Lourdes Hospital in southern New Jersey has announced that it is closing its L&D unit.
(Click here to read story).
The closure announcement starts to sound like a broken record. “They can no longer absorb the financial losses from low reimbursements!”
The state of New Jersey is concerned that more hospitals in the state are on shaky ground and could follow Lourdes’ lead and also shutter L&D.
Folks, we have to find a better model.
Alan
Monday, December 21, 2009
Friday, December 18, 2009
“Scrap the Health Care Bill -- Your Man Said So”
Over the past few months I have tried to give a unique perspective on the health care reform debate. Rather than take sides, I have asked questions about the bills, that neither the Democrats nor Republicans have addressed.
I have stated that we need healthcare reform, but that I do not believe that the current bills were getting us where we needed to go.
Yesterday, I introduced you to the time honored tradition of "Your Man Said So." Basically, when somebody on the other side agrees with you, the argument is over.
Democratic National Committee Chairman, Dr. Howard Dean M.D., has come out and said that it is time to scrap the healthcare bill.
In an editorial he said: (Click Here to Read Washington Post Editorial)
“If I were a senator, I would not vote for the current health-care bill.”
“In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.”
“I know health reform when I see it, and there isn't much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.”
As you can see by reading the full editorial, there were some things in the bill he liked and others he could not stomach. However at the end of the day, he is concluded that this bill as written “would do more harm than good to the future of America.”
Because of, "Your Man Said So," I now will take a position and urge you to do the same. "Scrap the current health-care legislation and start over."
Have a great weekend
Alan
I have stated that we need healthcare reform, but that I do not believe that the current bills were getting us where we needed to go.
Yesterday, I introduced you to the time honored tradition of "Your Man Said So." Basically, when somebody on the other side agrees with you, the argument is over.
Democratic National Committee Chairman, Dr. Howard Dean M.D., has come out and said that it is time to scrap the healthcare bill.
In an editorial he said: (Click Here to Read Washington Post Editorial)
“If I were a senator, I would not vote for the current health-care bill.”
“In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.”
“I know health reform when I see it, and there isn't much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.”
As you can see by reading the full editorial, there were some things in the bill he liked and others he could not stomach. However at the end of the day, he is concluded that this bill as written “would do more harm than good to the future of America.”
Because of, "Your Man Said So," I now will take a position and urge you to do the same. "Scrap the current health-care legislation and start over."
Have a great weekend
Alan
Thursday, December 17, 2009
"Your Man Said So"-- the Ultimate Debate Ender
Growing up on the streets of Brooklyn, New York, we did not play everyday sports with organized teams or umpires. Somebody had a football, somebody brought a rubber ball, maybe a softball with some bats, we chose the teams and we started playing.
Within a short time, a play would occur, and an argument would start. "It was fair!” “No, It was foul!” or, "He ran out of bounds." “No, he was in-bounds."
People would yell, they would point, re-create, and deliver arguments that would make Clarence Darrow proud.
Inevitably, someone on the opposing team would pipe up and agree with you. Your team says “fair, ” their team says “foul,” and all of a sudden, someone on their team agrees with you and says, "FAIR!"
That's it! Argument over! It was “fair” “YOUR MAN SAID SO”
“Your Man Said So,” is the ultimate conflict ender. It didn't matter, who on the other teams agreed. Their best player? Their worst player? It made no difference! “Your Man Said So,” was more was more powerful than the 10 Commandments themselves.
So what does this have to do with birth? Tomorrow, I will point out the ultimate “Your Man Said So,” in the healthcare debate.
Alan
Within a short time, a play would occur, and an argument would start. "It was fair!” “No, It was foul!” or, "He ran out of bounds." “No, he was in-bounds."
People would yell, they would point, re-create, and deliver arguments that would make Clarence Darrow proud.
Inevitably, someone on the opposing team would pipe up and agree with you. Your team says “fair, ” their team says “foul,” and all of a sudden, someone on their team agrees with you and says, "FAIR!"
That's it! Argument over! It was “fair” “YOUR MAN SAID SO”
“Your Man Said So,” is the ultimate conflict ender. It didn't matter, who on the other teams agreed. Their best player? Their worst player? It made no difference! “Your Man Said So,” was more was more powerful than the 10 Commandments themselves.
So what does this have to do with birth? Tomorrow, I will point out the ultimate “Your Man Said So,” in the healthcare debate.
Alan
Wednesday, December 16, 2009
Is Midwife Care Superior to Physician Care?
Whatever shortfalls are pointed out in our maternity care system, the birth advocates sing the usual response, "Midwives, all we need is more midwives."
In England, where midwives are still the norm for delivering babies, it seems every day there is another horror story coming out of the maternity wards. They all revolve around midwife and funding shortages.
In the attached article, (click here to read MailOnline article), a former hospital midwife reveals what type of care women are getting in England by the midwives.
My take on the story is that the "midwifery model of care." that is extolled by advocates in the United States is no longer being given at NHS hospitals due to resource allocations.
I want to make clear, that I am a huge supporter of midwives and the midwives model of care. I also have no intention of EVEN trying to answer the question: "Is midwifery care superior to physician care?"
