Steve Robinson’s melodramatic rhetoric regarding Veterans Affairs employees gaming performance metrics for wait times misinterprets facts to discredit single-payer health care and the VA (“VA corruption devastating for Michaud, single-payer fans,” June 7).
He confuses the VA health care system, a monopoly, with the single-payer system that’s been advocated by people such as Sen. Bernie Sanders.
The single-payer, universal health care system, as exemplified by Canada – and our own Medicare – is a monopsony. In a monopsony, instead of having a single seller, as in a monopoly, there is a single buyer.
A state monopsony would allow many advantages and eliminate many of the vices that exist under our privately controlled oligopoly of health insurance giants and health care conglomerates that buy, sell and trade care for considerable reward, while distributing care according to who can pay and impoverishing many Americans.
When the VA decided to offer financial incentives for lowering wait times, it was borrowing a tactic of the private sector. HMOs (notoriously) and today’s accountable care organizations use financial incentives to increase cost efficiencies, as recommended by the National Commission on Physician Payment Reform.
Mr. Robinson alleged: “Federal workers systematically defrauded transparency protocols to slake their greed.”
It’s as likely their deception was to avoid sanction. In an authoritarian organization, in the face of unreasonable demands, rather than raising protest, it’s sometimes easier to deceive your superiors.
The tempest over the fraudulent manipulation of wait-time data leaves few voices to ponder the reasons for excessive wait times, which suggest shortages of professionals. This is at the heart of the matter, for which there may be much blame to go around.
Perhaps our continual wars and the vast numbers of veterans who’ve sought help from a beleaguered VA system have something to do with this particular scandal, with its accompanying sound and fury.

UnitedHealthCare disadvantages Medicare Advantage

By the editorial board
St. Louis Post-Dispatch, June 24, 2014
One of the major flaws in the Patient Protection and Affordable Care Act is also one of the reasons it was able to pass: It accommodated, and in some ways enhanced, the role of for-profit insurance companies.
Last week, the Post-Dispatch’s Tara Kulash reported that thousands of Missouri seniors and hundreds of its doctors had learned that they’d be paying a high price for this accommodation. The patients are among the 95,000 Missourians who purchased a Medicare Advantage plan from UnitedHealthCare (2013 profits: $10 billion). Many of the doctors appear to be practicing in suburban or rural areas in such fields as dermatology, ophthalmology, gastroenterology and orthopedic surgery.
The company, the nation’s largest seller of Medicare Advantage plans, is reducing the number of doctors in its approved-provider network. It appears to be trying to steer patients into large hospital-affiliated physician groups, where there are economies of scale. By Sept. 1, eight months into the coverage year, patients will have to find new doctors.
Had there been the political will to enact a single-payer national healthcare system, this sort of problem could have been avoided.
Certain conflicts were inevitable with the ACA, one of them being the insurance companies’ desire to make as much money as possible and the government’s desire to cover as many people as possible at the lowest possible cost.
One of the ways the ACA does this is by gradually reducing its subsidies to Medicare Advantage Plans, which are purchased by about 30 percent of Medicare-eligible seniors. These 15.7 million Medicare Advantage policyholders get broader benefits and lower co-pays than the 20 percent paid by traditional Medicare patients. Indeed, those 20 percent copays help pay for the lower costs of Medicare Advantage.
But unlike basic Medicare, which is a fee-for-service plan that allows patients to see any participating doctor they want, Medicare Advantage plans are like HMOs: They specify the doctors, hospitals and other providers that patients can visit.
To offset declining federal reimbursements — or to boost profits, or both — some of the companies that sell Medicaid Advantage plans have decided to shrink the number of doctors in their provider networks.
UnitedHealthCare began cutting its provider network in Missouri and other states this spring. The second round of cuts announced last week will affect between 5 and 7 percent of the 10,000 physicians currently in UnitedHealthCare’s Missouri network.
UnitedHealthCare hasn’t offered a reason for its decisions. It owes a full explanation to doctors, patients and the public that is paying the Medicare bills.
The natural speculation is that UnitedHealthCare is hiding behind the ACA to boost its profits. In a letter to UnitedHealthCare CEO Stephen Hemsley (2010-2013 total compensation: $212 million) last spring, Thomas L. Holloway, executive vice president of the Missouri Medical Association, suggested the company is “cherry-picking … targeting the sickest, most costly patients and summarily terminating the physicians.”
The Centers for Medicare Services, which administers the program, should review such decisions. The ACA won’t work if companies can go back to dumping their sickest patients. The AARP, which teams with UnitedHealthCare on a popular Medicare Advantage policy, should reconsider that partnership. And during this fall’s enrollment period, patients might want to shop elsewhere.

Heart Of The Matter: Treating The Disease Instead Of The Person

by LEANA WEN

A 56-year-old man is having lunch with his wife at a seafood restaurant just outside Boston when he develops crushing chest pain. He refuses an ambulance, so the man's wife drives him to the ER.

What happens next says a lot about the difference that being a doctor or a patient can make in how one feels about the health care system.

First, how did the patient and his wife see the trip to the hospital?

