Harvesting Organs From the Poor. The American Way.

More sophisticated than whacking someone over the head and stealing their organs.

The papers and media are full of talk about former Vice President Dick Cheney’s recent heart transplant. There was much discussion about whether at age 71 he was too old, or whether he took advantage of special privileges to jump the line of thousands of others hoping to receive this potentially life-extending procedure. I am not prepared to comment on most of that: whether you call it an organ-allocation process or rationing, some will always consider themselves lucky, and others losers. I wish Mr. Cheney well.

Organ transplantation is often considered one of the triumphs of modern medicine. It has also made a lot of money for hospitals and doctors who do the procedures. Think of all the ads and press coverage we hear as hospitals seek to enhance their prestige and to attract other customers. The year I worked in Congress, Washington was attacked by lobbyists seeking to gain advantage in the national system of allocating donated organs. As much as these highly paid armies spoke of fairness, better outcomes, more equitable distribution, and the like; all of us staffers knew they were just fighting over the money. It was a cynical business. Continue reading “Harvesting Organs From the Poor. The American Way.”

I Love My Socialized Medicine.

I am less happy with private-sector managed confusion.

As I may have mentioned in these pages before, I am the beneficiary of socialized medicine in America. Yes, your tax dollars, supplemented by my lifetime of Medicare premiums (already spent on someone else) have been paying for my health care for the past year. Fortunately for you, I am in pretty good shape at the present time. Even better for me, the Supplemental Premiums paid into the kitty by my fellow United Healthcare Seniors are now paying my monthly gym fee through the Silver Sneakers program. That’s $30 or more a month I can spend on gin. I for one am in love with government-run socialized medicine.

Regular Medicare was easy for me. Uncle Sam signed me up automatically for the classic plan. It’s the private sector part of Medicare that is giving me fits. Picking a private Medicare supplement to cover copays and deductibles was relatively easy because UofL (my former employer) partially subsidizes only a single program for its retirees, and because of their feud with Humana, does not provide any support for Medicare Managed Care that might provide drug coverage. The University had earlier abandoned their promise to retirees that they would contribute to drug insurance coverage. (Ironic for an institution that aspires to be a drug company itself– or perhaps very smart.) We are on our own for drugs. Continue reading “I Love My Socialized Medicine.”

Kentucky Medicaid is a Mess.

Slow-Payments or No-Payments for medical care.

A week ago I was pretty tough on a possibly hypothetical physician who was said at a Frankfort hearing to have abandoned two child patients because one of the three new Kentucky Medicaid Managed care vendors had not paid him for three months. What is not hypothetical is that the Medicaid system is now in shambles. There are now four independent Medicaid managed care systems in Kentucky plus original Medicaid itself to deal with. Each of these has its own bureaucracy and unique systems. Thats a lot of different hoops for physicians and other healthcare providers to jump through. I have no doubt all are pulling their hair out. By all accounts, all three new vendors are in the pay-slow, pay-low mode. Cynics will point out that this is an easy way for an insurer to make a profit. After all, even Kentucky government uses the gimmick of paying healthcare providers late as a way to balance the books and make it look like they have actually been doing their jobs.

It is easy to assume that the three new managed care companies are to blame. That does not easily explain why all three seem to have failed at the same time, or why they appear successful in other states in which they work. When I worked in Kentucky Medicaid in the 1990s during my first-ever sabbatical and later as a faculty fellow, it was clear to me that there were major inadequacies in the state’s Medicaid computer systems and their ability to transfer and analyze information. I hope things have improved since then. Remember that all information about eligible beneficiaries, hospitals, and other providers has to be transferred to the managed care companies and continually updated so they know who to pay and for what. The three vendors have been silent publicly, but I will bet a martini in your favorite Louisville bar that internally they are struggling to interface with the state’s system. When you consider that each hospital and doctor’s office may also have their own computer system, it is no surprise that Kentucky Medicaid is staggering under its own weight and complexity. I hope we can pull out of this death spiral of cost and confusion. I still expect the state and providers to hold patients harmless, but that cannot continue infinitely. What a mess! Continue reading “Kentucky Medicaid is a Mess.”

Why is Single Payer Health Care so Scary to Organized Medicine?

When I worked in Government and later as a health care lobbyist, I often heard it said, seemingly in the jest of desperation, that the only way we were going to be able to “fix” the health care system was to wait for an economic or other meltdown such that a new health care Phoenix could arise from the ashes. I must confess that this did not seem so outrageous to me at the time, nor does it now. Just as the “Technology Bubble” burst, and then the “Housing Bubble,” and then the “Banking Bubble,” so do I see the pin approaching the “Health Care Bubble.” The unintended consequences of doing something different are less scary to me than the both obvious and unintended consequences of staying the course.

Ten years ago I dreamed (halucinated) a vision of what I thought healthcare should look like in this new mellineum. We are now approaching the end of its first decade and as I plan to update my Vision, I am hard pressed to see that we have made any progress at all. In many ways we are worse. Since few, if any, others think our health care mission has been accomplished, I assume my dreams are shared by at least some others, perhaps even by Dr Scott whose principled (perhaps courageous given the setting) comments stimulated this posting.

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Peter Hassselbacher, MD