I want to point out that if midwifery care were to become the norm in this country, the midwives would come under the same huge time and dollar pressures as physicians . It is quite possible that what what today is heralded as the standard that midwives give their patients, tomorrow could become a distant memory.
If tomorrow the physicians agreed that midwives (CNM's, CMS, CPM's, LMS, etc.) would deliver half the babies that are born in the U.S., and if there are 7500 practicing midwives (Dr. Robbie Davis-Floyd informs me that no one really knows the number of midwives in the US actually delivering babies) than each midwife would have to deliver almost 600 babies per year.
How much time do you think a midwife could spend with each pregnant woman if she had to deliver 600 babies per year?
Alan.
Alan@birthconference.org
In England, where midwives are still the norm for delivering babies, it seems every day there is another horror story coming out of the maternity wards. They all revolve around midwife and funding shortages.
In the attached article, (click here to read MailOnline article), a former hospital midwife reveals what type of care women are getting in England by the midwives.
My take on the story is that the "midwifery model of care." that is extolled by advocates in the United States is no longer being given at NHS hospitals due to resource allocations.
I want to make clear, that I am a huge supporter of midwives and the midwives model of care. I also have no intention of EVEN trying to answer the question: "Is midwifery care superior to physician care?"
I want to point out that if midwifery care were to become the norm in this country, the midwives would come under the same huge time and dollar pressures as physicians . It is quite possible that what what today is heralded as the standard that midwives give their patients, tomorrow could become a distant memory.
If tomorrow the physicians agreed that midwives (CNM's, CMS, CPM's, LMS, etc.) would deliver half the babies that are born in the U.S., and if there are 7500 practicing midwives (Dr. Robbie Davis-Floyd informs me that no one really knows the number of midwives in the US actually delivering babies) than each midwife would have to deliver almost 600 babies per year.
How much time do you think a midwife could spend with each pregnant woman if she had to deliver 600 babies per year?
Alan.
Alan@birthconference.org
Bean Counters Look at Only Half the Story
We often ask why Medicaid and insurance companies don't see the full results of their actions? Why do they NOT understand that their procedures and policies when it comes to childbirth, produces less healthy babies and cost them much more money in the long run?
A recent article about the single-mindedness of airline accountants has cost the airlines millions, yet they think they are actually making money. We are talking about baggage fees. A few years ago, the airlines (with the exception of Southwest and JetBlue) started charging for checking in. even one bag.
For the second quarter of 2009, this amounted to almost $670 million in baggage fee revenue. The bean counters were jubilant! Look how much money we've brought in, just from charging baggage fees.
Of course, the bean counters had no way of calculating how many passengers chose. NOT to fly the airlines that charged baggage fees. Second quarter revenue dropped by almost $130 billion. Those airlines that do not charge baggage fees suffered losses that were less than half of what the baggage fee charging airlines suffered. (Not to mention how hard it is to get back a customer that has left you for the competition)
(Click here to read article).
Very often when looking for solutions to improve birth, the bean counters, as well as the birth advocates view only one side of the financial equation. It is important to look at all sides when making decisions.
Alan.
Alan@birthconference.org
A recent article about the single-mindedness of airline accountants has cost the airlines millions, yet they think they are actually making money. We are talking about baggage fees. A few years ago, the airlines (with the exception of Southwest and JetBlue) started charging for checking in. even one bag.
For the second quarter of 2009, this amounted to almost $670 million in baggage fee revenue. The bean counters were jubilant! Look how much money we've brought in, just from charging baggage fees.
Of course, the bean counters had no way of calculating how many passengers chose. NOT to fly the airlines that charged baggage fees. Second quarter revenue dropped by almost $130 billion. Those airlines that do not charge baggage fees suffered losses that were less than half of what the baggage fee charging airlines suffered. (Not to mention how hard it is to get back a customer that has left you for the competition)
(Click here to read article).
Very often when looking for solutions to improve birth, the bean counters, as well as the birth advocates view only one side of the financial equation. It is important to look at all sides when making decisions.
Alan.
Alan@birthconference.org
Monday, December 14, 2009
Yet Another Hospital to Close L&D in January
The Philadelphia area has had 18 L&D. closures since 1997, limiting women's choices and putting a severe strain on remaining L&D units.
Mercy Suburban Hospital in Norristown PA, will close L&D, January 18, 2010.
(Click here to read article).
To those birth advocates that believe L&D is a profitable part of a hospital's operations, I would ask one question: "Why would a hospital that interested in maximizing revenue. close a profitable unit?"
Alan.
Alan@birthconference.org
Mercy Suburban Hospital in Norristown PA, will close L&D, January 18, 2010.
(Click here to read article).
To those birth advocates that believe L&D is a profitable part of a hospital's operations, I would ask one question: "Why would a hospital that interested in maximizing revenue. close a profitable unit?"
Alan.
Alan@birthconference.org
Friday, December 11, 2009
2.2 Million Reasons Not to Do a Vaginal Birth
An upstate New York jury awarded the family of a baby who died of seizures following the mishandled birth a $2.2 million verdict against, the obstetricians involved.
