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home : opinion : columns May 26, 2016


3/26/2013 6:00:00 AM
Column: With bonanza for health care executives, it's deja vu all over again
Jane Orient
Arizona Physician

Republican governors are following the script of Obama and Clinton in their campaign strategy for the Medicaid expansion that is needed to implement ObamaCare: The cast of earnest white coats and tearful upstanding, hard-working patients with hard-luck stories. Statements that sound as though they were written by the same PR firm. The same dire consequences of inaction.

Children won't get their shots, cancer patients won't get their chemotherapy, hospitals will close, a victim of hepatitis C will die without benefit of treatment, people won't go to the doctor and be made healthy, jobs will move to China, and on and on - unless we expand Medicaid to people at 133 percent (actually it turns out to be 138 percent) of the federal poverty level. But not 150 percent, 250 percent, or 500 percent.

"It's just the right thing to do," is a favorite concluding sentence.

What "it" basically means is to get the "free" federal money before somebody else does. Since it doesn't cost "us" anything, at least not at first, it's a "no brainer" to just grab it. It means billions of dollars, and thousands of jobs, for "us."

But if we exercise our brains for a minute, we see that in reality the billions go to "them," not "us." They are the ones in the expensive suits lurking in the background and attending the closed-door meetings. They are the million-dollar-a-year executives of managed-care companies or administrators in big hospital chains. They get the billions and trickle a portion down to people in scrubs and white coats who do real work, for the care of approved patients. They are the real players; the visible ones are props, shills, or camouflage. They are the decision-makers, who decide who is eligible for what.

They don't think like doctors. Doctors ask, "What is the best way to help this patient with hepatitis C?" Rather, they ask, "Is this person with a certain set of social characteristics worth spending some of 'our' resources?"

The case made by the hospital lobby does not compute. Big hospitals are expanding and renovating. They have opulent reception areas and building cranes in front. They claim to lose money on every Medicaid patient - yet they want more such patients? They bemoan the loss on uninsured patients - but their DSH payments (disproportionate share payments meant to compensate for this) will be cut more under ObamaCare if the state expands Medicaid than if it does not. Big CEOs are not dumb. They surely have a reason, with dollar signs on it, for wanting more Medicaid. I just don't think they are telling us what it is.

Managed-care companies want Medicaid for an obvious reason: It is their cash cow. They have the process of covert rationing down to a science. No need to worry about not meeting executive payroll. If drugs are too expensive, they disappear from the formulary; cancer treatments that are too costly become "inappropriate," "experimental," or even "futile."

Patients, of course, want care. But do they really want Medicaid? About one-third of eligibles do not enroll. Maybe it is just too difficult. Maybe they read the disclosure form explaining that if any money is spent on their behalf after age 54, whether for managed-care fees or actual services, it can be seized from their estate. Maybe they know that a lot of doctors won't make an appointment for them if they have a Medicaid card.

Doctors representing organized medicine are on the dais with the governor. But they probably don't want more Medicaid patients in their own practice. The pay is low, and administrative overhead is high. Worst may be the frustration in having to constantly fight to get patients what they need.

Medicaid was enacted in 1965 and has grown and grown to the point of threatening to bankrupt states. It covers about one in five Americans, but the number of uninsured keeps growing too.

One might think that it is time to do something different. Instead, when a government program fails, the no-brainer answer is to expand it further. We see it over and over again. It's as predictable as the result of letting Lucy hold the football for Charlie Brown.



Jane M. Orient, M.D., executive director of Association of American Physicians and Surgeons (http://www.aapsonline.org/), has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University Of Arizona College Of Medicine. She is the author of Sapira's Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care.


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Reader Comments

Posted: Thursday, March 28, 2013
Article comment by: Anson's Nephew

Roy

More chain e-mail garbage.

“Soroes went to Venezuela and bought all the coastal water lands, then Obama took millions to Venezuela and gave to them.”

Wrong. Now for the facts – This nonsense stems from a "preliminary commitment" made on 14 April 2009 by the board of directors of the Export-Import Bank of the United States. The banks intention was to loan $2 billion to finance exports to the Brazilian oil company Petróleo Brasileiro over the next several years, specifically to finance the purchase of U.S. made oilfield equipment and services. The mission of the Ex-Im Bank is to encourage exports by making such loans.

The e-mail claims the decision was due to an "executive order" by the president. No presidential order was required and none of President Obama’s appointees were members of the Ex-Im bank at the time of the vote. The Ex-Im Bank states: "… at the time the Bank’s Board consisted of three Republicans and two Democrats, all of whom were appointed by George W. Bush."

The e-mail further stated Soros would "benefit most" from the loan, also baseless. Soros’ hedge fund sold, before the loan, 22 million shares of common stock in the company (which carry voting rights) while buying 5.8 million shares of preferred stock (which is non-voting.) As reported by Bloomberg News, Soros reduced his stake in the company before any of the Ex-Im Bank’s promised loan had been dispensed.

“Just like government agents recommending to the owner of Gibson guitars, after illegally raiding their factory, that they should move to China. Reason: Gibson employees voted not to go Union.”

Also incorrect. Gibson was brought to task for the illegal purchase of wood from overseas. They broke the law, period, and it had nothing to do with workers or unions.


