Health “Scare” Reform?

In 1991 I attended a “managed care” seminar in NYC while working for my second medical device marketing company. I don’t recall much regarding the specifics, other the theme was dark and foreboding, with dire predictions of “crisis” and impending doom, sound familiar? The speakers were mostly from the insurance industry, with a few healthcare consultants mixed in, for spice and flavor I guess…

The takeaway, (other than all us sales reps hitting the town each night and exploring the “big apple”), was that the industry was changing quickly, like a virus spreading through the populous with no cure in sight.

Hospitals were forming alliances while insurance companies created something called, “HMO’S”. Patients would be herded into “managed groups” and forced to see only physicians that “participate” in specific plans. Coverage was changing for patients, with reduced reimbursement for hospitals and physicians, while the trickle down began to seep into the corporate profits of the medical products manufacturers.

The last night of the seminar, the President of our surgical instrument company, hosted a dinner at a posh Manhattan restaurant. As he raised his glass to propose a toast to the sales force, he offered a chilling comment of the things yet to come;

Ladies and Gentlemen, Camelot is over. – President/CEO, Storz Instruments

For years, our sales were booming, as the aging “boomers” required eye surgery (specifically a lens implant) to replace the cloudy “cataract” that often comes with aging, thus limiting vision. Hospitals and ophthalmic surgeons jumped in on the gold rush, some even buying vans to pick patients up at nursing homes and assisted living facilities (no lie). One “big cutter” I called on, had 2 operating rooms attached to his clinic (another trend in the 90’s;  the “Ambulatory” surgery center). He got his surgery time down to under 10 minutes, using a device I sold along with the implants, to suck out the cataract through a tiny incision.

Starting at 6:30am, he would routinely do 20 “extraction with implantation” procedures before noon; almost every day of the week. Jumping from one room to the next, ripping his gloves off as he walked through the door separating one patient from another. It was a literal assembly line of “seasoned citizens” awaiting their turn to see clearly again…

Now before you start demonizing the “rich fat cat” corporations or the healthcare providers, don’t forget to remind the “state media”, that setting the table for this money grab was the all mighty Federal government! That’s right folks, we aren’t on the verge of government take over and control of our healthcare system; they’ve been pulling the strings all along!

Yet as our company President declared, it was all coming to an end, as all good things do, especially when government is involved. Don’t believe me, well try and put a “spin” on this one. Liberal or conservative, O’Reilly or Obama, the facts are there for all to see, like a cataract extracted from your political eye. Just as Wall Street and the banks are blamed for the current financial mess, hospitals and insurance companies are being blamed for the healthcare “crisis”. The private sector vs. politicians, you decide….

Not to be overly complex (or boring) with the details of healthcare reimbursement and insurance, as it is as insanely confusing and bureaucratic as everything and anything the government does and tampers with, but here you go…

“Camelot” was ending for my old company, as well as a lot of the cataract surgeons and manufacturers, because reimbursement was being cut, drastically. The majority of these patients, qualified for Medicare or Medicaid, both government programs, as most of you know. For years up to that point in 1991, doctors and hospitals were “reimbursed” for the procedure of cataract extraction, for an obscene amount. At least for the amount of time the surgery required and the supplies utilized.

The “implant” I sold was simply a miniature-sterilized version of a lens in a pair of glasses. We sold it to hospitals for about $350, which the doctor then implanted. The hospital then “billed” the patient (or should I say Medicare), for the implant and the procedure. I have seen some hospitals charge as much as $2000 for the lens, and thousands more for the surgery. Approved and paid for by your tax dollars, through a federal government program called Medicare.

So what happens next is obvious, remember, it’s the federal government at work here. As the facts work through the bureaucracy, what with Medicare hemorrhaging cash while mismanaging the “program”, they (the feds) take notice of this huge category (cataract surgery) and decide to take from Peter and give to Paul. Yea, let’s slash reimbursement in half for one popular procedure and give to another. A literal shell game operating in hospitals around the country, compliments of your elected officials. They may not be doctors, but they play one on TV, at least that’s what they want you to think…

Now if you haven’t tuned me out yet and turned on some reality TV show or video game, pay attention please; your health is at stake. The current condition of our incredibly advanced health care system (guess where world leaders go if they get really sick, not Canada or England) is critical when it comes to cost and insurance because of three little letters. No, not greedy CEO’s or even AIG, but yet another good intention, liberal idea gone astray; D.R.G.’s (Diagnosis-Related Groups)

This is not an opinion, not some college professor theorist philosophy or political ideology, this is a fact. We debate in the arena of ideas about bail outs and banking, gun control and abortion, but D.R.G.’s have been in place and impacting our health care system since 1983! Real legislation with specific consequences, compliments of federal intervention into medicine;

The prospective payment system implemented as “DRG’s” had been designed to limit the share of hospital revenues derived from the Medicare program budget, and in spite of doubtful results in New Jersey, it was decided in 1983 to impose DRGs on hospitals nationwide. -N.J. D.R.G. payment system; William Hiaso, Harvey M. Sapolsky

Ladies and Gentlemen; I will propose that none of you have ever heard of, know anything about, or perhaps even give a damn about D.R.G.’s. Yet it was created by a typical Ivy league (Yale) policy wonk, supported and implemented by your local federal agency (HCFA – Health Care Financing Administration), oh yea, and passed in the middle of the night, while America slept, in 1983!

The concept has been an abysmal failure, as has almost every Federal program, from Social Security to “stimulus” bills. If you want to look inside the exam room, behind the scenes, get a glimpse what a national healthcare system would look like, learn a little more about D.R.G.’s, as well as Medicare and Medicaid. You have nothing without health, and I hope you are scared to death with what is currently being proposed by those who have manipulated the system and continue to fail you, the American patient:

The most significant change in health policy since Medicare and Medicaid’s passage in 1965, DRG’s, went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. – Mayes, Rick – Origins of Medicare’s Revolutionary Prospective payment system