(Click here to read article).
It appears that a hospital nurse told the obstetrician on duty that she was concerned about the baby's heart rate, but rather than do an immediate C-section, the OB gave orders to monitor and continue the vaginal delivery.
The baby became stuck during the delivery, suffered oxygen deprivation and brain damage.
Does anyone believe that the next time the doctors involved are faced with a similar situation, they will not immediately say "C-section now!”?
Have a great weekend.
Alan
Alan@birthconference.org
(Click here to read article).
It appears that a hospital nurse told the obstetrician on duty that she was concerned about the baby's heart rate, but rather than do an immediate C-section, the OB gave orders to monitor and continue the vaginal delivery.
The baby became stuck during the delivery, suffered oxygen deprivation and brain damage.
Does anyone believe that the next time the doctors involved are faced with a similar situation, they will not immediately say "C-section now!”?
Have a great weekend.
Alan
Alan@birthconference.org
Thursday, December 10, 2009
Another Hospital Closes L&D
I interrupt the discussion about health care and higher education comparisons, to report another. L&D. closing.
Southeast Baptist Hospital in San Antonio is closing their L&D unit effective January 1, 2010.
(Click here for news article).
A new hospital is scheduled to open (hopefully if there are no delays) .in 2011. Meanwhile, the people in the southeast community will not have an L&D unit for at least two years.
Do you believe that if L&D were a profitable service, they would close the unit?
Alan.
Alan@birthconference.org
Southeast Baptist Hospital in San Antonio is closing their L&D unit effective January 1, 2010.
(Click here for news article).
A new hospital is scheduled to open (hopefully if there are no delays) .in 2011. Meanwhile, the people in the southeast community will not have an L&D unit for at least two years.
Do you believe that if L&D were a profitable service, they would close the unit?
Alan.
Alan@birthconference.org
Wednesday, December 9, 2009
Tuesday, December 8, 2009
Comparing Healthcare Financing and Higher Education Financing
Every time there is an election, some candidate accuses the other candidate of wanting to cut higher education spending, and promises that he or she will fight for more money on higher education, and say “Because our young people are the promise for tomorrow” or something similar.
Let's imagine what would happen if in fact, government higher education financing was reduced or removed. No government student loans, No Pell grants, other German grants, etc.
And let's just say that tuition at College X. is $15,000 per year. (Some of you will say that's too cheap, and others will say way too expensive.) And now, there is no government aid.
Do you believe the colleges will all shut their doors? Do you believe that every student that does not have $15,000 at the beginning of the year will be unable to attend? Will they fire every professor? Will the University of Texas and University of Alabama shut down their football programs?
After 9/11, the airlines were facing the equivalent of the government shutting down student aid. "America was afraid to fly." Some airlines filed bankruptcy, others did not. Most kept flying. They cut everybody's pay between 25% and 50%, if not more, and had substantial layoffs. BUT, they kept flying.
What will colleges and universities do?
Offer their own loans? Cut salaries? Lay off staff? Merge and consolidate? Stop offering ridiculous electives? Re-evaluate how many credits are needed for a degree? Go to online classes? Sell some buildings? Reduce services?
The answer is, they will probably do ALL of the above. They will get creative. They may reduce tuition. They will do everything not to close the doors, and still offer quality education and profitable sports programs.
So your next question should be: "If they can do this without student loans and aid, why don't they?"
When you were a kid and your allowance was $2.00, you spent it. When it was raised to $5.00, you spent it. If you got $10, you spent it.
In other words, as long as the money is there, you will find a way of justifying and spending it. It’s the same with colleges and universities.
Do you think health insurance has had any effect on the cost of medical procedures? (answer tomorrow)
Alan.
Alan@birthconference.org
Let's imagine what would happen if in fact, government higher education financing was reduced or removed. No government student loans, No Pell grants, other German grants, etc.
And let's just say that tuition at College X. is $15,000 per year. (Some of you will say that's too cheap, and others will say way too expensive.) And now, there is no government aid.
Do you believe the colleges will all shut their doors? Do you believe that every student that does not have $15,000 at the beginning of the year will be unable to attend? Will they fire every professor? Will the University of Texas and University of Alabama shut down their football programs?
After 9/11, the airlines were facing the equivalent of the government shutting down student aid. "America was afraid to fly." Some airlines filed bankruptcy, others did not. Most kept flying. They cut everybody's pay between 25% and 50%, if not more, and had substantial layoffs. BUT, they kept flying.
What will colleges and universities do?
Offer their own loans? Cut salaries? Lay off staff? Merge and consolidate? Stop offering ridiculous electives? Re-evaluate how many credits are needed for a degree? Go to online classes? Sell some buildings? Reduce services?
The answer is, they will probably do ALL of the above. They will get creative. They may reduce tuition. They will do everything not to close the doors, and still offer quality education and profitable sports programs.
So your next question should be: "If they can do this without student loans and aid, why don't they?"
When you were a kid and your allowance was $2.00, you spent it. When it was raised to $5.00, you spent it. If you got $10, you spent it.
