?

Sermo Doc 168
I would love to try one, but I doubt my wife would approve.

glad to see there is still a sense of humor on this board!

People's incentive driven self profiting life is the root cause of all the current health care turmoil. The moderation of profit and the balance of selfishness is the key to successful mutually profitable harmonious health care system. People want the best health care system for almost for free. The lawyers want to win malpractice jackpot every time. The physicians want good pay for all the time, stress and high cost of medical education and high cost of medical practice over heads. The politicians the opportunistic middle men want to win power and money by simply spending hard earned tax payer's money lavishly- VIVA POLITICS- Physicians split when it comes to pay. The cognitive internist wants to be paid more by further cutting already low payments for procedures which he shuns to perform for whatever good reasons. Every body wants to profit at the expense of some other person. Why should any professional be paid more than any manual laborer and further more why one country man be paid more than the other. There is the zero point self concept to one self when it comes to one own profession, gender, race and country. Once the group limit is set every thing out side the box does not influence the graph of life inside the box. The apparent universal rules are mere concepts in this insular real world of existence. The ultimate nuclear fission of HARMONY results in HARM & MONEY when we see the differences only but not the similarities of our lives. The demand and supply for intelligence and diligence for the benefit of the humanity sets the prices for ones work and all the rest is profit driven rationalization. Whether it is Hydrogen or Uranium a significant nuclear over load disturbance leads to explosion with grave consequences. The same is true to the unintended economic consequences of the expensive health care reform of the short sighted politicians for their political gains and immediate voter's gratification. The slow meaningful changes evolve over a period of time unlike hasty mutations that mutilate the healthy system.

Agree 'renam' and repeat it:

"The same is true to the unintended economic consequences of the expensive health care reform of the short sighted politicians for their political gains and immediate voter's gratification."

BO's Socialist Govt. Experiment is spending countless Trillions and creating unbelievable Debt which is destroying the Country. He'll be out of office in a few years but generations will be suffering from the consequences of his Presidency.

We need to stop the madness. Defeat or stop BO's Reform Bill and all his other actions including Energy, Cap/Trade, TARP, TALF, Clunkers, Unions, Stimulus, etc.

Just say "No More".

My wife and I are both physicians. If our healthcare system is to effectively treat everyone, we desperately need high-quality primary care physicians. My wife has been ranked in the top 1% of physicians by national patient satisfaction surveys and yet she makes less now than she did ten years ago. When highly motivated, bright individuals can have a higher quality of life and make a far better living pursuing careers that require substantially less personal sacrifice, how will we recruit the necessary people? Without solving this dilemma, all other issues are moot. To cut costs, the government should identify which sectors of the healthcare industry have profited the most over the past 15 years and target those. We also need to recognize the fact that we have an aging population of baby boomers that demand the best of everything. Invariably costs are going to rise. It's a fact we just have to face. If cuts to physician reimbursement are made (and by far, most of us are making the same or less than we were five to ten years ago), we will be forced to cherry pick the patients that cost us the least headache and offer the best return. The government will be shooting itself in the foot.

Sermo Doc 169, you are correct, we know this, and yet the administration believes that we can replace your wife with less expensive nurse practitioners and PAs. We know this is nonsense, we know what years of training and experience are required to successfully practice primary care. We know the value or our physician colleagues...they don't and they don't care. Doctors like your wife should be screaming the message to everyone...starting with the President.

#1 Tort reform
#2 Insurance reform
#3 whatever plan is created after the above two points are included, the members of Congress MUST have the same plan as the everyone else! They cannot have some elitist type of coverage!

Reality check - what healthcare reform would look like if the Congress were not owned lock, stock and barrel by the large corporations they purport to regulate. What a joke, Senator!

1. Reform health insurers along the lines of public utilities. The notion of shareholder profit and pharonic executive salaries must be eliminated. Why? Because what is really needed is HEALTH INSURANCE REFORM. No more annual compensation of $126,000,000 in 2006 (Forbes) for a crook like Dr. William McGuire of UNITEDHEALTH Group.

2. No fault malpractice insurance with evaluation by professional boards of physicians, citizens and lawyers. Without reform of malpractice tort, defensive medicine will continue to cost billions.

3. Increase pay for primary care. Without primary care physicians all the insurance coverage in the world will not translate into cost effective ACCESS to care.

