Worth Reading - Article by Dr. Jay Fleitman - on The Shift in Health Care Delivery -

Usually one finds this blog commenting on an particular article, however this one article by Dr. Jay Fleitman is not only of great import, but aslo informative. To that end, it is shared here in the interest of the public.

From the Hampshire Gazette: "Jay Fleitman: Liberty bows in health care shift
By JAY FLEITMAN"

Tuesday, February 7, 2012

NORTHAMPTON - As chairman of the board of a local health care corporation, I recently prepared for our annual meeting, which was attended by over 100 physicians and representatives of the hospital administration and board of trustees. I discussed new and coming health care vehicles we have with the major insurance companies of Massachusetts.

These will fundamentally change the way health care is delivered. They carry acronyms like AQC (alternative quality contract) and ACO (accountable care organizations). These are known as risk sharing arrangements, which means that the providers of your medical care, hospitals and physicians, are at risk for the cost of the health care services they deliver to their patients. The less they spend on delivering those services, the more they are awarded in bonuses.

Yes, there are incentives built in for delivering quality care, but the real driver in these plans, both through private insurers and government, is to reduce the money spent on medical care. Legislation coming on Beacon Hill will accelerate this process already in place through Medicare and large Massachusetts insurers.

The holy grail and ultimate endpoint of this process is population-based care. This model has associations of physicians and hospitals being paid a lump sum to manage care for an entire defined population of consumers.

This is the future envisioned for American health care. The health care dollar, it is argued, will be more efficiently managed by consortiums of experts whose job it is to define what choices are acceptable.

One thing is conspicuously missing from these discussions. This is America, land of the free, a nation predicated on the liberty of the individual. The discretion of the individual citizen and family to control their own destiny is never part of these deliberations. The American citizen will be progressively stripped by experts and payers of their freedom of choice in personal health care decisions.

Americans would never tolerate this interference in our choices of food. We chafe at the government forcing our choice of light bulbs. Yet, for health care we are giving away our freedom to entities with no knowledge of the intimate details of our lives.

The money being managed by these systems is the private citizen's money. Whether it is your taxpayer dollar being spent in a government program or the insurance premium being paid by your employer as part of your reimbursement package, it is the individual's money being given over by proxy.

The "individual mandate" requires the citizen to buy insurance or pay a tax surcharge. By having everyone in the pool, the premiums on average are cheaper for everyone. What's next? Tax anyone over the age 50 who doesn't have a colonoscopy because they may ultimately cost the system more money if they develop colon cancer? This is not so farfetched. We tax cigarettes with the rationale that smokers cost society more in health care costs. The Massachusetts governor recently applied the same notion to raising taxes on candy and soda.

The Republican presidential candidates speak of fundamentally restructuring the health care system, and they are right. The health care dollar must be in the hands of the American citizen, not distributed in larger and more remote schemes by insurers and bureaucrats who are distant from individual choice.

This is not hard to craft. Indiana offers state employees the option of having catastrophic insurance that protects them after $8,000 in medical costs, and a health care savings account that covers the first $5,000 of the up-front cost. The employees keep the unspent money at the end of the year. Eighty percent of employees chose that plan, and their freedom in administering their own health care costs them 35 percent less than usual insurance plans. If someone understands the benefits of a medical service and decides not to spend their money on it, that is their choice to make. They may have better use of that money - a child in college or a sick parent.

We can open up markets across state lines, giving consumers far more choice in products.

I manage my medical practice by these politics. I believe that it is my duty to the fellow citizens who seek my care to respect their autonomy. I inform them of their choices and options, so they are able to exert control over their lives.

I am tempted to say that if Americans continue to cede their freedoms, the nation deserves to lose them.

Unfortunately, we are the protector of these freedoms for generations to follow, and so we squander their heritage as well.

As a physician living in Massachusetts under mandated Universal Health Care, as well as the Federal version, one can get a better grasp on the problems faced by physicians in their health care delivery and the solutions they offer, based on expertise not owned by a bureaucrat. Many thanks to Dr. Fleitman for sharing this most important article.

Congress Takes Heat for HealthCare as Constituents Revolt - Obama Joker Posters - A Point of No Return - Enter the Season of Political Discontent

Obama As the Joker - Poster in L.A. image: Fox News

As members of Congress go back to their districts to try and sell Health Care Reform (Universal Health Care) to the general public, they are being met with resistance. From Philadelphia to Texas, town hall meetings and appearances by Representatives are turning into demonstrations against the Democrats and Obama administrations plans for health care, and the tax and spend policies of the 111th Congress. In Nashville Blue Dog Democrat Jim Cooper, is struggling with the phone calls and emails urging him to vote against Universal Health Care. Blue Dog Democrats (moderates recruited by Rham Emanuel in order to win Republican districts and gain the house majority), are finding that they are stuck between a rock and a hard place, either vote like a conservative (or make good on campaign promises) or look for another job in 2011.

The situation has grown to the point where CBS News (You Tube video below) felt the need to report on the situation. The gist of the news report is that “Conservative Groups” are “partly” responsible for the massive email and phone campaigns both Republican and Democrat members of Congress – calling them “anti-reform forces”. The CBS Report fails to report that the crowd responded loudly when Specter mentioned the need to quickly “pass” the bill (original You Tube video below for comparison) Additionally, CBS also reported that it was the intent of Congress and the President to get this bill passed before the August recess, in order to avoid the public outcry that would ensure.

First, there is a problem with that thesis as the groups, The 9-12 project and Freedom Works.org are bi-partisan, attracting Republican, Moderate Democrats, Libertarians and specifically Independent (or unenrolled) voters – the biggest issue driving the general public perceptions against Democrats are the economy (taxes and specifically increased taxes due to the massive spending bills put through by this President and Congress in concert) and Socialism (Universal Health Care, government controlled industries such as banking and the auto industry). Secondly, had that bill passed in haste (see Stimulus), the political ramifications would have been damning. At the very least, those who are taking the “heat” from constituents now have the option of either voting the way the people who hired them want them to vote and keeping their jobs, or voting with their Party – which will result in a loss in 2010.

Apparently, the distaste for the present direction (socialism) that our nation is taking has reached Hollywood. KTLA is reporting that posters of President Obama depicted as the “Joker”, with the word “socialism” included are popping up around Los Angeles. The Posters are also showing up in Atlanta which left-of-center bloggers attribute to conservative groups who are against Universal Health Care.

The problem with that theory is that Cartoonish posters have been assigned to other Presidents, when public perception was shifting. Specifically, President Bush as Joker, during his last term.

It appears that the proverbial “shoe” is now on the “other foot” so to speak. Normally reserved moderates and Republican’s have taken a page from the liberal playbook – the louder you shout, the better the chance you’ll get what you want. A playbook written for Conservatives by Democrat’s on the blog Hill Buzz entitled “Why Persistence Matters When Facing Down Corporate America….” is a virtual outline of tactics employed by liberals - given to those who are otherwise – too Republican or Conservative to speak up and fight for their beliefs or a specific cause. No matter how normally reserved, regardless of party affiliation, a growing number of Americans are standing up for limited government and reminding their representatives in Congress and the Senate, as well as the man sitting in the Oval Office, that they work for the people. Regardless of the outcome, should the bill pass or no, the rift between the public’s perceptions of the Party in Power has dramatically shifted, and given history, change will come to Washington in 2010 and 2012. It was the Independent Vote that put the current administration and Congress in office, and they have clearly lost that segment of the voting public.

Original Video Specter and Sebilius Shoulted down in Philadephoia - on You Tube (a fragment shown on CBS below)

CBS News Video on Protests Against Universal Health Care