In other words, as long as the money is there, you will find a way of justifying and spending it. It’s the same with colleges and universities.
Do you think health insurance has had any effect on the cost of medical procedures? (answer tomorrow)
Alan.
Alan@birthconference.org
Monday, December 7, 2009
Health Insurance Was Never Intended to Pay for Birth
Why's it so hard to buy maternity coverage?
(Click Here for Article)
As this article in the Colorado Independent points out, it is difficult to buy maternity coverage for individual health insurance, and most the time. It's not worth it.
Why??
The answer is very simple: Do you want to have a car accident? Would like cancer? Do you want your plane to crash? Do you want your house to burn down? Do you want to be sued? Do you want to die?
I'm assuming the answers to the above are, "NO"
Anybody want to have a baby??
For many the answer to having a baby is "YES"
The whole concept of insurance, is to protect against things that might happen, but you don't want to happen. In most cases, maternity coverage protects against something you want to happen.
Insurance actuaries go nuts when asked to calculate desirable risk as opposed to undesirable risk. Had normal maternity coverage never been included in health insurance, then I believe that our entire system of labor and delivery would have evolved differently.
What many of you don't realize is that “complications of pregnancy”, which usually meant needing a cesarean section, was always covered by your policy, EVEN it had no maternity coverage.
I guess times have changed.
Alan.
Alan@birthconference.org
(Click Here for Article)
As this article in the Colorado Independent points out, it is difficult to buy maternity coverage for individual health insurance, and most the time. It's not worth it.
Why??
The answer is very simple: Do you want to have a car accident? Would like cancer? Do you want your plane to crash? Do you want your house to burn down? Do you want to be sued? Do you want to die?
I'm assuming the answers to the above are, "NO"
Anybody want to have a baby??
For many the answer to having a baby is "YES"
The whole concept of insurance, is to protect against things that might happen, but you don't want to happen. In most cases, maternity coverage protects against something you want to happen.
Insurance actuaries go nuts when asked to calculate desirable risk as opposed to undesirable risk. Had normal maternity coverage never been included in health insurance, then I believe that our entire system of labor and delivery would have evolved differently.
What many of you don't realize is that “complications of pregnancy”, which usually meant needing a cesarean section, was always covered by your policy, EVEN it had no maternity coverage.
I guess times have changed.
Alan.
Alan@birthconference.org
Friday, December 4, 2009
Affect of Super Simple Health Plan on Birth
For the past two days, I've written about the super simple two line health plan, which I put forward, not as a proposal, but rather as an example of how a major change could be made without a 2000 page bill.
The super simple plan is:
1) All US citizens and legal residents are automatically enrolled in the Medicaid program and will pay a fee equal to 5% of adjusted gross income, unless exempt by paragraph #2.
2) Persons having proof of health insurance or who have sufficient assets not to need health insurance are exempt from the requirements of paragraph #1.
So now the question is: “How would this plan affect. birth practices?”
The most obvious answer would be that with everyone being covered, less malpractice suits will be filed, since a large number of suits for birth injury are for the purpose of getting medical bills paid for the baby's treatment. Since medical bills a re covered under Medicaid, or insurance, r than alleviates the need for these lawsuits.
As an incentive for people to buy health insurance as opposed to Medicaid, the insurance companies might offer to pay obstetricians and family physicians and midwives a lot more money per birth in the hope that they would then refuse the meager Medicaid reimbursement amounts.
Medicaid might have to increase their payments to birth care providers, so they will continue to accept Medicaid patients.
Insurance companies might embrace concierge birth facilities as a way of keeping insured’s with private insurance from changing to Medicaid.
This is not comprehensive analysis, but then remember, the original proposal is only two paragraphs.
Have a great weekend.
Alan.
Alan@birthconference.org
The super simple plan is:
1) All US citizens and legal residents are automatically enrolled in the Medicaid program and will pay a fee equal to 5% of adjusted gross income, unless exempt by paragraph #2.
2) Persons having proof of health insurance or who have sufficient assets not to need health insurance are exempt from the requirements of paragraph #1.
So now the question is: “How would this plan affect. birth practices?”
The most obvious answer would be that with everyone being covered, less malpractice suits will be filed, since a large number of suits for birth injury are for the purpose of getting medical bills paid for the baby's treatment. Since medical bills a re covered under Medicaid, or insurance, r than alleviates the need for these lawsuits.
As an incentive for people to buy health insurance as opposed to Medicaid, the insurance companies might offer to pay obstetricians and family physicians and midwives a lot more money per birth in the hope that they would then refuse the meager Medicaid reimbursement amounts.
Medicaid might have to increase their payments to birth care providers, so they will continue to accept Medicaid patients.
Insurance companies might embrace concierge birth facilities as a way of keeping insured’s with private insurance from changing to Medicaid.
This is not comprehensive analysis, but then remember, the original proposal is only two paragraphs.
Have a great weekend.
Alan.