4. If you cannot bring Medicaid payment rates into parity with commercial insurance reimbursement, then think our of the box for once. Give physicians who provide services to MA patients a tax credit for the difference between paltry and ludicrous MA payment rates and commercial rates. Overnight access and coverage would improve tremendously. Protection from fraud can be combatted by standardizing direct payments and credits via medical debit cards and accounts.

5. Do not disallow HSA type accounts with rollover provisions funded by a percentage deduction from wages and SE income, the percentage scaled according to AGI. Even the poor must have these accounts, supplemented as necessary by Fed and State funding. Payment for primary care services should come from these accounts by medical debit card. If everyone has some skin in the game, watch the expensive ER visits for bronchitis and a diaper rash drop like a stone. Get real, Senator. We need to incentivize patients to healthier lifestyles and cost effecient usage of services. Only incentive I have ever seen that works is financial.

6. Catastrophic care Federal insurance funded in part by wage and SE deductions as in FICA taxes and partly by cuts to the "Defense" budget for our wars in foreign countries to fatten the bottom line of your Defense contractor buddies and patrons. Oh, and toss in a financial transaction tax as well. The taxpayers have supported the fat cats on Wall St and the bankers to preserve their absurd bonuses for rurnning this economy into a ravine. And the taxpayers have not been bailed out one iota. Time to pay up, Senator, or face the consequences. We are sharpening the guillotines....

Sermo Doc 170, just add "Universal Private HSA's" and we've got it made! Thanks.

As doctors we are forced to accept whatever rates insurance companies feel they should pay us. They are not only cherry picking, jacking up the rates well above inflation, and making record profits but also shafting us big time. Cap their profits to 15 cents out of every dollar with 85 cents going to direct patient care. I am being shafted so bad that I am almost ready to embrace a single payer system. At least I will know that no CEO will be getting their multimillion dollar bonus and laughing his guts out and thinking how stupid we are. So much education to have bean counters keep the money. Screw them! I have been a registered Republican my whole life but I have been shafted so badly by the GOP starting with Arnold Alois Schwarzenegger with passage of SB 899 "saving California" and bankrupting doctors, passing countless laws to put insurance companies in the driver seat and screw doctors, and "W" Bush creating the advantage programs. That piece of s#$^* was ready to give us a 10.6% decrease to keep is cronies in the Advantage programs from getting any cuts. I honestly feel betrayed by the GOP. Sweet talk doesn't cut it for me. Cap the insurance companies' profits or simply get them out of business. Maybe this Country needs to see doctors going bankrupt to believe that we are indeed mortals. Maybe attorneys and insurance employees can take care of patients when they run us out of business.

I am a huge supporter of TriCare, if only because it's the only real system that I know. It has its limitations, but think about the positives -- it is the Armed Forces' 'universal healthcare' -- there is availability, no co-pay (which does contribute to some limitations), and I strongly believe that we physicians in the military provide excellent services. I have to justify what I do in notes and coding, but the day-to-day payments/financial issues are where they belong: with administration and not between me and my patients (yes, I work at the military hospital, so I do know that this is different in different locations).

Finally, the malpractice falls under good old Uncle Sam. HUGE.

Patients under different parts of the plan can opt to select different providers with other copays, so they still have reasonable choices.

Now that I have a *choice* between the military facility and their civilian colleagues (change in family circumstances and change of station), I am actively requesting the military facility -- as is everyone else as the panels for the clinics for my children and me are all at/near capacity.

Let's not write off this 'universal health care' option as the devil -- it just needs to be in the right frame and context. And simplifying the nuts and bolts for the providers (that's my way of boiling down tort reform, SDR and all the other stuff that I'm learning in a crash-course this year!).
Thank you sir, for soliciting all of our responses.
FB

I agree with the above. I support the presidents goals for health care reform. But I also appreciate Dr. Coburn's attempt to humanize the current health care goals. I'm glad he's addressing the concerns that we physicans have about reform, such as maintaining the doctor patient relationship, malpractice reform, and opposing mandated protocols that de-humanize "the art of medicine". His discussion with Senator Mikulsky of Maryland was on time. But Dr. Coburn, we NEED health INSURANCE reform.

I agree that the most important 1st step is to pass malpractice reform. Especially if the government is going to decide what tests to pay for, we need to be protected. If we are going to be prevented from wasting money on defensive medicine, we also need to remove the reason that we began practicing that way.

blah, blah, blah....

ALL of the comments above deserve to be summarized..... ARE HIGHLY SIGNIFICANT

Will Dr Coburn with his two feet inside be able to deliver the GOODS to the WH?

