Repairing the Healthcare System: Politicians Are Hard To Trust: Part 2 Patient Power Wins Again

Stanley Feld M.D.,FACP,MACE

When citizens understand an issue they are motivated to act. They can put enough pressure on politicians so they act for the citizens’ vested interest. After all, the United States government was created by the people for the people.

HR 6331 called for a stop to the 10.6% reduction in physicians’ reimbursement and continues current rates for the rest of this year, while providing an additional 1.1-percent increase in 2009 to physicians.

Resolution 6331 flew through the U.S. House of Representatives 355 to 59 last week. It was defeated in the Senate by one vote. Both my Texas senators voted against it initially. The resolution needed only one more vote in the Senate to win. Protests were voiced by citizens in Texas and the rest of the country. The citizen outcry resulted in Senators switching their vote from a one vote defeat to a nine vote victory for senior citizens and physicians. (69-30). Both Texas Senators switched their vote from no to yes.

I hope my quick blog entry about the difficulty contacting politicians helped. I intended to provoke an outcry from many readers. I did. Many showed me how easy it is to contact their politicians and let them know their feelings.

The citizen outcry plus Ted Kennedy showing up for the vote won the day for the citizens over 65 years old and physicians. Both were going to suffer from a negative vote. President Bush still threatens to veto the bill.

However, I believe if he does, his approval rating will sink further, and his veto will be overridden.

If physicians continued to see Medicare patients many would be seeing these patients at a loss. Seniors going to physicians who do not take Medicare would be paying huge out of pocket expenses. Medicare costs would escalate because more seniors would be hospitalized for illnesses they could not afford to have treated. They would wait until they had no choice but to be hospitalized for a costly complication of their chronic disease.

The Senate’s rejection of the bill would have also protected the healthcare insurance industry by adding items in the bill to help the Medicare Advantage program’s growth.

United Healthcare and Humana are betting on the lucrative Medicare Advantage part of their business. The Medicare Advantage program develops doctor networks that are managed by the insurers in contrast to regular Medicare in which members can choose virtually any doctor, who is paid directly by the government.

“One in five of the nation’s 43 million Medicare enrollees are now in the Medicare Advantage program, which the Bush administration says has brought more choices and better benefits to the federal health system.”

My question is, “who can you trust?” Is President Bush really protecting seniors and the U.S. federal treasury or the healthcare insurance industry?

“ Medicare Advantage has become a political target, because — whatever its vaunted enhancements — it costs the federal government 12 percent more for each enrollee, on average, than the regular Medicare system.” “The Congressional critics see the policies as an extravagance whose main beneficiaries are insurers like Humana and UnitedHealth.”

Wake up America! Physicians only receive 20% of the Medicare dollar. Physicians are the people providing medical care, not the healthcare insurance companies.

Americans made the Senate act positively in one week by their outcry. We should make Congress go after the stakeholders that add little value to the healthcare system. The healthcare insurance industry consumes at least 50% of the remaining 80% of the Medicare dollar.

“Under Medicare Advantage, the insurer provides coverage through a network of doctors, and the government pays the insurer a flat annual fee per enrollee. That federal payment varies from county to county, but it averages about $9,000 per enrollee nationwide.

In my blog: Medicare Insurance: It is Not Cheap-Part 1 the maximum an enrollee pays is $3408 per year. If Medicare Advantage is receiving $9000 a year per enrollee the difference is $5592 per enrollee more than the government collects from the seniors who pay the most. The healthcare insurance industry receives $8380.88 extra for an enrollee that pays the least premium for Medicare (1112.60 per year). The dollar difference is large and yields a nice profit for the healthcare insurance industry provider.

“UnitedHealth, in contrast, will get about 15 percent of this year’s projected pretax profit of $7.48 billion from Medicare.”

It is no wonder United Healthcare can afford to pay their former CEO 1.80 billion dollar in stock options over 8 years.

“And Humana is transforming itself into a big-time government contractor. It will get almost three-fourths of its projected $1.28 billion in pretax profit this year from Medicare, mainly from the Medicare Advantage program, according to analysts.”

Clearly a healthcare insurance company can make large profits from Medicare Advantage.

Patient Power works as long as citizens know what is going on. Politicians will act in the citizens’ vested interest if citizens demand it from them. Citizens must demand that Congress and the administration stop this disgraceful behavior.

The media reports most of the information but never connects the dots. I have connected the dots. What I see is not a pretty picture. In fact it is a terrible betrayal of senior citizens and taxpayers.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.