This is a cosmetic change to our web site but there is also a lot going on  behind the scene at No Insurance Surgery. The web site is being rewritten and the online medical consultation is being re-engineered. Our blog is the first part of our web site to sport the new look. Let us know what you think.

We do not yet know all of the unintended consequences of recent health care legistlation but this one was fairly perdictable.

Read more: http://www.mcclatchydc.com/2010/04/06/91696/health-care-overhaul-spawns-mass.html#ixzz0kRSfz3fL

For many of the conditions which we treat at No Insurance Surgery patients cannot and should not wait for four years for surgery. We are hopeful that things will get better for everybody soon but we remain concerned about the unintended consequences of change.

No one wants to admit that “bending the cost curve” will lead inevitably to rationing of health care. The proposed cost savings are speculative and without cost savings then utilization has to be reduced. Do we really want government making these decisions for every one?

There is very little to be gained by paying doctors and hospital less or by making them work more efficiently. Medicare has been trying to computerize doctor’s offices for the past twenty years touting increased efficiency and cost savings. Doctors have been resisting this because the doctors that are computerized are not persuading their colleagues. Many doctors have abandoned their computerized systems in favor of their old analog systems. Though a few doctors are perfectly happy to stare at their computer while they interview a patient rather than face their patient, this is the exception rather than the rule. Studies from large hospital associations have clearly shown cost increase rather than savings with the adoption of electronic medical records. What electronic medical records does do is to provide an opportunity for data mining by the government.

Medicare already pays hospitals less than the cost of taking care of medicare patients. Over the past twenty years hospitals have only been able to survive by shifting the cost to privately insured patients. As hospitals close and doctors retire in droves access to health care will become a huge problem or as some see it a benefit. Either way it is rationing.

It is true that America spends twice as much per patient per year on health care than other developed countries. This does not mean that health care here is more expensive. It just means that we utilize more and better and faster. Critics of this point of view point out that we have a higher infant mortality rate than western european countries. But this is in reality a social issue rather than an access to health care problem. Our country is very diverse and is not comparable to other countries. Critics will also say that insurance companies are already practicing rationing. This is true but patients still have the choice of changing their insurance company or their benefits plan. We will lose these choices and much more when government is in charge everything.

Government health care will lead to rationing and then to loss of individual choice. When you think about it Sarah Palin’s alarm over possible death panels does not seem so over the top.

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No one disputes that everyone needs access to health care. In fact we currently have a safety net but it does not work very well. Medicaid covers the poor who need medical care. But anyone with a job or savings or a home cannot receive any benefits until they spend every thing that they have. This is called a “Spend down” and it is a huge problem for the uninsured.

We believe the spend down should be eliminated or at least modified so that a patient does not have to be dragged into poverty before they can receive benefits. Make the spend down a 10% spend down or anything else rather than the 100% spend down into poverty that is currently required. This would make medicaid just unattractive enough that it would encourage patients with means to think about helping themselves rather than rely on government. This would prevent a lot of bankruptcies as well as save lives.

Another thing that Medicaid could do is to kick in with cost control before the spend down. This is how it would work: A patient with a serious condition would immediately get a medicaid card based on the diagnosis and no insurance. The patient would see a physician who takes Medicaid and present his card. The patient would see the physician and pay the doctor out of pocket but only at the rate that medicaid approves. This would prevent price gouging which is a big problem for the uninsured. For example, a patient goes to the emergency room with a painful lump in his groin. The ER doctor diagnosis a hernia, gives the patient pain medication and then sends the patient home with instructions to see a surgeon and get his hernia fixed. At this point the patient is looking a cost of surgery of about $16,000 which is the average charge for this surgery around the country. Give the patient a medicaid card. Now he will be able to find a physician who accepts Medicaid and will be able to get his hernia fixed for about $5,000. If he cannot afford that price even with financed monthly payments he probably already qualifies for Medicaid with no further spend down and will get his surgery without any cost to him.

The point of this is that we can cover the uninsured without overhauling and giving government complete control of our health care. We have heard one news commentator say that it would cost about $35 billion a year to cover everyone that is currently uninsured. This is much less than a trillion dollars and does not ruin what is good about what we now have and is the envy of the world.

This is an excellent piece that I read on Fox News this morning. These are common sense and incremental improvements to our current system which can help a lot of people and do not risk bring down the economy of our country:Fixing America: Health Reform

It may appear to some that health care reform has been knocked off track. We feel that it has been saved and knocked back on track. The bills that were looming in Congress were partisan, idiological, secretive, full of special interest deals and viewed negatively by a majority of Americans. I blogged earlier about health care reform fatigue. I am excited again about prospects as I think a lot of other physicians and patients are. Now that the politicians have had a reality check we can have an open, transparent and bipartisan debate.

Over the years we have been approached by increasing numbers of people and organization who want to donate to No Insurance Surgery, Inc. Although we are very grateful for the offers we have had to turn them down because we have no mechanism to accept, manage and distribute donations. Because of the level of interest that we have seen in this we are exploring setting up a 501 Charity to benefit uninsured patients in need of financial support. Thoughts, comments and suggestions would be much appreciated here.

A proposal currently on the table is to save 450 billion over the ten years by eliminating “medicare fraud and abuse”. The politicians make it sound like there are legions of criminals out there stealing from the medicare system. The truth is that medicare pays less than what it costs to take care of a patient and every single hospital and doctor is constantly trying to figure out how to get paid better. It has been a back and forth struggle for decades. Medicare cuts payment for a particular code. Doctors find a better code. But the politicians then will say that there are doctors who are billing for deceased patients. It does happen but it is rare and it is now worth punishing every doctor for.

If the government cuts 450 billion from medicare over the next ten years the burden will be placed mostly on good and decent doctors and hospitals who are taking care of medicare patients.

I don’t know about anyone else but I am getting really tired of hearing about health care reform. The whole process has been quite ugly and a bit shameful to say the least. Broken promises, secrecy, shady deal making, misinformation to outright lies and politicians telling the American people that the people do not know what is good for themselves has been the politics of the day.

It seems that the politicians have bitten off more than they can chew and disaster may result. They could have achieved a lot of good if they had done just two things: First eliminate the exclusion from the anti-trust laws that insurance companies inexplicably have and second eliminate exclusion for preexisting conditions.

I succeeded in installing WordPress on a Windows Server in less than 30 minutes this evening. I must say that I am very impressed with how smooth the install was and how well the blog functions. It will take some time to move the old blog over to the new blog. In the mean time the old blog can still be reached at Old blog

Also you may return to No Insurance Surgery