Or is it just another POLITICAL STUNT!!!

Sermo Doc 43, I think this is all just grandstanding. I haven't seen any evidence that the pols take anything we say seriously. Now, if we were seeing Palestrant on Fox and CNN every other day, then I might believe that we were actually getting through.

I think that Congress intends to ram legislation through that will NOT address the problems. And we, the physicians, will be carrying the burden and assuming all the risk with our hands tied!

Good post, Sermo Doc 82.

The private Universal MSA/HSA would be a great reform with direct patient billing and it would keep big Govt. off our backs!

Main issue is reforming how healthcare workers are created. A national "Americorps"
with full economic protection from acceptance to providing care("priesthood" like)is neded first.
A new commitment to reasearch is mandatory as fedral edicts for health care protocols are impossible to change.
Atrial of access tocurrent federal medicine (VA, military,prison care, etc)
would be the best test for the American public to choose the path to the future.
Your efforts are appreciated in the tough forum of lawmaking.

Repeating myself again:
Americans Get Screwed Again by Bought-Off Washington Officials**
www.marketoracle.co.uk

"It is thought that the final bill making its way through the Finance Committee has the best chance of passing.
Why, you ask?
Quite simply because Senator Baucus is essentially working for the healthcare industry. Therefore, his bill is likely to be that most favored by republicans.

finance.yahoo.com

Baucus has been so loyal to industry lobbyists that they were the first to see the early version of the bill a couple of weeks ago, according to an admission by a White House spokesperson.
That's right. Baucus didn't send the bill to the president, his Chief Strategist David Axelrod, or other members of Congress.

He sent it to healthcare lobbyists so they could advise him of changes favorable to their industry.
Perhaps that is why the bill does not include a government insurance option to compete with the healthcare mafia, as originally promised by President Obama.

In fact, even Obama's most ambitious plans for healthcare reform fall way short of what is needed because he does nothing to address the biggest problem - unhindered price hikes by the industry.

Thus, his solution of providing subsidized healthcare insurance to qualified Americans while requiring all others to have it merely creates a bigger gravy train for the HMOs.
Thus, Obama's healthcare reform may turn out to be the insurance industry's counterpart to the Bush's Medicare Part D (taxpayer-funded) gravy train for the drug industry.

Whether a government insurance option is provided or not, healthcare is likely to be made worse because you will be required to buy private market insurance or face a penalty. This mandate is likely to boost total revenues to insurers, most likely with no pressures to compete for price. We are likely to see more industry collusion.

Thus, the plan only ensures higher profits for the health insurance industry, compliments largely of taxpayers.
As you can imagine, healthcare reform is going to be a big winner for HMOs. Investors should take note.

It just might turn out to favor illegal aliens since they won't be covered under the plan and thus won't be fined for not having health insurance issued by this syndicate. Thus, they will escape the vicious claws of America's healthcare mafia.

Baucus might feel he owes the industry some favors since he has received more than $5,000,000 from healthcare lobbyists since 2008. Clearly, Baucus has been bought off, similar to most others in Congress. Baucus just happened to get the biggest payout."
*******************************************************************************************

Corruption and Polotics pay off big time for good old Baucus! Another BOWO! **
OK guys, time for Plan B or is it C or is there any time left?

1) There needs to be real malpractice reform to decrease the number of frivolous law suits. The loser in such cases should be required to pay the legal fees of the winner. Doctors should only be judged by juries consisting of other health care professionals, not non-medical people who cannot understand and appreciate the medical reasoning process.
2) A centralized credentialing system for both medicare and private insurance companies will help speed up the entry of new doctors into the marketplace and decrease the burden of administrative paperwork.
3) In most cases, patients should be required to pay for their services directly to the doctor, and should be responsible for seeking reimbursement from their insurance or government. This puts them in direct awareness of the costs of medical care. Doctors should not have to deal with the hassles of the billing process.
4) Some government oversight would probably be useful to ensure that insurance companies follow good ethical standards and that they are paying doctors fairly (assuming #3 does not go into effect, but really #3 would be better).
5) Remove laws that keep insurance companies from competing across state lines. More competition = lower premiums and better services.
6) Get rid of employer-based insurance mandates - these decrease health insurance portability and effectively decrease competition. Instead, employers and individuals should get a tax break to purchase their own insurance or HSA. The basic point is that the system should be such that individuals are empowered to dump useless insurance plans instead of being bound to them because of their employment.

