We're gonna take you and the Queen Down to the guillotine It's somewhere in the heart of town And when that fella's through With what he's gonna do, You'll have no place to hang your crown
You Went The Wrong Way, Old King Louie by Allan Sherman
First of all, props to Mr. Allan Sherman, the Weird Al" Yankovic of my parent’s generation. I used to love listening to his schtick as a little boy, including this aforementioned chestnut.
Secondly, you gotta hand it to the French … at least the French as they were 200 plus years ago. I am referring to the days of the French revolution. They certainly knew how to deal with a problem. The French revolution still contributes so much to our modern pop culture. The vision of the guillotine, although I would venture that none of us have ever seen one in action, elicits a strong visceral response with most of us. Decapitation is a very strong statement.
Today I learned of a new type of decapitation, one that is taking place all around us, even though most of us are totally unaware of it. It is decapitation that is being performed by our health insurance carriers.
Let’s rewind 25 years or so to the days when the HMO was in it’s infancy. This new form of health insurance was a radical idea that had to be sold to the subscriber (patient) as well as the provider (doctor).
The selling point to the patient was cost control. Why spend $50 for a doctor visit when you can just join our HMO and pay just a small $2.00 co-pay? The providers were a bit harder sell. They were told that everyone would soon join a HMO and they would need to join the HMO network in order to retain their patient base. Sure, they would receive less money per visit, but this would be offset by a guaranteed patient volume as well as another new concept – capitation.
Capitation was a simple proposal. The primary care physician would become the front line health care provider to a finite group of HMO patients – perhaps several thousand in number. In addition to the co-pay that the provider would collect from the patient each visit, the provider would be paid a monthly fee for each patient that they were responsible for in the HMO – perhaps $10 a patient. This capitation fee was paid whether or not the doctor ever saw a patient – it was an automatic payment each and every month. Many providers found this concept too good to pass up and eagerly joined various HMO networks. Unfortunately for the providers, most found themselves over utilized by the HMO patients, and ended up with a financially losing proposition.
Fast forward, now, to the present day. The rascally HMO companies have slowly but surely changed the entire game in their favor. On the patient side, HMO co-pays have risen substantially. And they now pay as much as a $50 co-pay for each doctor’s visit. In other words, the fiscal advantage of the HMO has all but been erased from the patient’s point of view. Now, the other shoe has dropped on the provider side. Mercy Health Plans, a large Philadelphia based HMO, has recently informed their in-network providers that they are eliminating the monthly capitation fees. This, of course, leaves more of the money pie for the HMO.
You can be assured that other HMO’s will follow Mercy’s lead if Mercy gets away with this chicanery – and there is no reason why the shouldn’t be able to. The providers cannot simply ‘get out’ of an HMO network without facing a litany of legal obstacles, including patient abandonment – a serious for of medical malpractice. As providers start leaving their HMO networks, you can be certain of an all-out marketing blitz by the malpractice attorneys. Look or the TV commercials on ‘The Price is Right’ - right after the Hoveround spot.
Yes, heads will certainly roll on this move by Mercy – which, by the way, another alliterative that we can attribute to the French Revolutionists.
Snails, anyone?
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Western Medicine is finally learning to appreciate all that Mother Nature has to offer in the form of medicinal herbs and health foods. Following is a partial list of foods and herbal supplements with proven health benefits. The best thing about these natural wonders is that they are readily available over the internet, from a health food store, or even your local market. You won't need prescription to enjoy all the benefits that these natural wonders offer. Plus, they only cost a few dollars for a monthly dose!
Medicinal Herbs and Healthy Foods From Mother Nature:
* My mistake. Marijuana for medicinal use is only available in 14 states, and then only with a prescription. Use of marijuana in the remaining 36 states, or without a prescription, will typically cost you 1 to 4 years of your life.
Enjoy (most of) Nature's Bounty and have a happy and healthy holiday everyone!
