The Medical Freedom Channel

The temporary day-job continues to enlighten your editor. This week, a new insight: When in doubt, blame the IRS!

Let me explain: The other day, while engaged in my current duties of opening envelopes, pulling staples and prepping paperwork for scanning and further processing, I came across something that almost made me laugh out loud. In one batch of mail (whose source, identity and type shall remain undisclosed) I found about 50 envelopes, all from the same return-address, with ONE two-page enclosure in each — all involving the same subject, though concerning different cases — and each one bearing a first-class stamp.

Alongside these were perhaps another 30 or 40 envelopes, all from that very same source, containing TWO such submissions, and each also with a stamp attached. Only now, in addition to the extra two sheets of paper (still easily weighing in under the single-stamp barrier), there was stapled to the first page of each submission a small slip of paper containing the following message:

We have enclosed two [forms] since we didn’t receive envelopes for every [form].

These were done on lavender paper, carefully cut into strips (with wide top/bottom margins, as shown by the occasional thicker strip, with space above or below the message). This was obviously the result of a brainstorm (or other suffix?) on the part of some clerical worker at that facility, perhaps even with the okay of the proprietor. Apparently, the thought of stacking all those requests for further consideration (identical in each case, except for the specifics of particular cases), then placing them all into ONE ENVELOPE (with appropriate and much-cheaper postage for the package … never occurred to these rocket-surgeons.
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This editorial has taken a while to write — not because the motivation wasn’t there (though that was certainly a minor factor), but because your esteemed editor was a bit concerned about the “security” issues involved.

You see, for the past two weeks (and expected to be well into the immediate future) yr. obt. sert. has been engaged in a full-time job, back in the conventional workplace for the first time in nearly a decade. Since his skill-set, though highly esteemed in some circles, is a bit harder to demonstrate out there in corporate meatspace, he’s taken on a data-entry/clerical position in order to get some bills paid.

However, even in only two weeks of observing and training, he’s repeatedly noticed a number of common errors committed, by those submitting official forms for processing. (Note: Further details of the place of employment are neither relevant nor properly disclosable; suffice to say it involves government paperwork servicing the healthcare industry.)

As a result of this newfound knowledge, he considers it only fair to pass along some tips on how to streamline the process of getting the desired effect from such transactions (assuming that desired end to be the efficient handling of the question, reimbursement or contract fulfillment involved). If your livelihood involves (even in a small part) communicating with a bureaucratic entity, be it governmental or corporate in nature, there are undoubtedly forms to fill out and mail, fax or otherwise transmit to some agency or office – one which probably has hired a staff of clerical workers and supervisors with the sole mandate of opening, sorting and directing each missive to its proper destination.

Assuming your intention is to get prompt responses, your best bet is to follow the often-convoluted set of instructions for filling out such forms … to the letter. Most folks do this fairly well, but they also often seem to forget how such a mass of paperwork is handled, even before it reaches the actual processing stage. The people who first handle your transmissions have specific rules to follow in opening and routing for processing, each day, several thousand individual envelopes. As a guide to getting your request processed more effectively, herewith, one of those “top ten” lists so popular on the late-night talkshows:

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With all the claims from nationalized healthcare advocates, about the huge number of “uninsured Americans,” and how their socialistic panacea is going to cure all of this, it’s easy to overlook the fact that even the vast majority of those of us who DO have health insurance policies are often also playing Russian roulette about our wellness, anyway.

Fortunately, there’s at least one “progressive” writer who addresses this issue head on, rather than hiding behind the “statistics” about the alleged nearly 50 million Americans who “lack” health insurance. In a Boston Globe column this past week, Boston University professor Laurence J. Kotlikoff advances a rather interesting plan for healthcare reform.

