Fourth of July Appeal

Two hundred and thirty-two years ago, we overthrew an oppressive government. Today we again suffer government oppression. Fortunately, we need to act against only one part: the regulatory arm. We in healthcare ask this of you the Public for both your sake and ours.

We are drowning in rules and regulations; unfunded mandates and contradictory requirements. How can we take care of you when you - via your government - make it impossible?

The USA spent over $1.5 trillion dollars last year on healthcare. Thirty percent - more than $500 billion - did not go to us (in healthcare) in any form. It was consumed by activities that add no value: bureaucracy, inefficiency, regulatory compliance, and defensive medicine. Imagine what useful things we could do with all that money.

The huge waste is only the beginning. Ask yourself: why do we have rules and regulations in healthcare (or in anything)? Answer: to protect us from harm and to insure quality. Do the current rules and regs do that? Consider some examples.

Start with something that should be simple: getting a medical license. I have had licenses in five States. Each and every time, the process required going back to college for verification, checking every hospital in which I ever consulted, and filling out innumerable forms. The cost in time and money, multiplied by every doctor or nurse, is in hundreds of millions a year and for what? Is diabetes or asthma different in Massachusetts than California?

HIPAA is the latest regulatory fiasco, the proverbial 800-pound gorilla or hippoas I called it . Intended first to protect our medical insurance (it doesn't), it morphed into an effective obstacle to information sharing all in the name of confidentiality. It costs a fortune; creates a huge, expensive bureaucracy; generates hassle and frustration; impedes communication; increases errors; encourages lawsuits; with absolutely no evidence of a problem in the first place and no proof that it works now.

We are supposed to provide good care despite government-created conundrums. What should we do when HIPAA says we must not read medical information before FAXing it while the Patriot Act requires that we read it? Why am I prohibited from emailing my consultation letters while the referring doctor complains that she does not get timely feedback?

It is the accepted standard that your doctor or nurse makes evidence-based decisions and bears the consequences of bad outcomes. Managers and regulators affect patients at least as much as doctors and nurses. They are not required to have evidence before deciding, nor feedback (with teeth) after they make decisions? Why are they held to a lower standard?

You know we have worsening shortages of both nurses and doctors. Who in their right mind would work in a field where the whole system is designed to make your professional life impossible?

I could go on and on. Look up Government Accounting Office Report (GAO-04-637). It shows that even when the Federal Government passes reasonable legislation - UMRA, the Unfunded Mandates Reform Act - Congress does not follow the rules that it created. Look at the rules governing medical malpractice and ask if this system helps or even protects you.

On the Fourth of July, we health care workers request relief from the oppressive burden of government over-regulation. Without such relief, we cannot provide you with the care you need.

Comments

[Deane Waldman - Huffpost Blogger]

It would be wise to drop the delusions of conspiracy. The truth is much worse. In a completely unintentional, disorganized "approach," we have achieved a system that works perfectly AGAINST US.
1) Government over-regulation IS a large component of the dysfunction. In fact, it precludes any universal health care plan.
2) Private, for-profit insurance companies are part of the problem. Before you pillory them, remember that you will be vilifying the over 40 million Americans [you may be one and not even know it] who own stock and want them to make money. Under the current system, these companies generate profits by with-holding care. Answer may bot be to blame the companies (for doing what at least 40 million of us want) but to change the rules so it is profitable for them to keep us healthy.
3) Both Mrs Clinton and Mr. Obama are effectively suggesting universal health INSURANCE, not universal health CARE. These are two very different things. I suspect you, me and most of us want the latter.
PS. The medical establishment is the most dis-organized "establishment" you can imagine. It is a bunch of silos that do not talk, much less act in a coordinated fashion. On one thing I can give you complete assurance. There is no conspiracy because the silos in the medical establishment cannot get together. We make Arab tribes look like a fully integrated, smoothly operating machine system.

[Deane Waldman - Huffpost Blogger]

It would be wise to drop the delusions of conspiracy. The truth is much worse. In a completely unintentional, disorganized "approach," we have achieved a system that works perfectly AGAINST US.
1) Government over-regulation IS a large component of the dysfunction. In fact, it precludes any universal health care plan.
2) Private, for-profit insurance companies are part of the problem. Before you pillory them, remember that you will be vilifying the over 40 million Americans [you may be one and not even know it] who own stock and want them to make money. Under the current system, these companies generate profits by with-holding care. Answer may bot be to blame the companies (for doing what at least 40 million of us want) but to change the rules so it is profitable for them to keep us healthy.
3) Both Mrs Clinton and Mr. Obama are effectively suggesting universal health INSURANCE, not universal health CARE. These are two very different things. I suspect you, me and most of us want the latter.
PS. The medical establishment is the most dis-organized "establishment" you can imagine. It is a bunch of silos that do not talk, much less act in a coordinated fashion. On one thing I can give you complete assurance. There is no conspiracy because the silos in the medical establishment cannot get together. We make Arab tribes look like a fully integrated, smoothly operating machine system.

[texanna]

Our health care system isn't providing health or care at this point -- even to those that have insurance. The health and well being of the people is not a place for the market system. The market system requires that the businesses that compete within it operate with a single goal -- to increase profits. That goal is by definition diametrically opposed to a health care system. It is high time that this country began to take care of its citizens as does every other major country in this world and that we stopped the insanity of for profit health care as we know it today. The payback to society in a healthier citizenry is going to more than make up for the profits lost to the health insurance corporations.

[Deane Waldman - Huffpost Blogger]

Thank you for your thoughtful comment.
I agree that the way the market works now in healthcare achieves the opposite of what we want. As constructed, the profit motive encourages with-holding care! Of course the thing should be changed but to what?
Eliminating the profit motive entirely prevents the market from apportioning care. Then how do you economize? People seem to want the government simply to rachet down payments to hospitals, providers and drug companies. What will you do when the hospitals close their doors; there are no doctors or nurses; and no drugs? If you say it won't happen, experience elsewhere says otherwise.
Alternative: Change the system so that it is profitable to keep us healthy rather than pay solely for sickness care.
Either way, no "ptofit motive" or a modified one, we need radical change. The only way to get it is first to agree on what we want. That requires national dialogue, not just you and me and a few bloggers Commenting.

[HeevenSteven]

I appreciate that HIPPA is a boondoggle; but as to its ends; is there a better means? And if so, should we have that ready to go before we scrap it?

[Deane Waldman - Huffpost Blogger]

You are of course right...depending on the problem. Does a problem " of breaching medical confidentiality " even exist? What is the EVIDENCE of extent, manifestations and cause? What are options to fix it (the cause)? Which option works best, that is, what does preliminary, field-testing show? What does cost/benefit analysis show?
These are the normal questions you would ask before introducing a new product or service. NONE of such questions was answered " there was no evidence " before HIPAA was passed and implemented!
So, certainly let's scrap it now. It costs a bundle and is harmful. Meanwhile, let's study the questions above and answer them. As individuals, we all have to do our homework if we want to succeed. Why doesn't our government do its homework? Each of us pays for the consequences of our decisions, good or bad, successful or failures. Why don't our legislators and regulators?

[Wooty]

Do you hear that? It's the world's smallest violin playing for you. The biggest obstacle to quality health care in the U.S. isn't government regulation, but private, for-profit insurance company bureaucracy and the medical establishment's continued resistance to what this country desperately needs and what every other civilized society has: national health care.