Alan@birthconference.org
Thursday, December 3, 2009
Defending the. Two Paragraph Health Reform System
Yesterday, I put forward a super simplified health reform plan:
1) All US citizens and legal residents are automatically enrolled in the Medicaid program and will pay a fee equal to 5% of adjusted gross income, unless exempt by paragraph #2.
2) Persons having proof of health insurance or who have sufficient assets not to need health insurance are exempt from the requirements of paragraph #1.
Although I'm not proposing or supporting it. I've had a number of people ask me questions regarding it. So, I will post some questions and some responses.
1) Q. Won't expending Medicaid cause everyone to drop private insurance and move to the public program?
A. As long as providers and facilities are free to accept or refuse Medicaid patients Medicaid patients, then private insurers will offer plans with richer and better payment structures. Quite simply, their sales pitch is: “your doctor will not accept Medicaid, they will accept our insurance”..
2) Q. Your program is only available to US citizens and legal residents. What about the illegal immigrants?
A. Nothing prohibits private insurers from offering policies to no citizens, and non legal residents. A provision could be added, that if someone other than the US citizen or legal resident is given medical care and they do not pay for it, that could be a deportable offense.
3) Q. There is no exemption for the poor paying the 5% health fee?
A. There is no exemption for the poor to pay sales taxes or property taxes. Since everyone has the benefit of the expanded Medicaid program, why should they not have to pay something? On a $12,000 year income, the premium is $50 per month, regardless of how many children in the family.
4) Q. Why should a rich person have to pay such a high amount? A person earning $1 million / year would have to pay $50,000?
A. Since this program makes healthcare a right, then funding healthcare, becomes an obligation of all Americans. In other words, we now call it what it is “A TAX” and not an insurance premium. The fact is the wealthy pay more in taxes than the poor.
Again, I am not proposing, supporting or endorsing the two paragraph health plan. I am simply pointing out that if we really wanted to solve healthcare, we could do it, and it would be a lot easier than what is going on in Washington today.
Alan.
Alan@birthconference.org
1) All US citizens and legal residents are automatically enrolled in the Medicaid program and will pay a fee equal to 5% of adjusted gross income, unless exempt by paragraph #2.
2) Persons having proof of health insurance or who have sufficient assets not to need health insurance are exempt from the requirements of paragraph #1.
Although I'm not proposing or supporting it. I've had a number of people ask me questions regarding it. So, I will post some questions and some responses.
1) Q. Won't expending Medicaid cause everyone to drop private insurance and move to the public program?
A. As long as providers and facilities are free to accept or refuse Medicaid patients Medicaid patients, then private insurers will offer plans with richer and better payment structures. Quite simply, their sales pitch is: “your doctor will not accept Medicaid, they will accept our insurance”..
2) Q. Your program is only available to US citizens and legal residents. What about the illegal immigrants?
A. Nothing prohibits private insurers from offering policies to no citizens, and non legal residents. A provision could be added, that if someone other than the US citizen or legal resident is given medical care and they do not pay for it, that could be a deportable offense.
3) Q. There is no exemption for the poor paying the 5% health fee?
A. There is no exemption for the poor to pay sales taxes or property taxes. Since everyone has the benefit of the expanded Medicaid program, why should they not have to pay something? On a $12,000 year income, the premium is $50 per month, regardless of how many children in the family.
4) Q. Why should a rich person have to pay such a high amount? A person earning $1 million / year would have to pay $50,000?
A. Since this program makes healthcare a right, then funding healthcare, becomes an obligation of all Americans. In other words, we now call it what it is “A TAX” and not an insurance premium. The fact is the wealthy pay more in taxes than the poor.
Again, I am not proposing, supporting or endorsing the two paragraph health plan. I am simply pointing out that if we really wanted to solve healthcare, we could do it, and it would be a lot easier than what is going on in Washington today.
Alan.
Alan@birthconference.org
Wednesday, December 2, 2009
If You're so Smart, What Would You Propose for Health Reform?
Yesterday, I talked about 60 votes in the Senate being the most important criteria for the 2000+ pages of health care reform.
Someone just asked me how I would tackle it?
Here is my 2 paragraph starting point:
1) All US citizens and legal residents are automatically enrolled in the Medicaid program and will pay a fee equal to 5% of adjusted gross income, unless exempt by paragraph #2.
2) Persons having proof of health insurance or who have sufficient assets not to need health insurance are exempt from the requirements of paragraph #1.
The above can be tweaked, amended and improved, and it should not take more than 50 pages. Perhaps the premium charge is 4% or 7%, the number is irrelevant. Two paragraphs is about concept not specifics.
Providers would be free not to accept Medicaid patients and insurance companies would compete on that basis.
I am not proposing the above as a solution for healthcare, but, if you're really serious about solving the health insurance mess, then my suggestiosn would be a starting point and we work from there.
My analysis of the political parties involved, is that the Republicans are trying to defend an indefensible system, while the Democrats are trying to manage an unmanageable system.
Alan.
Alan@birthconference.org
Someone just asked me how I would tackle it?
Here is my 2 paragraph starting point:
1) All US citizens and legal residents are automatically enrolled in the Medicaid program and will pay a fee equal to 5% of adjusted gross income, unless exempt by paragraph #2.
