Health Care Reform Posts

Dr. Bandy Lee is Damaging the Psychiatric Profession

January 21, 2018

A Yale psychiatrist, Dr. Bandy Lee, is enjoying her fifteen minutes of fame as the editor of the bestseller “The Dangerous Case of Donald Trump.” This book contains the opinions of 27 psychiatrists and psychologists, some of whom believe the President suffers from cognitive dysfunction and mental illness. In doing so, they are damaging a specialty that has struggled to gain respectability among the general public and making it more difficult for those with mental disorders to receive treatment.

Psychiatry is a tough profession. Unlike other medical specialties such as ophthalmology, cardiology and orthopedics, our understanding of the brain is still in the Stone Age. The underlying physiology of the eye, heart and skeletal system is well understood. If a cataract is blurring vision, take it out. If a heart artery is blocked, unblock it. If a bone is broken, set it. But what do you do with a drug addict, an alcoholic, a schizophrenic or a depressed patient? There are no blood tests or radiological studies that give a definitive diagnosis of these entities let alone treatments that are highly successful. Thus, psychiatry constantly struggles to have parity with other medical disciplines as the general public is suspicious of its efficacy.

Dr. Lee’s attack along with a recent book about supposed White House dysfunction Fire and Fury by Michael Wolff have drawn blood. President Trump insisted in his annual physical that his doctor perform the Montreal Cognitive Assessment, which screens for Alzheimer’s and decreased mental functioning. The President obtained a perfect score.

Many psychiatrists – not a group that generally wears MAGA hats – disagree with Dr. Lee’s behavior. The American Psychiatric Association issued the following statement: “Using psychiatry for political or self-aggrandizing purposes is stigmatizing for our patients and negatively impacts our profession.” Dr. Lee’s psychiatric colleagues at Yale noted: “The Department affirms the importance of the ethical standard of conducting an examination of an individual and obtaining proper authorization before publicly stating a professional opinion about that individual.”

One doctor even believes that diagnosing President Trump as mentally ill is an insult to the mentally ill. Dr. Allen Francis, the retired chairman of the Duke University Psychiatry Department stated, “Mentally ill people are almost universally well-meaning, well-behaved, and decent, and Trump is none of these.”

But the true damage is done with the general public. The Trump-supporting truck driver from rural western Pennsylvania suspects that Dr. Lee would never be questioning the President’s mental stability if the President supported open borders, abortion rights, coddling our enemies and free trade. As the recent women’s marches have demonstrated, President Trump’s most fervent opposition consists of upper middle class women who are isolated from the economic chaos afflicting the working class – and Dr. Lee is a card-carrying member of this demographic.

Advances in psychiatry are crucial to decreasing human misery. Someday, psychiatrists will be able to cure opioid addiction, alcoholism and schizophrenia rather than simply manage these entities. But it will take years of expensive research until the complex neural pathways that predispose to these problems are found and sophisticated treatment options involving genetic substitutions or nanotechnology are discovered. Dr. Lee’s grandstanding may delay these efforts.

Donald Trump Should Replace Obamacare with a Universal Health Safety Net

November 27, 2016

President-elect Trump has promised to repeal Obamacare but thus far has been vague about alternatives. Rather than tinker with the system, Mr. Trump should boldly propose that all Americans have a Universal Health Safety Net that protects individuals and families from huge health care bills while lowering premiums for the middle class and working poor. The most straight-forward solution is to provide every American with government-backed catastrophic health insurance.

Because of technological advances, bureaucratic mandates and an out-of-control legal system, the average annual health care costs according to the actuarial firm Milliman, Inc. is $24,671 a year for a family of four. Those who are not self-employed pay $10,473 out-of-pocket while the employee pays the balance. Middle class wages have been stagnant for over two decades and now average $53,657 a year. When the employee contribution is included, many workers are paying almost 30% of their wages for health care.

Providing a Universal Safety Net does not require a new government program. It already exists. It is called Medicare – a plan that protects our elderly and disabled from large health care bills. All that is necessary is to extend Medicare to all Americans for medical bills that exceed $75,000 a year. Purchasing insurance to cover this first $75,000 would be inexpensive. This would be financed by increasing the Medicare tax (presently 2.9%). The vast majority of citizens would see their health care bills plummet to around $4,000 a year.

Further cost containment could be realized by classifying diseases and treatments according to efficacy and level of seriousness. It is well known that removing lung tumors before they have spread or treating hypertension and glaucoma saves and improves patients’ lives. Other treatments – back surgery without a herniated disc, prostate cancer and colon cancer chemotherapy in those over eighty years old – are controversial. These treatments could be partially covered and patients could decide if they wanted to pay out-of-pocket for them or else purchase extra coverage.

Furthermore, bureaucratic mandates are requiring doctors to waste endless time inputting useless data for the government to peruse while the complaints of patients are being ignored. Doctors are literally dealing with an Kafkaesque maze of acronyms – HIIPA, MIPS, QPP, APM, CEHRT, MACRA, PQRS (don’t ask) – that do nothing more than waste time.

Tort reform is crucial too. Forcing doctors to perform unnecessary tests adds 15 percent to medical costs. Doctors are also afraid to use modern technology such as e-mail, Twitter, Skype and Facebook to service their patients. Indemnifying doctors for these modalities would enable elderly patient and disabled patients to be consulted without leaving their homes and decrease the need for family members to take time off work, saving billions of dollars in worker productivity.

