George A. Sprecace M.D.,
J.D., F.A.C.P. and Allergy
Associates of New
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Rapid Response for SUNDAY,
families are products of the free market system. Nobody gave us
anything. Nor did we expect it. In that system, there were always
winners and losers. Then that was allowed, even expected - like the
tides. Given the last two or three generations, losing is not allowed.
Everyone must be a "winner", with "participation awards", with diluted
grades at both levels of the spectrum, and above all with ENTITLEMENTS.
The word itself indicates the mind - set: we don't have to earn or be
responsible...we are Entitled. The concept has now altered the genetics
of hundreds of millions of voters and potential voters and illegal
voters. The Democratic and Republican and Republicrat politicians have
done their job well. Thus, whether we are dealing with what the
author N.N.Taleb has coined "IYY" ("Intellectual yet idiot") or just
with run of the mill hypocracy / cynicism, THERE MUST BE NO LOSERS, as
is inevitable in a free market system. And there is another
problem. The "Free Market System" (aka. Wall Street in many minds) is
simply not to be trusted. Washington is considered not the only
"swamp". I think you will agree that some of this has been earned. So, what to do? For
that, you need to read or re-read my many commentaries regarding HEALTH
CARE REFORM" which populate my web site. They are all designed to
re-inject Personal Responsibility into the Health Care System. They are
all doable, given the legislative will. And they will all be attacked:
"YOU CAN'T TELL ME WHAT TO DO, JUST GIVE ME MY ENTITLEMENT". The end-game of that unsustainable scenario: with or without "medical care", prepare to suffer and die. "In a democracy, the people always get what they deserve".
there are of course bad actors in the free market, they are held
accountable for their actions. Bad actors in government are much more
dangerous because they have the ability to use force over others (that
is the essence of government) and the government just throws more money
at problem programs and departments while private companies are
decimated by the market, the SEC, and the DOJ when the do something
fraudulent (as they should be).
IMPORTANT: HEALTH CARE COVERAGE, "PRE-EXISTING CONDITIONS", AND GENETIC TESTING. A
genetic pre-disposition is Not a "pre-existing condition". I argued
that years ago, including on this web site. But I then cautioned
patients and the public not to undertake genetic testing unless and
until iron-clad safeguards for their equal insurability were in place.
Those safe-guards eventually came in the form of a Federal Law: GINA. See the article published in ctmirror.org July 2, 2017: "Safe Under ACA, Patients With Pre-Existing Conditions Now Afraid", by Charlotte Huff / Kaiser Health News. Of course, when dealing with lawyers and paid-off legislators, "it depends on what the meaning of the word 'is' is". Any
new Health Care legislation MUST safeguard the equal insurability of
persons who might seek information about genetic pre-dispositions
before any "manifest disease" is diagnosed. The alternate - no
protection or weasel-word "protection" would effectively eliminate this
important method of avoiding "manifest disease" in time.
MORE, EVER MORE, ON HEALTH CARE. This report has it exactly right.
Rapid Response for THURSDAY
and FRIDAY, March 9 and 10,
REGARDING HEALTH CARE DELIVERY... So you think that America is in a crisis? A little perspective here, please. How about the situation in 2030 and 2040 and 2050. Since
I can't be sure that I'll still be in Medical practice in 2030, when
I'll be 97 years old, the following is some information gleaned from an
article in "Biosupply Trends Quarterly", Winter 2017 edition, entitled
"Healthcare Crisis". After that, I'll offer some advice...of course.
is about the aging Baby Boomer Generation, born between 1946-1964. They
number about 75 million. In 2011, 41 million had reached the age of 65.
In 2030 there will be 71 million, a 73% increase. They are living
longer...but they are not aging well: Diabetes, Arthritis, Heart
Diseases, Obesity, Hypertension.... They will need a 100% increase in
knee replacements. They will need a 100% increase in hospitalizations.
And a big factor will be Alzheimer's Disease. In 2015 there were 4.7
million of this group. In 2040 there will be over 10 million, all
needing a great deal of care.