***** Found this Interesting, Entertaining or Informative? Please read the complete blog at: ***** http://healthcarehullabalo.blogspot.com/
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Some people didn’t like my original “Logan’s Run” post, where I suggested that we could save nearly a Trillion dollars every year by simply euthanizing senior citizens before they put an undue burden on our health care system. They think that I went too far.
Upon further reflection, I now realize that I didn’t go far enough.
Yes, there is no doubt that our citizens in their ‘golden years’ are costing us younger folk a lot of gold. And while offing the oldsters will help the US Government balance their health care ledger, it would bring little relief to our beleaguered health insurance carriers – and that’s just not fair to them.
All across the country, health insurance executives are feeling the economic pinch. I heard a rumor last week that a Senior VP at a well-known non-profit health insurance company was considering buying a used Maybach. USED! I don’t know about you, but I don’t want to live in a country where a highly compensated insurance executive would have to consider parking his keyster in a leather seat already deformed by some other fat cat’s butt.
Thankfully, I later learned that this was just another Urban Legend, told amongst insurance executives at their beach bonfires in Fiji, to scare each other during their semi-annual executive training seminars. The point is, this just might happen in the future if we allow our health insurance industry to continue to decline.
So, what can we do to prevent this from happening? Well, it’s easy to identify the root of the financial drain on our health insurance carriers. Succinctly, the problem is sick people.
When it comes to expenditures by health insurance carriers, by far, the greatest area of loss is dealing with sick people. You may not know it, but your health insurance carrier has an entire staff that they hire JUST TO DEAL WITH SICK PEOPLE. First, they have a whole section of professionals whose entire job is to find reasons to deny requests for ‘pre-authorizations’ whenever sick people want medicine, testing, or to see a specialist. They have an entirely different group of employees people specifically trained to ‘lose’ insurance claims, even when those claims are routed to the carrier electronically. Then, there is another entire department to answer the calls of sick people who call in to find out why their claims are not being paid. Then there is another department whose sole purpose is to find new and creative reasons for rejecting claims once they are actually ‘found’. Then, if the sick person demands that the claim be paid (sick people can get very nasty), they have another department to handle the appeal. And another department to handle the ‘second tier’ appeal. Finally, they have an entire team of ‘Medical Directors’. These brave souls are retired physicians who use their extensive medical training and experience to deny the claims of sick people. So your neurosurgeon thinks that you need brain surgery to remove that nasty tumor? Not so fast - Dr. Patel, (Retired Obstetrician/Medical Director) does not agree.
All of these people have salaries and benefits of their own, plus support staff – secretaries, janitorial staff, etc. Then there are additional costs that most people never take into consideration - I’d bet that there are at least a half dozen people just programming the voice mail system. (Voice Mail Systems are very advanced these days – most corporate systems work extremely well right off the shelf – it takes people with highly developed technical expertise to modify these systems so that don’t recognize simple words like ‘claims’, or that randomly disconnect your call.)
Yes, denying insurance claims is a very expensive business.
The solution to this problem, however, is very simple: Let’s get rid of the sick people. I’m not talking about someone with a cold or flu – I’m talking about people with long term issues like cancer, diabetes, , heart problems. etc. - these are the people who put the greatest burden on the claim-denial process.
When you think about it, this is also a humane approach to the situation. After all, who would want to suffer needlessly for 30 years with diabetes or a bad heart when they could be quickly and painlessly euthanized? Let’s follow the lead of our veterinarians, who know that it’s best to ‘put down’ a sick animal rather then let them go on suffering.
They shoot horse, don’t they?
But let’s not forget that these new rules will not apply to members of Congress or their families. Or to me or my family either. Or my friends, so you’ll want to stay on my good side and tell everyone you meet about my great blog (or else!)
This is a simple thing that we can do to help improve the profitability of our health insurance carriers. Like any solution, their will be downsides, but they will be completely offset by the upsides of tis solution. Perhaps the greatest obstacle that my plan faces is that the drugs that would typically be used to euthanize a human being are generally ‘branded’ formulations, and therefore not covered by most prescription plans.