This plan would also have several political benefits. First of all, it would attract bipartisan support. Many Democrats would see this as a reasonable compromise to the socialistic plan proposed by Bernie Sanders during his presidential campaign. Secondly, it would allow President Trump to negotiate better trade deals as the health care costs for corporations would decrease. Finally, it would decrease resentment towards illegal immigrants who receive free health care while those who are citizens of the country and forced not only to pay outrageous premiums, but taxes to support the emergency rooms that give the illegals free care. Lowering health care costs would make many more receptive to a reasonable plan to allow more immigrants.

The rise and fall of the Trump presidency will be determined by the upward mobility he can create for the working class who has been left behind by globalization – the so-called deplorables that Hillary Clinton and the liberal media enjoyed ridiculing. If President Trump and the Republicans extend coverage to all Americans for catastrophic coverage, not only will they be doing the country a great service; but they will enable small businesses and corporations to thrive.

ObamaCare – Poor Health Care Policy but Political Ingenuity

November 29, 2015

Detractors of ObamaCare are forever reciting the program’s failings: unworkable web sites, skyrocketing premiums, endless cost overruns, silly bureaucratic mandates, useless medical record requirements, bankrupt insurance co-ops along with the random cancellations of perfectly fine policies. They like to recount one of President Obama’s most famous mendacious declarations: “If you like your health insurance, you can keep it.” This is because these detractors assume that the purpose of ObamaCare is to provide health insurance. It is not. The purpose of ObamaCare is threefold: Redistribute wealth, increase the number of baseline Democrats and enrich wealthy contributors. Once this is understood, it becomes obvious that not only is ObamaCare a huge success; it is political genius. Let’s look at these points individually.

1. Redistribute Wealth. The President and his minions tacked on several taxes to finance ObamaCare, mostly on the upper middle class. Married couples who file jointly with incomes exceeding $250,000 annually ($200,000 if you are single) have to pay another 0.9% income tax and 3.8% on interest income and capital gains. While these taxpayers will elicit little sympathy from the average citizen, the real redistributor is the ability of the insurance companies to charge outrageous premiums while denying coverage. It is not unusual for small business owners to see premium increases of 30% for a policy with a huge deductable, spotty drug coverage along with random denials of payments to doctors, hospitals, radiology departments and laboratories.

Why can they do this? Because if you don’t buy the insurance, you are subject to penalty of 2.5% of your income. Since most small business owners are baseline Republicans, the President and his minions are losing few if any voters. Furthermore, the Obama administration hired thousands upon thousands of bureaucrats and IRS agents to enforce the law. This leads us to Point Two.

2. Increase the number of baseline Democrats. All these newly-minted bureaucrats will have good salaries, guaranteed pensions and outstanding federal health insurance, not ObamaCare. In fact the President wisely exempted federal workers, Congress, Congressional staffers and politically-connected unions from ObamaCare. These people will be clicking the Democratic lever for the rest of their lives. Many of these new jobs are located in Virginia, thus turning this previously purple state blue. Pure political genius.

This is just the beginning. The requirement to shift to electronic medical records along with mandates for doctors to report on patient information to the government, has spawned a cottage industry of coding technicians, software writers and data managers who rely on ObamaCare for their livelihood. More baseline Democrats.

The actual ObamaCare policies are hideous. Although inexpensive, they have huge deductibles and very few doctors participate. Thus, these patients go to the hospital emergency room. This is why to the “shock” of health care experts, emergency room visits increased rather than decreased. The hospitals have responded by doing a huge number of tests of dubious value to eat up this large deductible. Thus a patient with a mild headache will receive numerous radiological studies and create a $5,000 bill. If the patient has a $3,000 deductible, the hospital eats the deductible but keeps the surplus.

ObamaCare also increased the income requirements needed to qualify for Medicaid – the health care program for the poor. Now many lower middle class individuals, who previously found health care to be unaffordable, are insured. Since the Supreme Court ruled that individual states could refuse to participate in this mandate, many Republican Governors opted not to extend Medicaid to the lower middle class. But Republican Governor John Kasich of Ohio did. Thus, threatening to repeal ObamaCare renders it more difficult for any Republican candidate to carry this crucial swing state.

3. Enrich Wealthy Contributors. Because of ObamaCare, the insurance companies are coining money. Their stock prices have almost quadrupled in value and high-level executives are taking salaries and exercising stock options worth tens of millions of dollars. They leave a small tip to the President and the Democratic Party in the form of campaign contributions. The recent threat of United Health Care to pull out of ObamaCare is nothing but a taxpayer shakedown. ObamaCare allows what are called “risk corridors,” that enable insurance companies to milk the taxpayers if they start losing money.

It would be unfair to blame President Obama for this state of affairs. He is merely exploiting the incompetence of the Republicans who never acknowledged that health care was becoming unaffordable to the middle class. All Republican presidential candidates are planning to abolish ObamaCare but offering alternatives that are nothing more than variations of the old system. This all but assures Hillary’s election in 2016. If the Republicans embraced extending Medicare for all medical expenses exceeding $75,000 a year; it would render health care affordable for everybody except for the poor, who still be protected by Medicaid. Purchasing insurance to cover a maximum of $75,000 a year would be relatively inexpensive. Unfortunately, most Republican candidates are spending their time appealing to a very narrow swath of voters and not planning for the general election. Perhaps this will change.