Wednesday, April 15, 2009

Government reform - Hey, Big Spender

Hey, Big Spender,

The minute you walked in the joint,

I could see you were a man of distinction,

A real big spender,

Good looking, so refined.

Say wouldn't you like to know

What's going on in my mind?

So, let me get right to the point.

Lyrics, Hey, Big Spender

April 15, 2009 - I know not if President Barack Obama’s big spending proposals to save the economy, invest heavily in green energy, reform health care, and make the U.S. globally competitive are the right thing to do.

Neither, I am persuaded, does anybody else. Nevertheless, the popular sentiment is: we’ve got to do something.

Finally,I know this. This is tax day, and tea parties are being held around the country by hundreds of thousands of Americans in 300 cities, at 750 events, in all 50 states, to protest high taxes and big government spending.

This is apparently a spontaneous uprising. No political parties are involved, and there is no grand GOP conspiracy to discredit the Obama’s spending proposals.

I know this. Tea party backers are taking a page out of the social networking successes if and playbooks to organize “smart mobs” and “flash crowds” at a moment’s notice to send a message, In the tea party case, – that message is: big government spending has a downside – federal deficits as far the eye can see and the mind can stretch. There’s a tangible fear out there that the U.S. is spending our way into national bankruptcy.

And I know this. Doctors fear big spending will make them prisoners of the federal government, unable to offer choices outside of government programs. For years, the Association of American Physicians and Surgeons (AAPS), a small conservative group in Tucson, has been backing the idea of private contracting between doctors and patients outside of Medicare. Ihis concept may resurface soon in other quarters of organized medicine.

And I know this. Obama’s proposals have aroused fears among the medical establishment that a government take-over is at hand. This is more than fear-mongering about “socialized medicine.” It is fear doctors will not be able to treat patients as they see fit outside the constraints of government and patients will be limited in choices of care.

And I know this. An Internet conservative counterrevolution is afoot.
President Obama owes his election partly to a magnificently organized and beautifully orchestrated election campaign rooted in the Internet. He is now using the e-mail collected in his campaign and Obama websites to inform his e-constituency of what he is doing to mobilize support in his perpetual campaign.

The Internet is a nonpartisan two-edged electronic sword. The tea-parties are one manifestation, and efforts of Conservatives for Patients Rights, aptly abbreviated as CPR, are another. Backed by $15 million for Rick Scott, former CEO of HCA, inc, the big Nashville-based hospital company, CPR has launched a series of Internet and television commercials to bebut President Obama's health care proposals.

And I know this.,, and Obama websites will preach the gospel of moral obligation ( see “Health Care for All: A Moral Obligation,” Letters to the Editor, New York Times, April 15, 2009, with tag lines blasting the villainy of private profiteering, such as “Let’s put insurance companies out of business as soon as we possibly can.”

Meanwhile on the other side of the aisle, we shall hear the messages of individual enterprise vis-à-vis collectivism, “The Fewer the Choices, the Longer the Lines, Choice, Competition, Accountability, Personal Responsibility.”

Finally, I know this. The answers lie somewhere in-between, and the Internet Health Care Tug of War is underway to define just where the bipartisan line resides.

For the conservatives it will be an uphill battle. The big spender, whose budget for 2009 multiplies the budget deficit 2 1/2 times to 28.5% of GDP, is good-looking with a radiant charm, is a speaker of distinction, and has a 60% presidential approval rating.


TheCampbells said...

I have been on the billing side of healthcare since 1982, I'm that lady with the glasses on her nose that used to hand type your HCFA 1500's and stuff them into envelopes and mail them to the payers. I opened your mail and posted the payments from the ins. companies and send statements to the patients. I answered their angry calls when they swore they never received the first 3 statement but were insulted to have received a `dunning` collection letter - smiles. What I know is back then, patients who had surgery scheduled for Weds were admitted on Sunday - and insurance paid. They may not have been discharged after that minor surgery until the following Sunday - and insurance paid it. Straight 80/20 back then. The provider side got greedy and took advantage of the system. I was there when capitated plans came about, and usual and customary, and Graham Rudman and all the other write off processes that have us were we are today. We have a family practice provider that will no longer perform colonoscopys because his Medicare pymt of $54.85 doesnt cover his cost to clean the tools, rent the suite and be out of the office not seeing 3-4 regular patients. Medicaid pays our OB-Gyn $532 for a normal delivery, heaven help her if the woman did come to her at 4 weeks for the full 10 months, and then stays in active labor for a few hours your down to about $20 and hour for care, that doesnt pay the liability insurance. Providers got greedy but they were individuals, and now there up against a machine - PAYERS. How to bring back balance? Well I can tell you when I encontered slow payers, I would print the claims sorted by Employer and mail them to the HR dept and ask them to contact the payer - since they pay the premiums, thats who they listen to. If the consumer doesnt get educated nothing will change and unfortunately the payer and the government is doing a better job of advertising their so called solutions then the providers. Providers are afraid to advertise, to talk about the issues, remember when attornies felt the same way? DO IT - get out ther fellas and fight your own battle - after all we already trust you - we trust you with our VERY LIVES!!

Richard L. Reece, MD said...

I agree doctors have less clout than payers and the government, and some fees are ridiculously low. I also agree doctors have most, for the part, any means or backbone to stand up against "the machine." You are right, too, when you say patients have to be educated. Blance may be restored when the doctor shortage becomes painfully obvious.