Right now, see the recent Post: "WSJ editorial. Are any of these guys on Sermo?" and rethink your Plans!?

There are a number of options:
1) Control malpractice. Included in this would be the removal of undue reliance on lab tests and imaging and limiting the size of awards. Adverse outcomes as a result of disease processes or acknowledged risk should not the basis for lawsuits. Malpractice should be for genuine malpractice.
2) Physician fee maldistribution must be corrected.
3) Make patients pay a significant proportion of investigations. In addition, patients should be made aware of the cost of investigation,and treatments as well as their own liability for this. This will reduce the temptation to prescribe the latest and most expensive (esomeprazole, Nexium) when an older and cheaper drug would do (omeprazole).
4) Ensure that the information on treatments that have been cast into question by good quality research is presented to patients as part of informed consent:
See arthroscopy for knee pain, surgery for back pain and others.
5) Structure the insurance to cover major or catastrophic illnesses. These are unbelievably expensive but only occur in a small proportion of individuals.

Fooling the People:
10.05.2009: What We Would Have Told Obama; From The Wall Street Journal
By Donald J. Palmisano, William G. Plested II And Daniel H. Johnson Jr.
October 4, 2009

"We aren't among the doctors invited to a Rose Garden event today to 'join the President in pushing for health insurance reform this year and [who] have offered their help and support,' as a White House press release put it. It's unfortunate only supporters of the president's plans will be there. Mr. Obama has missed an opportunity to learn more about the real issues facing patients and doctors and to formulate a plan that truly puts patients in control with doctors as trusted advisers.

"The United States has the best health care in the world today, and thanks to the ever-expanding frontiers of science and medical innovation the brightest days are ahead. It is true that there are Americans who fall through the cracks of our medical system every day—and as a caring nation, we must do what we can to expand access to medical care to those who need it. But this can be accomplished without a costly and inefficient government overhaul of the entire system. One easy reform would be to enable individuals to buy policies offered in any state, not just where they live. This will enhance competition. But more government-run health insurance will only lead to disaster.

"Today, Medicare already reimburses doctors less than what many of their treatments cost to provide. Now the government is saying that additional Medicare cuts are coming—thus forcing doctors to try and make up the difference in volume, by seeing more patients. If you ask patients about this, they understand that more volume means less time with the doctor. That's something that all patients and doctors should oppose. In time, it will be difficult to find a physician ...

"There are many other ways to expand access to health care for uninsured Americans. We could strengthen incentives to purchase low-cost health savings accounts, provide tax credits for individuals and families buying health policies on their own, and extend subsidies for those who need financial help. Also, the right of patients to privately contract with physicians to ensure they have the medical care they want, without penalty—regardless of what the government pays—must be recognized and protected. Today, if a doctor wants to bill a patient for additional payment over the Medicare reimbursement, he has to withdraw from Medicare entirely for two years. A patient who agrees with this arrangement can't receive any Medicare money for that service, either. ..."

To View The Entire Article, Please Visit:

online.wsj.com

Read the article tonight good stuff.

Dear Senator Coburn:

I just found out that the Senate Finance Committee decided to exclude hospitals form the cost-cutting Independent Medicare Advisory Comimission (IMAC). I STRONGLY OPPOSE THE CREATION OF THE IMAC, and most importantly the exclusion of participation of hospitals in the IMAC. If reduction in provider medicare payments are to be implemented, certainly, hospitals should participate in this and not be exempt.

I was born in a country where socialized medicine exists. I came to this country to flee from the frustrations of practicing in a socialized healthcare system. Please do not allow for our healthcare system to become obsolete and ruled by the big government. Kill the public option and co-ops that will raise taxes on everyone.

I am heartened by the comments of many of you--there seem to be a number of folks who agree with me that health care is a RIGHT and a responsiblity, NOT a privilege. Sermo Doc 89 has it right about the profit motive with regard to both insurance companies AND drug companies. Several first-world democracies (Japan, Switzerland, Germany) have not-for-profit health insurance so they don't even need a public option; none of these systems is problem-free, but they sound a lot easier to work within than our own (less bureaucracy, paperwork, etc.). Malpractice reform should indeed be part of the picture, though it is probably not the panacea some folks would make it out to be; several good ideas have been advanced here as to how to accomplish this. And, universal coverage does mean that everyone will HAVE to have insurance; but that can't happen if there isn't an affordable option. Providing universal health coverage and getting the profit motive out of it is an ethical imperative.