But let’s not dwell on the negative aspects of my plan. Instead, let’s revel in the glorious upside. Health insurance carriers would be able to lay off thousands of workers and maintain, or even increase, executive compensation. The entire health insurance industry will be revitalized and simplified – under my plan, the only pre-existing condition would be ‘life’ The economy will be stimulated as companies like Aston-Martin, Rolex and Chris-Craft will see sales returning to per-recession levels. There will be a real estate boon in places like Palm Beach and Cabo.
The only thing that stands between us and this glorious re-birth of our health insurance industry is a bunch of whining sick people. A plan this good has got to catch on. So, let’s all start dumping our under performing stocks and re-invest our savings in crematoriums and cemeteries. Mark my words - they’re going to be the new Amazon.com. (Yet Another Sarcasm Alert: That previous blog was entirely sarcastic - well, at least the part about killing off sick people was - the rest of the post was pretty spot on. Anyhow, if you're going to be reading this blog your going to have to understand the word 'sarcastic'. Don’t know what “sarcastic” means? Blame your High School English Teacher and look it up – Funk&Wagnals makes a very nice dictionary, complete with pictures.)
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Misery loves company. That’s why I was so happy to see a news story last week about a Delaware County (Pennsylvania) grandmother who had to enlist the intervention of a local news reporter, ‘3 on your side’ in order to get a $600 dental claim paid by her insurance carrier. You can read all about it here”
After my recent battles with my own carrier, I felt kind of relieved to learn that I wasn’t alone in this boat. But then, as I re-read the article, I wasn’t so sure that I wanted to be associated with 75 year old Marie Ettorre. Apparently, this old biddy doesn’t like to play by the rules.
According to her insurance carrier, United Concordia, Ms. Ettorre’s claim issue could have been resolved amicably if only she followed her carrier’s appeal process. Instead, frustrated by her carrier’s inaction, she went and blabbed to some nosey newshound, who then proceeded to slander the carrier’s good name all over the local news. For shame! I can envision the poor CEO of Concordia complaining “….and we would have gotten away with it, too, if it weren’t for you meddling kids!” It occurs to me that senior citizens can be a real pain in the ass. After all, what gives them a right to break the rules of a mighty insurance company? Besides, it is a well established fact that seniors use a disproportionate share of our health insurance dollars. Perhaps we would be well served to consider the consider the approach depicted in the classic Sci-Fi novel/movie ‘Logan’s Run’ . To wit, maybe everyone should have a crystal implanted into the palm of their hands. When that crystal changes color, long before owner reaches that persnickety age, they would be forced to turn themselves in for that long dirt nap.
Actually, this is a great idea on many levels. I know that the government is concerned about how they are going to fund Medicare and Social Security in the upcoming years. The “Logan’s Run” approach would solve those problems as well. Since the majority of money that we spend on health care is spent during the last year of our life, this would allow us to nip that problem in the bud as well. The end result would be annual savings in the hundred of billions of dollars. The current 2010 Medicare budget is now 326 billion dollars. Add to that another 667 billion in savings in Social Security. That’s almost a Trillion dollars in savings annually. It could prove to be just the boost that our economy needs.
Oh sure, there would be some downside to my plan. South Florida and Phoenix would become empty wastelands. . Restaurants would lose their profitable 4:00 PM dinner seating. No one would be there to greet you at your local Walmart. But the tradeoff would be well worthwhile.
Unlike many ‘band-aid- solutions proposed for solving the national health care crisis, this solution could very well prove to be the last one we’ll ever need,,,, a final solution, if you will.
Of course, there would have to be some exceptions to this legislation. Members of Congress, as well as their families, would be exempt. After all, we all know that they can’t be expected to abide by the same restrictions as the proletariat when it comes to health care. Along this same line of thinking, my family, friends, and, of course. Yours truly, would also be exempt – after all, it was my idea.
U realize that this may sound like an extreme approach to solving the health care reform issue, but drastic times do call for drastic measures. We can’t afford to continue to allow disgruntled senior citizens to drag the good name of our health insurance carriers through the mud now, can we?