Titled “We are all uninsured now”,” the piece presents a rather intriguing perspective on how poorly even the folks who HAVE health insurance are faring under the current system. And it is here that he makes his strongest case, just as Michael Moore did in SiCKO on the same issue (despite that film’s many problems and inaccuracies on other aspects of the question).
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The battle should be over by now, but it’s not. Congress has still not passed the bill that revises and reconstitutes the State Children’s Health Insurance Program (SCHIP), since it recessed for summer vacation – umm, excuse us, constituent services travel – before reconciling the House and Senate versions of the legislation. However, as a final step in at least attempting to insulate this impending legislation from simply becoming another clandestine step to nationalized health insurance, the Bush administration has added what Reuters called “new standards” to limit the applicability of that healthcare subsidy to truly low-income recipients.

If a state wants to offer subsidies to families with incomes above 250 percent of the poverty-level, they must first prove that they have already extended the offer to at least 95 percent of those families earning below the 200 percent amount, providing for those children through either Medicare or the child health program. (There are other conditions, but this is the one raising the most unwarranted controversy.) Since none of the 50 states have thus far come anywhere near that level of coverage for the truly indigent, the expectation is that efforts to raise the bar will now be considered to be in violation of both spirit and letter of the SCHIP authorization.

Why this is exactly wrong somehow … well, that remains to be seen. If the intended beneficiaries of a “hand-up” program (aiding the children of poor families) are not being served adequately, it’s hard to argue that funds aimed at that target population should somehow be diverted to helping those who are somewhat less hamstrung by their economic status. The charge that advocates of such a “middle-class handout” are merely using the SCHIP reauthorization to promote their intended socialization of healthcare seems pretty valid. But immediately following the news of the Bush regime’s rule-change, the barrage began.
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The lead news story kicking off this week’s editions of Medical Freedom Channel is an Associated Press news-analysis entitled, “Pain medicine use has nearly doubled.” As noted in the editor’s note on the blurb, the most significant fact in this account is that this account is based, not on studies and surveys performed by physicians and other health professionals, but on “statistics from the Drug Enforcement Administration.”

In other words, the focus is on “drug abuse” by those who misuse painkillers (presumably illegally), rather than on the prescribed recommendations of pain management physicians and others caring for those afflicted with chronic ailments, involving constant or acute physical agony, for whom such substances as are in existence should (in a humane society) be readily available to ease their distress, by any means.

Well, that’s the conclusion we should be drawing, were we living in any kind of sane culture!
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We already have socialized health care in the US – it’s just disguised under a needlessly complex system of regulation, in a combination of mercantilism (which is another form of socialism) and taxation. We’ve also had that socialized medicine system since the mid-sixties – oddly enough, from about the very time costs started soaring through the roof.

Meanwhile, consider this: The people who invariably give out grades for the best healthcare are mostly diehard proponents of socializing medicine (along with everything else, for that matter).

And a third point for your consideration: socialized systems are parasitic on private systems, and cannot exist for long without their host/victim. Without a private system in existence, there’s no way for the socialized system to have any idea how to set prices or what services to provide. Instead some moron somewhere sets a quota, with no conception of what this should properly be, even were there justification for doing so.

I note that all the proposed schemes for nationalizing healthcare intend to leave a remnant of the private system in place, so they’ll have some clue as to what to do and what to charge.
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The battle over the “chip” continues – not the V-chip of parental TV control, or the imbedded hardware of national ID threat … but the S-CHIP of children’s healthcare. In each case the main excuse is that it’s “for the children,” but there the similarities disappear.

SCHIP (the State Children’s Health Insurance Program) has been operating for many years now, with the stated intention of providing a “safety net” to ensure that “children” will receive necessary health and wellness care, regardless of their parents’ impoverished financial condition. This was clearly a laudable goal, and for the most part it was the primary justification for maintaining such a program.