2) Persons having proof of health insurance or who have sufficient assets not to need health insurance are exempt from the requirements of paragraph #1.
The above can be tweaked, amended and improved, and it should not take more than 50 pages. Perhaps the premium charge is 4% or 7%, the number is irrelevant. Two paragraphs is about concept not specifics.
Providers would be free not to accept Medicaid patients and insurance companies would compete on that basis.
I am not proposing the above as a solution for healthcare, but, if you're really serious about solving the health insurance mess, then my suggestiosn would be a starting point and we work from there.
My analysis of the political parties involved, is that the Republicans are trying to defend an indefensible system, while the Democrats are trying to manage an unmanageable system.
Alan.
Alan@birthconference.org
Tuesday, December 1, 2009
Why Congress Can't Write a Good Health-Care Bill
Due to the Senate starting to the debate on healthcare reform, I'm going to hold off “Institutional Versus Entrepreneurial Financials” a day or two to comment on health reform.
Question: what is the most overriding concern regarding health reform legislation? Is it a bill that covers all Americans? Is it reducing insurance premiums? Is it a public option? Is it reducing long-term costs? Is it tort reform? Is it making the United States the best healthcare system in the world?
The answer to all of the above is “NO!”
The only single overriding criteria for Health Care Reform is: “Can the Democrats get 60 votes to allow the bill to be voted on”
That’s right, the only criteria is: “Can 60 votes be found”
Am I the only one that thinks this is a crummy way of changing or improving our health care system?
Alan
alan@birthconference.org
Question: what is the most overriding concern regarding health reform legislation? Is it a bill that covers all Americans? Is it reducing insurance premiums? Is it a public option? Is it reducing long-term costs? Is it tort reform? Is it making the United States the best healthcare system in the world?
The answer to all of the above is “NO!”
The only single overriding criteria for Health Care Reform is: “Can the Democrats get 60 votes to allow the bill to be voted on”
That’s right, the only criteria is: “Can 60 votes be found”
Am I the only one that thinks this is a crummy way of changing or improving our health care system?
Alan
alan@birthconference.org
Monday, November 30, 2009
Entrepreneurial Birth Versus Institutional Birth
Why are women, generally happier with the care they received at a birth center or homebirth as opposed to the hospital?
Many of you will list reasons such as: less interventions, empowerment of women, comfortable surroundings, individual care, and a host of others.
Allow me to introduce a different concept. In fact, it is a business concept. A hospital is an institutional form of business, while a birth center or homebirth is entrepreneurial. Quite simply, the birth center midwife or homebirth midwife is an entrepreneur (some midwives are birth center employees, however, birth centers usually operate at or near breakeven, thus a midwife employee feels like an owner or manager) , where the hospital is an institution.
You are dealing with Mary the midwife, who may be the birth center owner. In the hospital, most of your contact is with a L&D nurse, who you probably do not know. You probably do not know her, nurse manager, and most definitely do not know the hospital CEO or president.
Mary the midwife will treat you well, not only because she really cares about your birth, but also because she cares about her business. If you have had a problem with your care, you will tspeak to Mary. If you have a problem in the hospital, you will speak with some bureaucrat. To Mary, you are special! To the hospital, you are another patient.
Some physicians practices are still entrepreneurial and others are now owned by the hospital and are institutional.
Which model is more likely to try to meet your needs? Institutional or entrepreneurial?
Tomorrow, we will put some dollar signs into the models.
Alan.
Alan@birthconference.org
Many of you will list reasons such as: less interventions, empowerment of women, comfortable surroundings, individual care, and a host of others.
Allow me to introduce a different concept. In fact, it is a business concept. A hospital is an institutional form of business, while a birth center or homebirth is entrepreneurial. Quite simply, the birth center midwife or homebirth midwife is an entrepreneur (some midwives are birth center employees, however, birth centers usually operate at or near breakeven, thus a midwife employee feels like an owner or manager) , where the hospital is an institution.
You are dealing with Mary the midwife, who may be the birth center owner. In the hospital, most of your contact is with a L&D nurse, who you probably do not know. You probably do not know her, nurse manager, and most definitely do not know the hospital CEO or president.
Mary the midwife will treat you well, not only because she really cares about your birth, but also because she cares about her business. If you have had a problem with your care, you will tspeak to Mary. If you have a problem in the hospital, you will speak with some bureaucrat. To Mary, you are special! To the hospital, you are another patient.
Some physicians practices are still entrepreneurial and others are now owned by the hospital and are institutional.
Which model is more likely to try to meet your needs? Institutional or entrepreneurial?
Tomorrow, we will put some dollar signs into the models.
Alan.
Alan@birthconference.org
Wednesday, November 25, 2009
Happy Thanksgiving to You and Yours
As people are heading out of town to see loved ones for the holiday, let me take a moment to put my Blog in perspective.
I am thankful to live in the greatest country in the world. We can argue ways of improving birth, ways to improve paying for it, ways to give women more options and who is the best care provider.
BUT:
A mother of a 25 week preemie is thankful that we have the technology to give her baby a chance.