In the above article, these present and future patients are described as a "highly opinionated and vocal demographic". Folks, that won't be enough for you to navigate your "Golden Years". Herewith, the elements of a plan, also my plan. 1) Live a healthy life -style. You know what I mean. 2) Your "Retirement Plan": DON'T RETIRE! Rather, plan for a second and even third career. You're likely to have the time. 3) Save your 401-K for your health care expenses. Sounds terrible...but it's realistic. 4)
Explore different kinds of health care for yourself. Make personal
choices, and not only for end-of-life. Not everybody needs or wants
"everything". 5) Choose your physician(s) carefully and for the long-term. 6) Advocate to unchain physicians from the regulatory and legal morass in which they find themselves now. 7) STAY FRIENDS WITH YOUR FAMILY! 8) PRAY.
Good Luck to all of us.
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Rapid Response forTUESDAY
and WEDNESDAY, December 13 and 14,
THE STATE OF OUR HEALTH
By George A. Sprecace., M.D., J.D.
A Recent Interview with Adam Sprecace, PE,
On the Lee Elci Radio Show, December 13, 2016
Note: You can also hear the
segment broadcast on December 30, 2015...
1) A BRIEF SUMMARY OF HEALTH CARE IN AMERICA?
Quality: excellent at the top; modest on average, and decreasing. Access: sporadic. Cost: excessive and wasteful. IN GREAT NEED OF EFFECTIVE REFORM.
2) WHAT HAS LIFE BEEN LIKE, WORKING IN THE TIME OF OBAMACARE?
(eg. patient workload, reimbursement rates and dependability, electronic record-keeping, etc.) Workload
increasing; compensation decreasing; EMR’s poor for the private
practicing physician and patient, necessary for hospitals but
generating increasing cost and workload and decreasing quality as
measured by productive provider – patient interaction.
3) HOW HAS OBAMACARE AFFECTED PHYSICIANS?
Much more stress and strain, with less physician and patient satisfaction. Physician burn-out and declining physician health. Pressure
to practice UNETHICALLY: eg. ACO’s, BUNDLING, etc., which for first
time would force the physician’s self-interest to work at variance with
that of his or her patient, with whom he has a Fiduciary Responsibility.
4) IS OBAMACARE GETTING BETTER OR WORSE?
Increased premiums, reduced coverage…. Obamacare
was and is a Christmas Tree of Wants, with no attention given to needed
Health Care Reforms. The Goals are reduced costs at any cost, and
increased Regulations by many who have no knowledge of what they are
doing. Example: THE 30 DAY READMSSION RULE, which substantially
penalizes hospitals for readmitting an inpatient within 30 days of
discharge…EVEN FOR AN UNRELATED READMISSION DIAGNOSIS!
5) WHAT ABOUT THE PENALTIES FOR REFUSING TO BUY MEDICAL CARE COVERAGE UNDER OBAMACARE?
20 million subject to penalty. 8 million paid penalty. 12 million exempt. Thus, more subject to penalty than were covered.
6) WHAT’S BEEN HAPPENING WITH RELIGIOUS HOSPITALS THAT REFUSE TO FOLLOW OBAMACARE MANDATES?
Litigation, including the USSC. Coercion: loss of Freedom of Religion,
reduced quality and availability due to intimidation and decisions in a
System (ie. Catholic Hospitals) that is nearly the largest in the
7) WHAT WOULD YOU CHANGE ABOUT OBAMACARE?
and Replace, with a two year transition period. a) increase insurance
policy competition across State lines; b) reduce and rationalize
Regulations; c) make all patients financially at stake at every
encounter (HSA’a, co-pays, defined contribution instead of defined
benefit plans, etc; d) retain coverage for pre-existing conditions
while imposing penalties for continued bad life-styles, which account
for about 50% of all health care costs; e) as “Defensive Medicine”
accounts for 20-30% of health care orders – costs, REFORM MEDICAL
MALPRACTICE LAW – eg. Health Law Courts; f) promote and enforce End Of
Life Decisions – 50% of Medecare costs occur in the last 6 months of a
recipients life!;g) make electronic medical records OPTIONAL for
private physicians; h) re-think and revise EMTALA LAW – currently a
poor and wasteful use of ER’s; i) prohibit UNETHICAL medical practice
and payment programs; j) pay physicians fairly – they are now bearing
the brunt of this Christmas Tree. ETC.