Given the fact that children are not born into the families of their own choosing (except under certain spiritual tenets), and are not granted any sort of autonomy and choice by our society (such as declaring their own emancipation), it only seems right that at least some guarantees might be in order, so that the particular circumstances of their upbringing do not hamper their physical well-being and growth into functioning adults. (While libertarians will be quick to point to private and voluntary means for providing this support, it must be admitted that of all the things government does do, this might be among the least heinous uses of present-day taxpayer dollars.)
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The rather glowing review in this space, of Michael Moore’s latest film, SiCKO, has gotten far less response than we would have expected. Nevertheless, it seems time for some “leavening” of the bread. Herewith, a consideration of some of the criticisms of the work, from a couple of other sources. One is a respected free market thinktank, while the other might be charged with the label of “industry flack screed.”

The first voice is a familiar one, for regular MFC readers. From the blog of John Goodman, the self-proclaimed “father of health savings accounts” and President of the National Center for Policy Analysis, comes a June 29th entry, archly entitled “Michael and Me.” Goodman begins by charging that “Michael Moore didn’t want me to see SiCKO … [and] If you know anything about health care systems, he didn’t want you to see it either. At least, not at first. In the beginning, the only people allowed to view the film were reviewers who knew nothing about the subject. The apparent theory was: get it reviewed by people unlikely to spot all the errors and omissions before you open it to more discerning viewers.”
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Well, I saw it … and all things considered, it wasn’t all that bad. In fact, I can honestly call this Michael Moore’s best-film-that-deserves-to-be-labeled-as-“documentary” …

SiCKO takes on the so-called “healthcare” industry and leaves no prisoners. That part is hardly surprising, since he is known for not pulling punches; what is unusual is, this time Moore chooses to present the story in something resembling a fact-based manner, letting his prankster self (and his physical self for the most part; he’s not at center stage much of the time) take a backseat to a basically honest appraisal of American health insurance game.

Gone are the blatantly distorted time-shifted portrayals (e.g., Charlton Heston, speaking well before the Columbine tragedy, yet presented as though he were wryly pontificating to an NRA assembly the week after the shootings). Instead, we see a fairly straightforward and linear presentation of some real horror-stories of both patients and health insurance workers, one after the other. This is then followed by segments on Canadian, British, French and finally Cuban options, analyzing how those nations care for their sick and lame.

Does he cherry-pick the people he selects to back up his thesis? Of course he does, but this is the nature of doing an honest documentary on any subject, when you have a perspective to present. (The great documentarian Frederick Wiseman did as much in his award-winning films of the 60s, 70s and 80s; at the same time he mainly let the facts make his point. Michael seems to be trying far harder to emulate Wiseman’s path here.)
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Sometimes, the topics for editorials come right to us, within the stories we post. This week, two surveys, and a report from Massachusetts, dovetail to present a clear warning-sign for healthcare reformers.

The bottom line is trifold: (a) patients are spending more time in emergency rooms, but enjoying it a lot less; (b) even many of those who already have insurance coverage would rather clog emergency rooms than deal with their assigned healthcare providers; and (c) those who are the most essential participants, if reform efforts are to succeed, are among the least likely to participate in the programs willingly.

First off, based on a survey done by the U.S. Centers for Disease Control and Prevention, the number of ER visits went up again last year; in fact, the results show almost a 20 percent increase (to 1.2 billion admissions) over a previous study five years ago. According to an MSNBC article, this can be attributed mostly to the graying of America, and the rising extent of Boomer-generation healthcare usage, or as they put it, “The reason is clear — Americans are getting older.” They quote a CDC official as giving this summary: “When you reach 50 things start going wrong, just little by little, and you keep going back to the doctors.”

Meanwhile, according to another survey, conducted by Press Ganey Associates, Inc. (defined as “the healthcare industry’s leading provider of measurement and improvement services”), the average time per visit being spent in emergency rooms has continued to rise, with “significant variations by state,” as they summarize it. According to their figures, the average ER patient experience lasts four hours, up 18 minutes from last year. Moreover, in larger hospitals, the ER time goes up another half-hour for every additional 10,000 annual patient-visits. The range varied from just over 2-1/2 hours, to almost 6-1/2 hours in the worst cases.
State by state, the top ten fastest ER times were found in these cities: 1. Milwaukee 2. Indianapolis 3. Columbus 4. Oklahoma City 5. New Orleans 6. Detroit 7. Nashville 8. Cleveland 9. Kansas City 10. Chicago. Meanwhile, on a statewide basis, the bottom-feeders in the survey included Kansas (46), Virginia (47), Arizona (48), Nevada (49) and Utah (50). A copy of Press Ganey’s 2007 Emergency Department Pulse Report: Patient Perspectives on American Health Care report is available at http://www.pressganey.com/ER-report.pdf and upon request.