A woman with severe PPH is thankful that in this country that there is no shortage of anti-hemorrhage drugs or safe blood for transfusion
We don't worry about sterile instruments and clean gloves.
No hospital threatens to keep the baby if the bill is not paid (not true in some parts of the world)
Our doctors and nurses are well-trained, even though we can argue about birth interventions.
The illegal immigrant is so thankful that her newborn baby is automatically a citizen of these United States.
Enjoy the holiday! Enjoy the food, the warmth, the family and the traditions. On Monday, I will again be exposing, prodding and picking apart our birth care system. For this weekend, "Be Thankful." Many people do not have the blessings and abundance that we have, even in these bad times.
Alan
Alan@birthconference.org
I am thankful to live in the greatest country in the world. We can argue ways of improving birth, ways to improve paying for it, ways to give women more options and who is the best care provider.
BUT:
A mother of a 25 week preemie is thankful that we have the technology to give her baby a chance.
A woman with severe PPH is thankful that in this country that there is no shortage of anti-hemorrhage drugs or safe blood for transfusion
We don't worry about sterile instruments and clean gloves.
No hospital threatens to keep the baby if the bill is not paid (not true in some parts of the world)
Our doctors and nurses are well-trained, even though we can argue about birth interventions.
The illegal immigrant is so thankful that her newborn baby is automatically a citizen of these United States.
Enjoy the holiday! Enjoy the food, the warmth, the family and the traditions. On Monday, I will again be exposing, prodding and picking apart our birth care system. For this weekend, "Be Thankful." Many people do not have the blessings and abundance that we have, even in these bad times.
Alan
Alan@birthconference.org
Tuesday, November 24, 2009
A Death Panel by Any Other Name
On November 15th, the Wall Street Journal published an article entitled: "The Rationing Commission -- Meet the Unelected Body That Will Dictate Future Medical Decisions."
(Click Here for Full Article)
The Journal points out some things that are extremely troubling:
“In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty
So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer…
Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."”
There is a lot concerning the current Senate Healthcare reform bill, and I will discuss this over the next week or two. I just wanted to share what the Wall Street Journal is saying, because I'm sure you have not heard about this. If you watch the news on healthcare reform, all you would know is that Sen. Lieberman will filibuster the bill if it contains a public option.
2000+ pages, and the media boils it down to, "Sen. Lieberman and the public option !!”
Think about that!!
Alan
Alan@birthconference.org
(Click Here for Full Article)
The Journal points out some things that are extremely troubling:
“In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty
So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer…
Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."”
There is a lot concerning the current Senate Healthcare reform bill, and I will discuss this over the next week or two. I just wanted to share what the Wall Street Journal is saying, because I'm sure you have not heard about this. If you watch the news on healthcare reform, all you would know is that Sen. Lieberman will filibuster the bill if it contains a public option.
2000+ pages, and the media boils it down to, "Sen. Lieberman and the public option !!”
Think about that!!
Alan
Alan@birthconference.org
Monday, November 23, 2009
Cash or Accrual??...... What Does This Have To Do with Babies?
There are two methods of accounting, cash or accrual. Most households use cash and large businesses generally use accrual. What does this have to do with birth issues, you may be asking? Give me a moment, I promise it will all fit.
Cash is simple! You charge a client $200 they pay you $200, you record $200 as revenue. You receive a bill for $100, you mail a check for $100 and record $100 as the expense. "Simple!"
Accrual,…. not so simple! You send a client a bill for $1000, and record $1000 as revenue, even if you have not collected any money. You receive a bill for $500 and record a $500 expense, even if you have not paid the bill yet. A little more complicated.
Try this: you send an insurance company a bill for $5000. Under the accrual system, you record $5000 as income. Three months later, the insurance company sends you a check for $1100. You must then go back and make a $3900 adjustment to revenue to reflect the transaction and balance your books.
I think you can see my point! Many smaller businesses (and larger for that matter) can get into trouble with accrual accounting. You send in those $5000 claim form to insurance companies, and you think you've made $5000. It looks really great on the books, until the check comes and you have to make accounting adjustments. I have seen many birth practices get into trouble, because it looked really good in accrual, but really bad in cash.
Very often, when the government makes projections,. they think in terms of accrual. A 10% tax increase will bring in 10% more revenue. So they accrue, the extra 10%, and then they spend it, because in government accrual accounting, you show the revenue you expect to collect and then you spend it. Then the extra 10% does not come in, because people change the way they do business to avoid paying the10%, and now the government has a budget shortfall.
When the federal government has a budget shortfall, they print more money. When you have a budget shortfall in the birth practice, you close your doors!!!
Always keep an eye on the real bottom line.
Alan.
Alan@birthconference.org
Cash is simple! You charge a client $200 they pay you $200, you record $200 as revenue. You receive a bill for $100, you mail a check for $100 and record $100 as the expense. "Simple!"
Accrual,…. not so simple! You send a client a bill for $1000, and record $1000 as revenue, even if you have not collected any money. You receive a bill for $500 and record a $500 expense, even if you have not paid the bill yet. A little more complicated.
