Wednesday, August 12, 2009

Govt Healthcontrol? Anyone Remember HMO's?

Obamacare? Hello America, this is Cassandra calling...
Anyone recall the brouhaha over the one time dreaded HMO's? Remember how, this was what, the early 90's? Where everyone wanted to be sure that their insurance plan did not restrict them to HMO's? Remember how if you couldn't afford a plan that gave you the ability to pick your own Dr's (what a concept), we at least wanted to have PPO's instead?

Don't you remember why?

Oh yes, it was the early 90's... as a matter of fact, it was about '93 when the fear that Hillarycare was going to look like an HMO which sunk Clinton's national healthcare proposal during that go around.

Anyone remember WHY the HMO's were so dreaded at that time? If you don't remember, there were lawsuits and biter complaints flying right and left over things like:

  • malpractice suits,
  • hours and hours of waiting in crowded (seated lines) in doctors offices,
  • an inability to get the more effective treatments and medications,
  • bottom of the barrel physicians - even in many cases incompetent,

What brought those issues about? It's a simple question, and there is a simple answer.

Because Doctors were not free to practice Medicine in the way the Doctor's would choose to practice it! And at that time, this was mostly due to private rules - imagine how things will be when they are being told what to do by Federally mandated rules! Here's a summary of what takes place in the physicians mind (and here a much fuller explanation of not only the issues, but of the immorality behind them) who is not free to make his own decisions,
"Today, in one form or another, the following also has to enter that brain: 'The DRG administrator [in effect, the hospital or HMO man trying to control costs] will raise hell if I operate, but the malpractice attorney will have a field day if I don't -- and my rival down the street, who heads the local PRO [Peer Review Organization], favors a CAT scan in these cases, I can't afford to antagonize him, but the CON boys disagree and they won't authorize a CAT scanner for our hospital -- and besides the FDA prohibits the drug I should be prescribing, even though it is widely used in Europe, and the IRS might not allow the patient a tax deduction for it, anyhow, and I can't get a specialist's advice because the latest Medicare rules prohibit a consultation with this diagnosis, and maybe I shouldn't even take this patient, he's so sick -- after all, some doctors are manipulating their slate of patients, they accept only the healthiest ones, so their average costs are coming in lower than mine, and it looks bad for my staff privileges.' ..."

In part, the uproar over HMO's (and the fear of hyper-HMO's that Hillarycare would've mandated (which pales in comparison to Obamacare)) was due to what the:

Insurance companies policies and existing govt regulations,

  • would and wouldn't allow their Dr's to do or offer,
  • the hours they shecheduled them to work,
  • the time they'd allow per patient visit,
  • the 'allowed' diagnosis' and tests they would pay for

Or as one of the Insurance companies sites today that is promoting both HMO's and PPO's describes some HMO considerations as,
"That means your costs stay lower - but there will be restrictions on how you receive your care....HMOs and PPOs differ in two main ways: cost and access... The tradeoff for these low costs is that your HMO plan comes with restrictions on when you can receive care - and who you can receive it from."

What seems to slip peoples awareness, is that these factors came about in an environment where there were free market 'controls' of consumer choice (also called competition) in effect.

Ok, anyone remember where HMO's came from? Or why? Did they come from the free market? Well ... sort of... at one time. Originally HMO's were little different from company co-ops, a pooling of patients for lower costs from Dr's willing to systemize there fee's onto a schedule of limited services. They weren't all that popular, and had pretty much died out in the free market for lack of interest, on the party of either party, due to general dissatisfaction in both receiving AND giving care.

Almost dissappeared. Why not completely? Well....

Along came something called the "Health Maintenance Organization Act of 1973", a govt plan to keep pesky medical care costs from rising (at which point of course they rose even faster), and it was signed into law by the proregressive republican President Richard Nixon. Passed in typical little 'r' washington republican fashion, as a 'moderate' way of countering a leftist's proposal that 'we put a gun to our heads and pull the trigger', with an offer for a less extreme compromise of 'how about we inject ourselves with a slow acting poison instead'?

Oh, and guess who the 'gun to the head' option was sponsored by? Oh, come on, guess!

Correct! Sen. Ted Kennedy. I just can't wait to receive both barrels of his wisdom, fermented now for 36 years!

It bears all the hallmarks of proregressive, leftist, policy making: Experts create panels of experts to lay out the most 'scientifically' sensible plans for managing (always a key term) all potential issues beforehand, which expert 'healthcare professionals' aka bureaucrats, can then use to direct and manage the healthcare process, smoothly, efficiently, and for lower costs.

What was the predictable result of this proregressive leftist washington wisdom?
  • patient dissatisfaction,
  • doctor dissatisfaction,
  • rising malpractice suits,
  • hours and hours of waiting in crowded (seated lines) in doctors offices,
  • an inability to get the more effective treatments and medications,
  • bottom of the barrel physicians - even in many cases incompetent,
  • a shortages of doctors able to cover the hours they shecheduled them to work,
  • rationed time allowed per patient visit,
  • inflexible and often inappropriate 'allowed' diagnosis' and tests they would pay for

Sounds like I've heard those warnings somewhere before (... oh, hello there Cassandra)

Ladies and Gentlemen, HMO's were the creation of the federal government, created to FIX THE HEALTHCARE SYSTEM that was working far better then, than it was after the FIX was applied.

I don't know about you, but I can easily foresee what will happen when the entire healthcare system becomes one big HMO, when the 'Insurance policies' are written by the govt and are immune to any pesky concerns over competition or 'consumer' complaints.

Does anyone have any reason, any evidence, any track record to hearken to, in order to believe that the Federal Government, this time, will make things better, instead of worse?


Anyone interested in some info that doesn't reak of the current conflict of today? If so, might want to take a look at what USS Ben has to say on current matters (VA, etc).

Not enought? How about a little recollection on previous promises of how things would turn out, things like,

Income Tax was promised to be - a temporary tax for current (circa WWI) defense related costs, that's all , what it was promised it would never exceed "1 percent tax on net personal incomes above $3,000 with a 6 percent surtax on incomes of more than $500,000", and who it would NEVER apply to - only one-half percent of Americans would EVER pay taxes, only the richest people would ever be taxed! Ever! How'd that bit of hope and change work out for ya?

Social Security - was promised to be only a tax of 1% each on the employer and the employee, on the first $3,000 of earnings, and originally, Social Security benefits were not taxable income, it was sold as an "Insurance Plan", a 'Trust Fund' but was from the very start a 'pay as you go' ponzi type scheme.

Medicare - When passed in 1965, it was confidently forecast that it would cost only 9 Billion in 1990. As is typical of Govt forecasts, that was a bit shy of the mark, it was 66 Billion in 1990 (don't ask, it's projected to become insolvent by 2017).

Perhaps a few reminders from the past might yet help us keep Cassandra at bay:

Two videos on the key issue, far more important than ANY consideration of costs,
Health Care Is Not a Right By Leonard Peikoff

Anyone interested in an indepth balanced (meaning much of it rankles me)
Overview, from Duke Univ. Law Journal

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