Healthcare, from the Trenches

Tuesday, July 28, 2009

Healthcare, from the Trenches

(Being a guest entry by a long-time Family Nurse Practitioner in response to an earlier exchange of Comments.)

Dear Mr. Overton,

Thank you. We have returned from a little trip, and I again have access to "The Blog."


I believe most of us are under NO illusion that healthcare is a "free lunch." This is not a fact, as you assert in your post, but rather an oft-used comment that seems to be used to incite fear among the lay taxpayers to prevent them from supporting critical reform in a very broken system.

I often hear "free lunch" chanted in the same breath as how our personal healthcare will suffer; that we will pay more, and we will be rationed.

Hell, my private healthcare of recent gave me a rationing kick-in-the-pants when they refused to allow me a cardiac stress test. Nor does it cover a number of prescription medications. As a Nurse Practitioner, a PROVIDER, I can't tell you how many hours we spend trying to match our patient's needs to their fiefdom's formularies.

THEN you've got to call the patient back for additional visits to make sure the substitute works. Many times it doesn't. And we've "eaten" the cost of multiple unpaid visits and taken time from other patients for this silliness. How much does that cost? Where billing needs to occur, as in Medicare, we are taking unnecessary doctor visit dollars from folks with fixed incomes because their insurer wants to save a buck. This is not cost effective.

For at least a decade my privately-held health insurance premiums and co-pays have been rising, as my access to medications has been severely restricted. And I buy the best top-of-the-line policy my employers (who are in the health care trade) offer. The best! So we know about paying more already. It's started with the privates. I'd rather it went into a pocket that wasn't tailor-made for some "non-profit" schmoo spending it on a Bali Toga Birthday party for his wife; but put it back into the healthcare system.

I'd like to see the Feds buy our meds and plummet the price of drugs. No, I'd love to see that happen, as drug companies swallow each other whole.

Do you hear me? Our current system is DOA.

It is estimated that twenty percent (20%) of all requests for patient care needs are ROUTINELY refused by private insurers to maintain their bottom line. That is huge, Mr. Overton.


On the final part of your comment I agree with many of your assertions.

Yet, I don't think we'll be losing doctors as you say -- as the market tanks, smart kids previously majoring in business are going to gravitate toward the medical degree. But I do agree they shouldn't have to pay off school debts for decades. And I do agree that primary care should be reimbursed at a better rate to attract the best and brightest to the trenches I occupy as an FNP.

Further, the competent mid-level care provider Nurse Practitioner can certainly occupy a significant portion of that vacuum. Physician Assistants, too... at a significant cost savings and with greater efficiency.

I also agree in tiered systems -- pay more for the premium product. I also agree that if you smoke or use drugs, you pay more. If you let your kids get morbidly obese, you help pay their costs.

Remember, the Obama Team doesn't want to take away your private plan; it wants to fill the gaps and provide the competitive incentive to the greed that is swallowing or precluding Joe the Plumber from buying a reasonable plan.

In Conclusion:

Go 'Bama! We need this so badly it could kill the economy of this country upon the backs and hearts of the Boomers.

Write your legislators and tell them that change needs to happen now.

Don't be afraid.

If something needs adjusting, fine.

We need to be better, more efficient, shift reimbursement cost effectively, assign risk, develop a national database (so you don't need that tetanus shot!) and change the greed to need in prescription assignment.

Thanks for your consideration, Mr. Overton.


1. Guy said...

Thanks for that. I think you said it well and it needed to be said!

2. Ray Overton said...

After reading through a signficant portion of one of the House bills on health care as well as the President's promises on new legislation regulating private insurance companies, I can only hope he applies the same rules and regulations to Medicare and Medicaid. The Government has often imposed rules on others that they conveniently exclude themselves from compliance.

It is quite obvious that with a bill this critical and comprehensive we have no chance of predicting the final product.

I am wondering and hoping we'll find out having a national health care plan will automatically absorb the separate Medicare and Medicaid programs, that they become part of the overall public health option. I think that makes sense. Less bloody paper and red tape!
– Jeanne

3. Ray Overton said...

Based upon comments from Congressman Barney Frank and House Speaker Nancy Pelosi, it is clear that the goal of the current Congress is to push the health insurance companies out of business and create a single payer system. They admit they can't get this passed in one shot, so their intent is to enact legislation so restrictive as to drive insurance companies out of the health care market.

The reality is they have the numbers in Congress to do this. The other reality is, if they are successful, the thousands of people working for those companies will become unemployed. The answer will be having these folks come to work for the federal government and become members of the American Federation of Government Employees entitled to the benefits/retirement packages afforded federal employees.

Like schools, towns, counties, states and, yes, the auto industry, these legacy costs will dramatically increase the cost of the program tremendously as time goes on. Since these contracts will be non-negotiable, the cost will simply be passed along to the taxpayers and the very administrative costs that everyone feels will be reduced will be expanded.

Of course, this will take about 10-15 years to start coming to fruition. By then, many of the folks crafting the legislation will be gone (hell, I might be too) and it will be up to someone else to fix the mess.

This is just my prediction and it really doesn't count for much. Our leaders obviously know what's best for me, so I am dropping my fight against this legislation. Bring on socialized medicine.

If it is any consolation, I have never seen Obama in the back pocket of any union. I've always liked that about him. He's also no dope. He has handily assembled teams of specialists who are creative, innovative and fiscally sober.

I am certain the hiring of those thousands of displaced insurance employees will occur, and that the aquisition of what you term "legacy costs" will not be an option. We can't afford it.

Something more reasonable will be forged, and likely we'll grandfather out the expensive old contracts within ten or so years.

As a result:
  1. The bottom line profit margins will diminish; as we needn't pay for marked up services or executive perks. Drug costs will be slashed.
  2. A database will help providers treat patients without costly or harmful duplication of services.
  3. Drinking the well dry" by less honorable providers will be much harder to hide.
There likely will be caps on spending and visits just as there are now, and co-pays, and folks will need to pay for their insurance (as they do now but don't realize it), and levels of insurance will be available -- just, for example, as there are levels of investment options on your retirement today.

Yes, it will take years to get this up and running. Our capitalistic experiment has resulted in at times an avaricious transmogrification that I doubt our forefathers ever imagined possible. Capitalism clearly today requires reform, not replacement.

Let's watch and read the news and contact our legislators with our concerns. I wholeheartedly support the full public health insurance option. To my thinking it drops costs drastically in short order (short being ten years to me.)
I think we've covered all we can here. Thanks for your efforts and interest.
– Jeanne

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