Try this: you send an insurance company a bill for $5000. Under the accrual system, you record $5000 as income. Three months later, the insurance company sends you a check for $1100. You must then go back and make a $3900 adjustment to revenue to reflect the transaction and balance your books.
I think you can see my point! Many smaller businesses (and larger for that matter) can get into trouble with accrual accounting. You send in those $5000 claim form to insurance companies, and you think you've made $5000. It looks really great on the books, until the check comes and you have to make accounting adjustments. I have seen many birth practices get into trouble, because it looked really good in accrual, but really bad in cash.
Very often, when the government makes projections,. they think in terms of accrual. A 10% tax increase will bring in 10% more revenue. So they accrue, the extra 10%, and then they spend it, because in government accrual accounting, you show the revenue you expect to collect and then you spend it. Then the extra 10% does not come in, because people change the way they do business to avoid paying the10%, and now the government has a budget shortfall.
When the federal government has a budget shortfall, they print more money. When you have a budget shortfall in the birth practice, you close your doors!!!
Always keep an eye on the real bottom line.
Alan.
Alan@birthconference.org
Friday, November 20, 2009
The 3P's, Which Has the Most Clout?
Yesterday, we discussed whether or not, Rush Limbaugh is worth $400 million. My point being, "your opinion has no bearing on whether or not he is worth $400 million.
Today we'll talk about the 3P's of healthcare: Payer….Provider…..Patient. Whose opinion matters most?
In a perfect world, the answer is easy, "THE PATIENT We do not live in a perfect world..
Some quick definitions:
Provider- usually a physician or hospital who invoices the payer. Providers can be a nurse or therapist, if they bill directly or indirectly through an agency. Usually the services are billed for by the facility, and so they are not normally considered providers.
Patient- the person getting treatment. At times, the relationship extends to family members who make decisions or collaborate on decisions with the patient.
Payer-usually an insurance company or the government; such as Medicare or Medicaid. Occasionally, the patient may be the payer.
We would like to think that providers carry great weight. However, they are constrained by insurance preauthorization, small reimbursements, drug formularies, government and insurance approvals and other parameters that do not always allow them to make the decision that is in the patient's best interests.
Then the patient has the most clout! This would be nice; however in the great majority of cases the patient doesn't pay the bill. It's usually pay by insurance or Medicaid. Interestingly, when the patient wants to pay cash, often obstetricians do not want to accept it.
What if the patient understood how little the obstetrician gets paid from HMO or Medicaid. What if the patient says to the doctor: "I will pay you extra, give me more personalized care.” If the doctor takes the money he/ she would be breaking the law.
I guess the patient does not have much clout.
That leaves us with the payer! The payer can decide to pay more for a physician than midwife, pay for hospital birth but not a homebirth, pay for an anesthesiologist but not a labor coach, pay for infant formula. But not lactation consulting, or the payer can decide to put you, the provider ,in-network BUT require you to carry malpractice insurance which costs over $100,000 per year.
So, who has the most clout? By now, the answer is easy. So how can activists effect change? The answer... learn to speak the language of the payer!!!
Next week, more about hybrid birth centers, also "Are Death Panels. Becoming Reality?"
Have a great weekend
Alan
Alan@birthconference.org
Today we'll talk about the 3P's of healthcare: Payer….Provider…..Patient. Whose opinion matters most?
In a perfect world, the answer is easy, "THE PATIENT We do not live in a perfect world..
Some quick definitions:
Provider- usually a physician or hospital who invoices the payer. Providers can be a nurse or therapist, if they bill directly or indirectly through an agency. Usually the services are billed for by the facility, and so they are not normally considered providers.
Patient- the person getting treatment. At times, the relationship extends to family members who make decisions or collaborate on decisions with the patient.
Payer-usually an insurance company or the government; such as Medicare or Medicaid. Occasionally, the patient may be the payer.
We would like to think that providers carry great weight. However, they are constrained by insurance preauthorization, small reimbursements, drug formularies, government and insurance approvals and other parameters that do not always allow them to make the decision that is in the patient's best interests.
Then the patient has the most clout! This would be nice; however in the great majority of cases the patient doesn't pay the bill. It's usually pay by insurance or Medicaid. Interestingly, when the patient wants to pay cash, often obstetricians do not want to accept it.
What if the patient understood how little the obstetrician gets paid from HMO or Medicaid. What if the patient says to the doctor: "I will pay you extra, give me more personalized care.” If the doctor takes the money he/ she would be breaking the law.
I guess the patient does not have much clout.
That leaves us with the payer! The payer can decide to pay more for a physician than midwife, pay for hospital birth but not a homebirth, pay for an anesthesiologist but not a labor coach, pay for infant formula. But not lactation consulting, or the payer can decide to put you, the provider ,in-network BUT require you to carry malpractice insurance which costs over $100,000 per year.
So, who has the most clout? By now, the answer is easy. So how can activists effect change? The answer... learn to speak the language of the payer!!!
Next week, more about hybrid birth centers, also "Are Death Panels. Becoming Reality?"
Have a great weekend
Alan
Alan@birthconference.org
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