I f people can't afford health insurance to begin with, what good does making it mandatory or taxing them going to do?
DEFINITELY need to allow insurance across state lines, and eliminate some of the virtual monopolies in some areas with big companies.
Should have mandatory not for profit sections of all companies for basic plans, with risk sharing across the board, and for profit options for more elective items of health insurance.
Should decrease costs of medical education, since reimbursements are decreasing, and this would also make it easier for residents to choose primary care.
Need to work on malpractice reform to reduce frivolous suits, and all the legal as well as medical costs of current system.
Need to make medical care decisions more controlled by physicians and patients.......OFTEN I am forced by insurance companies to go with MORE expensive options either short term or long term, or forced to go with ineffective meds "because they are on formulary".
Medicaid payments (one of our government systems) does not even cover gas to get to work, much less salaries or overhead, and are so far from being reasonable that they do not improve access much. Most of us consider that charity care. There will NOT be physicians if they are forced to pay more to operate their business than they can take in.....that is NOT reasonable. One doesn't expect grocers to PAY people to take their bread.
We need to go back to a primary care system with specialists for support, rather than having most of the primary care by specialists. We would have less fragmented care, and better quality of care. That means we have to support primary care doctors, AND reimburse adequately so that they have TIME to do preventive care. We also need to encourage and empower primary care doctors to do more than decide which specialist should handle each problem the patient has. Primary care doctors CAN handle more than they are allowed to by specialists in urban areas......this is something we need to address within our OWN profession .

Senator,

Thanks for taking your time to listen to people who really understand the issues.

The problems are simple.
1. You get what you pay for. If you pay less than the cost you will see fraud, overutilization, and poor quality because coordination of care will not happen.
2. There is no brain in the machine. No one is at home in Medicare or Tricare. You think the IRS has problems. You can't get anything done with these payors. And they pay less than the cost of care. It doesn't take a really smart person to figure this out.
3. The ability of any provider to balance bill anyone to what their cost of service is should be a given. Only in socialist countries is the value of work controlled by the government. Whoops, that's what we do here and the US Congress is the one doing it. Maybe a fee schedule for trial lawyers limiting them to the $100/hour which Medicare requires us to follow.
4. Yes, there should be payment by people who don't otherwise participate in insurance. You can take this out of their witholding.
5. Anybody should be able to purchase insurance anywhere anytime at an equitable (not affordable) price. Why not?
6. Forcing doctors to use the cheapest option is just plain stupid. Don't you think we know how to do our job?
7. Stop the silly doctor bashing "you get paid more the more you do", isn't that how you get ahead? Why don't we pay people adequately to think?

HSA is the model of what Medicare/Medicaid/Tricare and all insurances should be. The sooner the Congress realizes this, the sooner things get fixed.

In addition, Medicaid is a complete disaster. Don't expand it. Fund it propoerly so the people who already qualify get the help they need. Kick off the people who are on there fraudulently (I estimate 1/5).

Sermo Doc 182 , amen to that but I doubt it'll happen.

Senator,
I agree with many of the ideas expressed above.I think that health care reform needs to be undertaken. BUT AGAIN A BAD FIX IS WORSE THAN NO IMMEDIATE FIX.
HERE IS THE SCARY PART: THE NEXT TERRORIST ATTACK IS NOT WITH BOMBS,BUGS OR CHEMICALS. IT IS DONE WITH WORDS FOLLOWED BY AN ATTACK ON THE AMERICAN ECONOMY LIKE THE ONE THIS WEEK ON THE DOLLAR. Once we have voted for a costly program which has vaporous promises of being better and cost-effective, you undermine financial security i. e. the DOLLAR. Then it does not matter who has health insurance, inflation and interest rates sky-rocket, A DEPRESSION, the likes of which no one could ever imagine, ensues and all this is an exercise in futility.Just my $0.02.

Wow, I agreed with Optics Thinker. How about "any willing provider" laws as a capitalist reform?

Dont you guys get it? You people can write/talk all you want but until sermo hires a well paid lobbyist no politician will listen. When it comes to politics money talks BS walks. I emailed my senator about the upcoming medicare cuts and I received the following form email response.

Dear Dr. *****:

Thank you for contacting me about health care reform.

The legislation the Senate Finance Committee proposed intends to allow those who are happy with their insurance keep what they've got, including veterans and seniors on Medicare. It also creates state-based exchanges where those without coverage, or those who are unhappy with what they have, can get coverage at an affordable price.