Posted: Thursday, March 28, 2013
Article comment by: anonymous anonymous

original Kingman resident....your amusing to say the least, your use of "you libs" as if it was some social disease is telling you just cannot get over your party had 8 years under Bush Jr who spent like a drunken sailor, two mid east wars on a Chinese credit card and the bill is due, obviously you think blaming others will make him disappear from history as a mirror image of Herbert Hoover! The whiners today are the sore losers who lost the last two presidential elections and just cannot figure how they lost since they think they are in this mythical majority! Reality is nationally GOP is about 22% of the electorate having heavy pockets in back water towns like Kingman does not a majority make!

Posted: Thursday, March 28, 2013
Article comment by: Nice Chuckle

@Linda

"It is time to do something different. Let's hope Dr. Benjamin Carson runs, wins and leads us in a new and better direction with health care. He's got the brains, he's got the plan."

And let me guess, you will support him fully too, right? Well, until he falls behind in the polls and you declare he would never have won and you never were really for him. Like you did in the last election. LOL


Posted: Thursday, March 28, 2013
Article comment by: Anson's Nephew

Ms Athens

“Let's hope Dr. Benjamin Carson runs, wins and leads us in a new and better direction with health care. He's got the brains, he's got the plan.”

No, let’s hope he doesn’t – oh wait, sure, let him run (and believe me he would never win) along with the rest of the right wing we saw last time around. Nothing will guarantee Hillary the White House than another long string of spewing utter nonsense and hiding their money off-shore.


Posted: Thursday, March 28, 2013
Article comment by: Face It. KDM Plays The Propaganda Game for the Right

Do we really expect this newspaper with the current leadership to run articles that are supportive of anything associated with President Obama?

Posted: Thursday, March 28, 2013
Article comment by: Roy Leggett

Yes, there are sudsidies for oils companies, but not in America. Soroes went to Venezuela and bought all the coastal water lands, then Obama took millions to Venezuela and gave to them. Next Obama stopped off shore drilling in the US. Brilliant move on their part in saving American jobs...NOT....Just like government agents recommending to the owner of Gibson guitars, after illegally raiding their factory, that they should move to China. Reason: Gibson employees voted not to go Union.

Posted: Wednesday, March 27, 2013
Article comment by: origional kingman Resident

@ Trained observer

The money would be better remaining in the pocket of the person who earned it in the first place.

Remember, you libs whine about all the tax subsidies that supposedly only oil companies and insurance companies get. The taxes that will pay for obama care will come out of the pocket of middle class working people.


@ Cliff

I agree 100%!


Posted: Wednesday, March 27, 2013
Article comment by: Linda Athens

Great letter from Dr. Orient. She is right on. As we go along and more and more of this is revealed, it's going to get worse and worse.

It is time to do something different. Let's hope Dr. Benjamin Carson runs, wins and leads us in a new and better direction with health care. He's got the brains, he's got the plan.


Posted: Wednesday, March 27, 2013
Article comment by: Sounds like You Doctor

Sounds more like you are talking about yourself there Doctor! "But if we exercise our brains for a minute, we see that in reality the billions go to "them," not "us." They are the ones in the expensive suits lurking in the background and attending the closed-door meetings. They are the million-dollar-a-year executives of managed-care companies or administrators in big hospital chains."

Posted: Wednesday, March 27, 2013
Article comment by:

@(not so) trained observer:

You must be one of those adults not working and/or making less than the 138% of the federal poverty limit, who wants free medical care!

the topic is medicaid expansion and giving the feds more control over our healthcare system. Quit bringing up the tired bulls$*t whine about subsidies of oil companies (which don't exist) and focus on the issue.


Posted: Wednesday, March 27, 2013
Article comment by: Anson's Nephew

"Jane M. Orient, M.D., executive director of Association of American Physicians and Surgeons "

Yep, no conflict there.


Posted: Wednesday, March 27, 2013
Article comment by: anonymous anonymous

As I read this fairy tale it quickly became apparent it was a anti-Obama rant, and when I read the writer is a MD/Doctor who advocates for Doctors it all made complete sense to doctors, nurses and the funny part of the story was it was like the pot calling the kettle black! Insurance companies and doctors, nurses, hospitals all work together for mutual profits! They see socialized medicine as the end of their monopoly and end of their ability to charge them $5 fees for asprins, and their path to becoming rich members of the 2% class! Funny how healers in bygone eras truly did care about healing and not their bottom line profiteering, but alas the end is near for the leeches on society who profiteer off the illnesses and misfortunes of others they will fight, scream but the fact is its coming!

Posted: Wednesday, March 27, 2013
Article comment by: Cliff Foster

Doctor. Patient. Cash.

Everything else, whether HMO, PPO, or ObamaCare, is a shell game intended to insert more middle men between patient and caregiver.

For those that cannot afford a doctor and are in duress, seek charity hospitals. When recovered, be charitable and donate to said charity hospital. If said charity hospital does not exist, work with your local church or spiritual body to institute one.

Lastly, push for tort reform.

Health care dilemma solved.


Posted: Tuesday, March 26, 2013
Article comment by: B Snake

? think about it all? medical, insurance co, politicians, big oil, big bankers etc? in 10yrs we will be like mexico or Greece!! 10% ultra rich 90% poor!!. they even steal from our schools! L.A.s primary language is Spanish already. yet every time they label a new prop,bill saying it,s for our schools, medical etc, the real money is in the small print nobody hear,s about and it all vanishes never to be seen again? until the next elections!!.

Posted: Tuesday, March 26, 2013
Article comment by: trained observer

Yes lets take this away completely. We all know that the money spent here would be better given to the oil companies as subsidies or to foreign countries that hate us. Why give anything to anyone here that has no other options?
Another greedy doctor in AZ.




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