Repealing ObamaCare for Responsible Health Care
As a health care provider, I have been very interested in following the etiology, pathology and possible demise of healt
h care in the United States. As a participating provider in my own private practice, in just about every health insurance plan, I’m familiar with coverage, deductibles, co-pays, electronic and paper claims, and “maximum allowed amounts” for reimbursement.
All providers have “usual and customary fees”, which means that for every procedure, there is a particular code assigned to that procedure, and a corresponding fee. In theory, a provider could set a fee at whatever he or she wants. So if a person went to a provider for treatment, that provider could charge that patient whatever he or she decided that set fee was. Now if everyone paid out of their own pocket, with no insurance, a free marketplace would dictate the fees. Providers who had set fees which were too high would have fewer patients because people would shop around and find that they could get the same service/procedure from an another equally competent provider for less money. As long as the service was comparable, people would rather have the money in their own pocket than the provider’s.
When a clinician is a “participating provider” in any given health care plan, he or she usually signs a contract which states that for the privilege of being accepted into that health care plan, the provider agrees to accept less reimbursement than what he or she has established as the “usual and customary fee”. Now back in the 1990′s, it was more difficult to be accepted into a plan, so the idea was that a provider would receive more referrals from the plan, which would make up the difference for the reduced reimbursement. Depending on the plan, reimbursement rates would vary between 41% (Medicare) and 70% (commercial payers), with Medicaid averaging about 54% of the “usual and customary fee”.
About four years ago, Congress decided to decrease Medicare reimbursements for all providers, hospitals and many nursing homes. We all took a 9% cut in reimbursements; several other cuts were supposed to have been enacted, which would have amounted to over a 20% decrease. This last cut was scheduled to begin in January but a temporary hold was voted on that reduction until later this year.
- Does any of this lead to improved health care services for Americans?
- Does any of this create financial hardships for providers and hospitals?
- Does any of this motivate our best students to pursue a career in health care?
- Has Congress voted to reduce their salaries or do they continue to receive cost of living increases each year in their salaries and benefits?
How do we fix our health care system in the US? I totally agree that it needs a major overhaul and would like to see responsible changes. The problem is we just can’t afford to give away health care to everyone without breaking the bank. Providers and hospitals can’t afford further reductions in reimbursements. Some medical specializations require huge overhead like diagnostic imaging and instruments, large staff and staggering malpractice premiums. Who pays for this with draconian cuts in reimbursements?
It’s human nature, that when a person gets something for nothing, it is not valued as highly or appreciated in the same way as when that person earned it through his or her own efforts. I believe that if we are to increase health insurance benefits for Americans, then Americans need to do their own share toward maximizing their own health. Rather than treating symptoms, let’s focus on the causes of many illnesses and become proactive. Since we know that much of illness is due to maladaptive lifestyles, we need to start changing unhealthy choices: diet and exercise are two ways to make significant improvements in health, with minimal cost. In fact, by eliminating unhealthy food choices, we can save money because most junk foods are expensive. Quitting smoking can save a substantial amount of money each month.
Rather than the government legislating who gets what procedures/services, people who actually work toward improving their health can be rewarded with preventive care and tiered prescription formularies. Successful efforts at weight loss, healthy diets, reductions in blood pressure, and other biological markers could be easily monitored as participation in the plan. Likewise, the presence of illegal substances, continued ingestion of fast and processed foods would have an impact on eligibility for transplants and other costly procedures. Rather than restrict services based on age, restrictions could be a function of a person’s commitment toward health. Healthier people will require less care. Likewise, food stamps should not cover foods which are highly processed, prepared, fattening and full of artificial additives. (Read Dr. Russell Blaylock’s newletters about that.)
ObamaCare needs to be repealed. When Congress sits down to re-design health care, maybe they should include some of the top scientists and physicians who are at the cutting edge of preventive medicine instead of the pharmaceutical companies and lawyers. America should be a worldwide standard for a healthy population. We can be if Congress has the courage to institute the necessary changes so that each American appreciates his or her own role in good health.
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About Dr. Virginia
As a licensed Psychologist practicing Cognitive therapy, I work with my clients to help them identify the personal issues that are preventing them from achieving a more satisfying and well-adjusted life.
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