(Sarcasm Alert: That previous blog was entirely sarcastic – from start to finish. Other than Ms. Ettorre’s story, I didn’t really mean a word of it. I said all of those nasty thing to illustrate a point. However, as my wife pointed out, some people don’t actually ‘get’ sarcasm and might be offended by such remarks. What a shame. Sarcasm is such an effective tool. Perhaps people who were born without the sarcasm gene should be forced to vacation in New Jersey until their sarcasm neural pathways are established)
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same old story same old act One step up and two steps back
Bruce Springsteen, One Step Up
Ah, the Boss – unofficial poet laureate of my generation.
Bruce certainly knows a lot about life’s ups and downs. This is in no doubt due to his experiences living in the great Garden State.
Witness, if you will, the latest debacle surrounding Medical Marijuana in New Jersey.
The prior governor, John Corzine, was certainly no Cracker Jack prize. His free-spending attitudes nearly bankrupted the state. But, giving proper respect where it’s due, Corzine did do at least one thing right: Shortly before leaving office, he made New Jersey the 14th State to approve the use of Medical Marijuana.
Now the new governor, Chris Christie, is doing a lot of good things to help the state get back on its’ feet financially. Many are talking about him being a front runner for being the Republican presidential candidate in the next election. However, he is doing one thing very wrong here – he is doing whatever he can to sabotage legal Medical Marijuana in the state.
OK, I get it – Medical Marijuana wasn’t his idea – it was dumped upon him by his predecessor as a parting shot. But, Mr. Governor, that’s not any reason to try to sabotage a good idea.
At first, Governor Christie did whatever he could to drag the state’s collective feet on Medical Marijuana. He claimed that a production system had to be established. A distribution systems had to be in place. The entire matter required a great deal of study and evaluation. But, to anyone with half a brain, it was easy to see that this was just stalling tactics on the Governor’s part.
Hey, General Eisenhower didn’t ‘study’ and ‘evaluate’ this much before invading Europe in 1944. Besides, if he ever bothered to tour any college dormitory in the state, he would have seen that many production and distribution systems are already in place….
Finally, after a year of delay, the Governor is now talking about ‘compromises’ in order to get Medical Marijuana off the ground in NJ. Chief among these ‘compromises’ is his declaration that Medical Marijuana can only be prescribed as a ‘last resort’ medication when all other medications have failed. In other words, if you are lying on your death bed, suffering through the final stages of terminal cancer, maxed out on morphine, Christie will give you a reluctant green light to light up.
Give me a fricken break.
Another compromise will limit the potency of Medical Marijuana. Yet another great idea. Patients who are dealing with extreme health issues will be forced into inhaling greater quantities of smoke in order to receive the needed dose. After all, conventional wisdom in the 1940’s was that smoking was good for you – none of this new-fangled anti-smoking rhetoric from Trenton, thank goodness. Maybe they should pass a law taking that pesky surgeon general’s warning of the side of the cigarette pack – that stupid warning makes it so much harder for teenagers to look cool these days.
No other prescription drug is limited by such provisos, including popular pain killers like Morphine, Codeine, Hydrocodone, Oxycodone, Methadone, Fentanyl and Meperidine. These drugs are all opiates, closely related to heroin. And they all carry the terrible potential side effects of addiction, overdose and death. (Of all the potential bad side effects of modern pharmaceuticals, death, for me, is one of the biggies). But the good Governor obviously doesn’t have a problem with these popular medications, even though they carry with them the very real risks? No siree – pop ‘em if you got ‘em – it’s OK with Governor Christie!
After reading about the latest developments with Medical Marijuana in NJ, I had to stop and check a calendar, and yup, it turns ot that it actually IS the year 2010. So why are we still treating Medical Marijuana like the good people of Salem Massachusetts treated their single womenfolk back in the 1600’s? The governor doesn’t appear to be stupid or naive – so why the witch hunt on Medical Marijuana?
