Pulling out of the nosedive
History proves that every time that the government has gotten involved in the control and supervision of American Health Care it has been to its detriment. Since 1965, every act of Congress and all CMS rules for Medicare have violated the original Medicare law. But, free-market principles applied to healthcare insurance can avoid inflicting permanent damage.
Every time that the government gets involved in an industry, it plants and nurtures the seeds of its destruction. It has been said many times, in many ways: ”Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies,” said Groucho Marx. “If you put the federal government in charge of the Sahara desert, in 5 years, there’d be a shortage of sand,” said Milton Friedman. “Asking government to fix government is like asking cancer to cure cancer,” anonymous. “A government big enough to give you everything you want, is strong enough to take everything you have. I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them,” said Thomas Jefferson. And, that is exactly what the US federal government had done over the last century.
Originally, in 1912, soon to be President Teddy Roosevelt, called for a national health insurance program during his campaign. From the War Powers Act of 1941, that enabled employer sponsored health insurance, to the so-called Patient Protection Affordable Care Act (ACA) of 2010 that destroyed employer sponsored health insurance, government actions, witting or unwitting, are our undoing. Take Medicare 1965 legislation for example. It was passed to provide the aged and infirmed seniors of 65 years and older with health insurance. Bear in mind, in 1965, that very few survived to 65 years old and there were many in the working class to pay for each senior. Now, the demographics are reversed and there are many more seniors who are living to 65 years old (60.6 million Americans covered by Medicare in 2019) and relatively many less working to support them. The original promise was that you would invest in Medicare taxes all your working life and it would accrue and compound to buy you Medicare insurance when you retire at 65. Problem was, Medicare was a Ponzi scheme that offered immediate benefits to 65 year old retirees, who hadn’t paid in one thin dime. In fact, former President Harry Truman was given the first ceremonial Medicare card at the program’s inception in 1965, because of his goals of a national health insurance fund in 1945. He hadn’t contributed, just benefitted.
The HMO act of 1972 warped health insurance by creating, “health maintenance organizations or HMOs,” that redefined health insurance. Instead of being a per incident charge to patient and insurance, pt either paid nothing or small nominal fee at incident of care. Physicians and hospitals were paid a low monthly, “maintenance,” fee per person, or capitation payment and all care was included and expected by all parties. This transferred the risk from the insurance company, a traditional risk taking entity to the physician or hospital, not traditionally a risk taking entity. Translate that into less pay, more responsibility and more risk for physicians and hospitals. More pay, less responsibility and less risk for insurance companies.
“In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.” (https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA) In other words, yet another unfunded mandate on physicians and hospitals. By the 1990s, between the HMOs proliferating and mandated EMTALA care without payment, both care and insurance skyrocketed, while government crony insurance companies laughed all the way to the bank.
HIPAA, the Health Insurance Portability and Accountability Act of 1996 provided for the digitalization of analog medical charts. Lobbyists had succeeded in planning a digital takeover of medicine for the coming decade via EHR, Electronic Health Records. And, it was all in the name of privacy, at least that’s how it was sold to the American public. In reality HIPAA was not a privacy act at all, but a disclosure act. It specified that government and insurance entities could get access to your, until now, private medical records, while others, like physicians, had to go through hoops just to get information on their own patients.
“The American Reinvestment & Recovery Act (ARRA) was enacted on February 17, 2009. ARRA included many measures to modernize our nation’s infrastructure, one of which was the “Health Information Technology for Economic and Clinical Health (HITECH) Act”. The HITECH Act included the concept of electronic health records – meaningful use [EHR-MU], an effort led by Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT (ONC). HITECH proposed the meaningful use of interoperable electronic health records throughout the United States health care delivery system as a critical national goal.