When the man arrives in the ER, he is told to take off his shirt. He lies in the hallway, in pain, naked from the waist up. Strangers surround him. They don't introduce themselves, and they talk over him, at each other.

Pagers ring and there's a lot of beeping. Someone else must be really sick, he thinks; that must be why no one is paying attention.

After a few minutes, he signs some forms and finds himself being wheeled into an elevator. Masked figures enter. He feels a cool liquid flowing into his veins. The lights go out.
He wakes up hooked up to machines, uncertain what has happened. It takes several hours for the staff to find his wife, who is still waiting in the ER lobby and has no idea why her husband is in intensive care.
They are both surprised when they find out, two days later, that he's had a heart attack. As soon as they get home, they file a complaint with the hospital about their terrible experience.
Now, how did the staff at the hospital see it?
A triage nurse greets the patient immediately upon his arrival and finds out that he has chest pain. Within three minutes, he gets an electrocardiogram that shows he is having a heart attack. The ER doctor activates the special heart attack pager, which immediately summons the emergency cardiology team.
The doctors and nurses arrive and bring the patient up to the catheterization suite. There, the attending cardiologist threads a catheter through an artery in his groin and pushes it all the way to his heart, where the doctor sees on an X-ray machine that a vessel is blocked. She inflates a small balloon in the catheter, opening the artery and restoring the flow of blood to the man's heart.
All told, it took only 22 minutes from the time the man entered the hospital for the cardiology team to clear the blockage. The cardiology team is proud that they beat the national averagefor what they call door-to-balloon time by 42 minutes. The faster a blockage can be cleared, the better the odds are for a full recovery.
The patient gets well without complications. Two weeks later, he's back at work and exercising again. The ER and cardiology teams consider the man's case a resounding success.
Why then are there such different views of the same ER visit? Who's right? The doctors who believe they delivered exemplary care, or the patient and his wife who feel he was treated badly?
http://www.npr.org/blogs/health/2014/06/25/324005981/heart-of-the-matter-treating-the-disease-instead-of-the-person

California probes Obamacare doctor networks at Anthem and Blue Shield

California regulators are investigating whether Anthem Blue Cross and Blue Shield of California have violated state law in connection to patients struggling to find doctors under Obamacare.
Officials at the California Department of Managed Health Care said they are looking into whether consumers were misled by inaccurate provider lists and the difficulty some patients are still having at locating a physician in narrower networks statewide.
"We began our review based on a pattern of complaints that came to our help center regarding provider access," agency spokeswoman Marta Green told The Times. "Our preliminary investigation gave us good cause to believe there are violations of the law."
Green said the department expects to wrap up its investigation within 60 days and then send its findings to the two companies. The insurers will then have 45 days to respond.
The disclosure of a state investigation raises the stakes for one of the biggest problems plaguing the initial rollout of the Affordable Care Act.


Confusion over doctor lists is costly for Obamacare enrollees in state

Frustration and legal challenges over the network of doctors and hospitals for Obamacare patients have marred an otherwise successful rollout of the federal healthcare law in California.
Limiting the number of medical providers was part of an effort by insurers to hold down premiums. But confusion over the new plans has led to unforeseen medical bills for some patients and prompted a state investigation.
More complaints are surfacing as patients start to use their new coverage bought through Covered California, the state's health insurance exchange.
"I thought I had done everything right, and it's been awful," said Jean Buchanan, 56. The Fullerton resident found herself stuck with an $8,000 bill for cancer treatment after receiving conflicting information on whether it was covered.
"How am I going to come up with that much money?"
Insurers insist that pruning the network of doctors is a crucial cost-cutting measure and a major reason that so many Californians could find affordable coverage in the health law's first year.
"These narrow networks are making a huge difference in terms of affordability," said Mark Morgan, president of Anthem Blue Cross, a unit of industry giant WellPoint Inc. "We found in convincing numbers that people value price above all else."
But regulators, lawmakers and consumer advocates are pushing back to ensure patients know what they're giving up in return for lower rates — and don't run into unnecessary roadblocks to care.
This month, the California Department of Managed Health Care began investigating whether two major insurers, Anthem Blue Cross and Blue Shield of California, are violating state law related to inaccurate provider lists and offering timely access to treatment.






Regulators say customers of those two companies, which account for nearly 60% of Covered California's enrollment of 1.4 million people, have complained the most about provider-related issues.
Consider Buchanan, who lost her previous coverage when her insurer dropped out of the individual market last year. She was diagnosed with breast cancer in July, so she opted last fall for a Platinum plan, the highest level of benefits on the state exchange, from Blue Shield.
Buchanan started treatment at UC Irvine Medical Center in the fall, and her oncologist there took her new Blue Shield insurance in January and February. Then the day before her lumpectomy, UC Irvine called to say her insurance wasn't accepted after all. She initially canceled the surgery, but her family and friends told her she shouldn't risk waiting.
Buchanan is paying $200 a month on her $8,000 surgery bill. UC Irvine said there's been considerable confusion among Blue Shield customers with exchange plans.