Perhaps the governor is concerned that, if Medical Marijuana was given the acceptance that it deserves, millions of dollars of the NJ economy would flow out of the state and across the river into Philadelphia. Philadelphia is, after all, the home of the Tastycake factory. Come to think of it, the Governor is a known Twinkie aficionado – perhaps he is fearful of a shortage of his favorite sweet snack?
Applying Ockham’s Razor, it’s most likely some other influence that is affecting his decision making regarding Medical Marijuana – but what, pray tell, can it be?
Let’s take a moment to ponder this query – and whilst we ponder, here is an interesting, totally unrelated, factoid.
Did you know that 10 out of the top 12 pharmaceutical companies in the world have ties to New Jersey? Here’s a list:
1. Johnson & Johnson - 5 NJ Locations including US and World Headquarters
2. Pfizer - 7 NJ Locations
3 – Roche - 2 NJ Locations
4 – GlaxoSmithKline - 2 NJ Locations
5 - Novartis - 3 NJ Locations including US Headquarters
6 - Sanofi-Aventis - 2 NJ locations, including their US Headquarters
7 - AstraZeneca - No NJ connections (Boo! Hiss!)
8 - Abbott Laboratories – 2 NJ Locations
9 - Merck & Co. - 4 NJ Locations including Global Headquarters
10 - Bayer HealthCare - 2 NJ locations
11 – Eli Lilly – No NJ locations
12 - Bristol-Myers 2 NJ locations including Corporate HQ
Those ten top companies with ties to NJ had combined revenues in 2009 of around 389 billion dollars.
That’s not a typo – that’s Billion with a ‘B’
Isn’t that interesting?
OK, enough pondering – let’s get back to our main topic.
.Rats. Ponder as I may, I still can’t figure out why so many of our elected leaders are so against Medical Marijuana.
I guess we’ll never know why our politicians are so freaked out by an ugly little weed that has proven medical benefits with very few harmful side effects? This is not some illicit substance that outlaw bikers are cooking up in an abandoned trailer out in the woods – it’s a silly little plant that anyone could grow in their backyard. And that, my friends, is the problem.
Big Pharm doesn’t want the competition. In fact, they have none of the formulations that they produce can compete with Medical Marijuana when it comes to the ratio of benefits/harmful side effects. In addition, no one needs Big Pharm to produce Medical Marijuana – almost anyone could produce their own. Big Pharm hates competition. They spend billions on lobbyists and spin doctors to help ensure that no one rains on their 400 billion dollar cash parade. In the meanwhile, millions of Americans are suffering needlessly because they are being denied medicinal use of this ugly little weed – and it’s just not fair. In fact, from my standpoint, it’s downright criminal.
So what are we going to do?
Well, regular readers of my blog should know that I have already published the solution last Spring. If anyone had the foresight to follow my lead, the entire Medical Marijuana controversy would already be over. In case you missed it, here’s a link to my brilliant idea:
Barring that, I would ask a special favor of all our lawmakers who continue to roadblock Medical Marijuana– something we all should demand them to do before they consider any further legislation against Medical Marijuana. It wouldn’t take them very much time, but I’ll warn them up front, it may be the most difficult thing that they will ever have to do.
First, I would ask them to visit a few people in their constituency. People wasting away in cancer hospices. Other people who are in the midst of battling cancer, and who are devastated by the horrible side effects of chemotherapy. Other courageous souls who are trying to live with Multiple sclerosis. Or with the insidious creeping blindness of Glaucoma. Or living with chronic pain. Or who are dealing with a host of other debilitating diseases and conditions. People whos suffering might just be eased, even a little bit, by a silly, ugly little green plant.
Then, after visiting these people – people who they’ve sworn a sacred oath to represent – after seeing and experiencing the hell that is their daily lives – I would ask them to go back to their homes, walk into their bathrooms, and take a long good hard look at themselves in the bathroom mirror.
That’s all I would ask of them.
I bet they can’t do it.
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