The bill also will hold insurers' feet to the fire, requiring them to cover everyone and preventing them from dropping someone who gets sick. Additionally, it contains several measures aimed at reducing overall medical and prescription drug costs and eliminating waste and fraud in the system.

Among the improvements I added to the bill is a provision that preserves benefits for an estimated 800,000 Medicare Advantage enrollees in Florida and another one that protects tax benefits for seniors who have high medical expenses.

As for a public-option, there were two similar proposals to establish a public insurance plan as part of the health care legislation. I voted for the plan offered by Senator Schumer because I believed it offered help for consumers through fair competition to private insurers and stood the best chance of final passage. Unfortunately, it was defeated by the committee 13-10. Right after the vote, Senator Schumer promised he'd keep fighting to get his proposal included in the broader health care bill - and, he'll have my backing.

Regardless of where anyone stands on the specifics, I think we all can agree that the system we have can be unfair and too costly, and needs reform. Again, I appreciate hearing from you on this important issue. Please don't hesitate to contact me in the future.

Sincerely,
Senator Bill Nelson

•    WSJ BEST OF THE WEB TODAY
•    OCTOBER 8, 2009
"Too Good to Check
Want to cut the deficit? Just spend $829 billion!
Through what voodoo exactly does the CBO surmise Congress will cut the deficit while spending close to a trillion dollars? CNN does not even attempt to detail the argument. Instead we have to turn to Megan McArdle of The Atlantic:
Virtually all of the extra benefit appears to come from estimating that employers will see their health care costs fall, mostly because they put those workers into federally subsidized programs, pass the resulting savings along to their workers in the form of higher wages and salaries, and that the Treasury will thereby gain, at a rough guess, about $12-15 billion a year in tax revenues.
This is somewhat confusing to me. The CBO seems to be assuming it will get just about 20% of the amount spent on subsidies back in the form of tax revenues. But the effective income tax rate on the quintiles covered by the subsidies, according to the CBO, is less than 5%. Perhaps the savings comes from the payroll tax, but even including the payroll tax, it's less than 15%. And the tax rates are directly proportional to the size of the income, while the subsidies are inversely proportional. I'm sure I'm missing something that would make the math work, but I can't figure out what.
Aw, c'mon, Megan, it's a joke! It isn't funny if you have to explain it!

On Monday afternoon, CNN featured, live and in studio,a performance by students... which include such memorable lines as these:
My tummy's turning and I'm feeling kinda worried
Capricious coverage is killing me.
That's when a doctor said, "You'll have to go."
Bipartisan support was tried so we wouldn't be denied
But Joe Wilson yelled, "You lie!"
So we throw our hands up for health-care reform
Make your choice today.
Private and public care
Will a marketplace treat us fair?
Sheppard's reaction: "Be afraid, America. . . . CNN knowingly used children to advance legislation that most polls indicate the majority of Americans are against. Shocking and disturbing to say the least."

Great Moments in Socialized Medicine
Then there is this report from the Sun:
This crippled plumber horribly broke his arm TEN months ago and is still waiting for surgery to repair it.
Torron Eeles busted his left humerus bone leaving it grotesquely out of shape when he fell down stairs.
Today he slammed the NHS for "unacceptable" delays--claiming they have cancelled FOUR separate operations.
His arm hangs limply by his side meaning Torron cannot work for a living and now faces the prospect of losing his home.

Finally
Blitzer: Here's another leader, the leader of the free world, there he is, the president, of the United States.
Black: I've always said--this is a man who is full of hope and he really is. I mean, and that's what was so attractive. I've been around and done a lot of touring of Europe, performing over the summer. The kids in this country, the Europeans, they all gravitate towards him and it's because he is full of hope. He actually, Wolf, his nipples are bursting with hope. He's the first man and the first president in my life who is lactating hope. He continues to lactate hope."
See:
online.wsj.com

Why just do not give a tax break for employers that offer health insurance. For the unemployed raise the limit that can be accepted on Medicaid.
Make the insurance compete nationaly, that they can operate in every state, so if I find a cheaper or more competitive insurance in another state, I could have it.
Don't forget Tort reform

Employer created HSA's would do it. The cash in your HSA would cover routine Medical visits and a cheap catastrophic insurance policy would cover the major problems. It would be tax deductible also, if BO didn't tax it along with everything else under the sun!