Meaningful Use was defined by the use of certified EHR technology in a meaningful manner (for example electronic prescribing); ensuring that the certified EHR technology connects in a manner that provides for the electronic exchange of health information to improve the quality of care. By using certified EHR technology, the provider must submit to the Secretary of Health & Human Services (HHS) information on the quality of care and other measures.” https://www.cdc.gov/ehrmeaningfuluse/introduction.html
Although the stated goals were improving care and exchanging health information, the act did the opposite. Care worsened as physicians and other took their eyes and attention off the patients. This frustrated patients too. The act also made information exchange more difficult as the systems had no standards for exchange and has lots of red tape, complete with HHS threatened monetary penalties for non-compliance.
The final ax in the back of health insurance was the Patient Protection and Affordable Care Act of 2010, that was unilaterally passed by Democrats on Christmas weekend. The act completely redefined health insurance into three narrow bands of coverage, instead of the hundreds of different options that were previously available. It resulted in insurance costs skyrocketing, and patients being dropped by their insurance plans, employers dropping coverage, patients forced to either buy bloated expensive via PPACA individual mandate and shared responsibility payment or be fined/taxed by IRS, or be forced on to Medicaid government taxpayer sponsored insurance for the poor. Literally, we spent billions to save millions of dollars; a ridiculous proposition. For all these reasons I called ACA, “the Unaffordable Careless Act.” See the schematic below by Dean Clancy, a healthcare policy wonk at Adams Auld LLC.
Regarding Medicare, Congress passed MACRA with MIPS, Medicare Access and CHIP Reauthorization Act with Medicare Incentive Payment System - Quality Payment Program, in 2015. Now, instead of Medicare paying Physicians and Hospitals a set fee (one price fixed by Medicare) for care and services, Medicare was going to grade physicians and hospitals based on arbitrary criteria and outcomes for payment. This was indeed the last straw. Insurance was destroyed and Medicare was no longer true insurance either. See below illustration. All this despite the original 18 page Medicare legislation of 1965 declaration, “Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine…” yet, every rule by HHS, CMS’ unelected bureaucrats, not to mention congress, has violated original Medicare law.
In summary: The US federal government changed established natural norms and motivated and facilitated the creation of employer sponsored health insurance. Then, they ruined it with the creation of HMOs. When that went bad, because it was a bad idea and went naturally sour, they forced the digitalization of healthcare through Medicare and Medicaid to have more government control and the ability to sell out to lobbyists. Of course, that failed miserably too, so they launched a more complete takeover with ACA. This doubled and tripled costs, while eliminating individual personal coice, and created over 100 new government entities for control. See below diagram. Now, this too is failing and some are calling for complete government control of all healthcare entities through single-payer healthcare, like Medicare and Medicaid, or socialized medicine complete government ownership and management.
Is there a way out of this utter chaos caused by government destruction of healthcare? Yes! Repeal or disable all government healthcare legislation and allow freemarket competition and innovation to proliferate naturally. We must support the success of DPC, direct primary care and other forms of direct care where physicians and healthcare facilities compete for patient “business,” and patients pay directly at the time of service, with no intermediaries to down them in red tape or excessive cost overruns. Payment models include direct pay, whether through membership models and fee for service arrangements. Let's pull out of this government piloted nosedive before we hit the ground.
After all this, the US federal government must not be permitted to overtake any industry. Politics, Presidents and Congress have utterly torn apart and redefined healthcare to serve itself and it’s cronyism lobbyists. To save the best healthcare in the world, we must repeal all the industry warping and redefining legislations with fancy confident names which are not reflective of the permanent damage they inflict on all parties. Free Market capitalism, entrepreneurial innovation and competition would yield consumer choice, quality and best price.
A Plan for Health Freedom and Individual Choice - The Case for Full Repeal
Craig M. Wax, DO, Family Medicine
Kristin Held, MD, Ophthalmology
Presented at National Physicians’ Council for Healthcare Policy
December 4, 2016 Washington, D.C.
A brief history of Medicare in America
President Johnson signs Medicare into Law
Emergency Medical Treatment & Labor Act (EMTALA)
(formerly, known as Electronic Health Records Meaningful Use)
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program