And in the final story, a Boston Globe analysis of young, healthy adults in Massachusetts shows few if any who are willing to jump into that state’s mandated health insurance pool, thereby (with their absence) guaranteeing skyrocketing rates for those older citizens who do enroll, given the realities of actuarial calculations on mortality and risk management. The story interviews one 30-something fellow, a juggler whose act includes performing while astride a tall step-ladder, noting that this lad refuses to provide a safety-net, either literally or figuratively, for his endeavors, since he “has been without health insurance for about a decade and cannot remember the last time he saw a doctor.”

As is noted in the editor’s note attached to that story-blurb on these pages, “The failure to at least get periodic checkups is a major factor in ending up with a surprise ailment, too late for a cure. Meanwhile, by engaging in hazardous behavior, with no regard for at least some ’safety-net,’ this idiot is just an accident waiting for others to pay for it!” If one chooses to engage in dangerous behavior — whether it be hanging from wires or chain-smoking, skydiving, binge-eating … or refusing to get some assurance of continued good health via regular checkups – one should be expected to pay the freight for such stupidity.

According to the article, though, “many young people partying and working near the Marketplace on a recent night were not sold on getting insurance. As they smoked and talked outside the area’s bars, most of those without insurance said they opposed state-mandated coverage. Many were worried about how they would pay the premiums. Others said they would not skimp on beer or move to a less expensive apartment to pay for healthcare.”

In other words, none of them were willing to take on the self-responsibility of taking care of their own wellness, and doing the minimal things required. Or is that really the case? We can’t tell from the article; the question is never phrased that way. All we know is, these young folks don’t want to cut back on their other expenses just to pay for health insurance they don’t need right now; we have no idea how many of them (other than the juggling fool) might be paying out of pocket to see a healer for regular checkups, setting aside something in case of emergencies, eating sensibly and limiting risky behavior, or otherwise making themselves less likely to become a charity-case down the line.

If these vital youth had their choice, they might be quite willing to take on a little low-cost, catastrophic-only coverage, coupled with a medical savings account in their own control. The Massachusetts wonder-plan doesn’t offer this as an option, however, so we may never know how that would have sold to these vibrant souls.

But the real question here is, what can we learn from these three stories? Well, to begin with, there’s the obvious fact that Emergency Rooms are still the preferred venue for far too many people in need of healthcare (while, more than likely, the vast majority of these folks do not NEED emergency care). It is always assumed that this represents the uninsured, and is thus a valid basis for agitating for universal ’single-payer’ health insurance. In reality, the CDC study found somewhat different results: “The report found that 46 million of the visits made to ERs in 2005 were by people with insurance, compared to 19 million by people without insurance.”

In other words, even among the already insured, many still choose the ER over a regular doctor’s office when they are in need of health services. Whether this is due to overbooked individual physicians, poorly run clinics that chase away patients, refusal to play the “co-pay” game or some other factor … that question doesn’t get addressed in either of these surveys. Clearly, though, the bulk of the problem of long waiting times in emergency rooms is not just a factor of the uninsured among us.

However, if we look at both sets of data, something does begin to emerge. Breaking out of the mindset that this can be fixed by insuring everyone (just wait to see how many flock to the ER when it not only doesn’t cost anything but is just as good or bad an option as seeing your own doctor!) is mandatory, if we are to have any hope of improving the situation. Finding ways instead to encourage people to do the right thing, and to give them incentives for self-aware living … there lies the pathway of the true healthcare reformer.