Wednesday, September 25, 2013

Obama Care The Good The Bad and The Ugly

In the early 1970’s I worked as Administrative Assistant for the Director of Nursing for a non-profit Catholic owned hospital.  At that time everyone had access to healthcare, there were free clinics in every community that were staffed pro bono by physicians and nurses and health insurance was provided by employers with no premiums.  Non-profit hospitals wrote off a lot of the care they provided for the indigent. 

With the dawn of HMO’s a new for-profit healthcare delivery system was born.  Throughout the United States there were State and County run hospitals that provided not-for-profit care for their citizens.

Where I worked the hospital staff was very close knit and by and large had chosen the healthcare field because of their dedication and compassion.  In the early 1980’s nursing personnel who came to work in the facility where I worked related horror stories of the for-profit HMO hospitals practices. 

I was told by nurses that had relocated to Wisconsin from States where HMO’s had taken over, that HMO’s were notorious for refusing care to uninsured patients.  Once the HMO determined there was no insurance coverage, the patients were loaded up on the ambulance and re-routed to the nearest county or state owned hospitals.  Many of the patients died on the way.  Soon these stories became common place and were reiterated on 60 Minutes.

According to an article in the Santa Clara University publication entitled, A Healthy Bottom Line: Profits or People? By Claire Andre and Manuel Velasquez from 1988:

In Alameda County, a private hospital turned away a woman in labor because the hospital's computer showed that she didn't have insurance. Hours later, her baby was born dead in a county hospital.

In San Bernardino, a hospital surgeon sent a patient who had been stabbed in the heart to a county medical center after examining him and declaring his condition stable. The patient arrived at the county medical center moribund, suffered a cardiac arrest, and died.

These two hospitals shifted these patients to county facilities not for medical reasons, but for economic ones -- the receiving hospitals feared they wouldn't be paid for treating the patient. These patients simply weren't "good business."

It took the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 to require hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay to rein in HMO’s.

Under Ronald Reagan, the American Medical Association, a for profit Association that has fought against universal healthcare since its inception was given a free ticket to set up reimbursement codes for care provided to Medicare patients. 

The AMA produced a billing system for reimbursement of Medicare costs called Diagnosis Related Groupings (DRG’s).  With DRG’s all patient care was broken down into each part of care that was provided.  For instance, instead of a patient being charged for an appendectomy, the patient was charged for a surgeon, an anesthetist, for each stitch, for each operating room technician, surgery suite etc.  There was a set reimbursement rate.  If the patient acquired a hospital borne infection they had to be rediagnosed and each part of the care was re-coded and Medicare was billed accordingly.

The AMA proclaimed they had proprietary rights to the Medicare reimbursement codes and every time their codes were used they received a kickback for the use of their billing codes.  To receive reimbursement for care provided it was required by law to use the AMA codes, thus a costly Medical payment monopoly was constructed. 

For instance:

   *Doctor for appendectomy $5,000 x 20% for AMA code = $1,000 total cost $6,000
   Surgical Suite cost $500 x 20% for AMA billing code = $100 total cost $600

*These figures are hypothetical but you get the picture, the AMA received a percentage of the medical expenses just for inventing the reimbursement codes.

And on it went.  That was why Medicare is going broke.  Laughably the AMA kickback billing scam is called “Fee For Service”.  It is really a mafia type scam that was codified into law under Reagan and exists today.

So when Obamacare was cooked up by the insurance companies it was heavily weighted to ensure not only insurance company profits for those at the top, it also preserved the AMA kickback billing scam. 

While, there are some enhancements to patient care under Obamacare, like preexisting conditions and keeping children on your policy till they are 26, the parasitic parts of the for profit healthcare are codified into law.  While it is marginally better than the system we have now, the Obamacare system requires citizens to purchase insurance from insurance companies through a tiered program that appears to have different types of care depending on what you can afford. 

There is bronze, silver, gold and platinum coverage for sale.  If you cannot afford to buy insurance from the insurance companies participating in the Obamacare scam, depending on where you live and your circumstances, money from the U.S. Treasury will be routed directly to the insurance providers to pay for your care.  It appears the more expensive plans have lower deductibles and co-pays.  If you are in a State like Wisconsin where the Republican Governor refuses to expand Medicaid, you may not qualify for any coverage at all.

When politicians say nothing has been done to drive down the cost of insurance in the U.S. they are correct, the AMA and insurance industry and Wall Street are the biggest winners of the insurance scam and the American people are the biggest losers.

No industrialized country in the world has a for profit insurance system that ensures profits, they have no insurance companies involved at all. 

But on the bright side, Obamacare seems unworkable as is and if changes are made, maybe it will become a system closer to universal healthcare.  Home Depot, Cleveland Clinic and others are dumping their coverage for families of their employees, and maybe that will force politicians to act in the interest of their nation and people and not Wall Street health related profits. 

This may turn out OK in the end; we have to see what’s in it first.  Republicans say it must be stopped because if people start getting subsidies and care they won’t want to give it up.  That alone gives hope.

By Patricia Baeten 

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