8) DO PHYSICIANS AND HOSPITALS GENERALLY AGREE WITH YOUR POSITIONS ON OBAMACARE?
physicians, yes. Hospitals are ambivalent: gaming the system where
they can; merging and selling out; trying to “go along” so as to “be at
the table” when government decisions are made – not working; acting
like trained businessmen when dealing with professionals: “win-lose”
instead of “win-win”, treating professionals like widgets…. A bad plan.
WHAT IS YOUR PROGNOSIS?
Short-Term, GUARDED. Much damage has been done. Long-Term, FAIR, now that competents have retaken the ASYLUM.
GEORGE A. SPRECACE, M.D., J.D. has been writing and speaking on this
subject since the late 1970’s, a practicing physician for 60 years…and
counting. These Commentaries are found on www.asthma.drsprecace.com
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Rapid Response forFRIDAY,
Sounds like a no-brainer, right?
Not when your Government defines and implements it!
fact, although our Health Care Regulators are doing as much as possible
to make it sound like "motherhood and apple pie", THE DRIVER FOR THIS
PLAN IS REDUCTION IN HEALTH CARE CRSTS, at any cost.
vehicle for this trip is inherently UNETHICAL: rewarding physicians for
providing less health care, and punishing them for providing more
health care...perverse incentives that for the first time place the
interests of physicians in opposition to the interests and needs of
It is RATIONING ON STEROIDS, couched in such
reasonable terms as "evidence-based medicine", "efficient health care
delivery" and "patient satisfaction".
NOW HEAR THIS: That's
exactly how I have always practiced Medicine in my 59 years as a
physician. But that will not shield me from being crippled with yet
more demands for "documentation" beginning in 2017; and it will not
prevent me from being penalized 4% of my receivables beginning in 2019
unless I want a 4% increase by cheating my patients of the care they
need. That's what we're talking about, without the sugar-coating.
ABOVE IS DIRECTED MAINLY TO THE PATIENT / PUBLIC. For the
don't give a damn about what physicians and other health care providers
care or say. They do care about what the voters say.
So: "DON'T JUST STAND THERE. DO SOMETHING", for a change.
Response for SATURDAY through
MONDAY, September 28
through 30, 2013
OBAMACARE - AND MY PLAN B
As a practicing
physician (not a "provider") for over 56
years, I know what works - and what doesn't work - for my patients and
me. That is what has kept me eager and effective in my
OBAMACARE is just the latest challenge to that work.
monstrosity that will fall of its own stupidities within the next three
a gaudy Christmas Tree of wants with no attention paid to the true
needed in the U.S. delivery of health care.
But we must survive
the next three miserable years.
Herewith, my personal Plan B for survival in practice.
My greatest value to my patients is my
Decades ago I decided to maximize my professional
integrating my work with that of highly trained Registered Nurses.
This has allowed me to accept all insurance
regardless of the often - insulting levels of payment, except for those
programs that require a prior referral from a less qualified physician,
impinging on the patient's right of choice of physician.
This has also allowed me never to have "closed my
to new patients.
The only condition I place on patients in return
continued interest and efforts on their behalf is that they be equally
interested in their own care. I work with patients,
patients; and those who are not equally engaged, cooperative
compliant with my instructions find themselves discharged from my care.
I offer my "best efforts " and personal
never guarantee my work or the outcome of that work. And I
take personal or financial risk for the outcome of that work, a stance
that would put me in a conflict of interest with the patient and which
thus would be unethical.
Some of the coming
demands of medical practice under OBAMACARE
will place the above approach under great strain. But that
not change. Contrary to the posture of too many of my medical
who, in the last two decades when ordered to "JUMP", have supinely
responded "HOW HIGH?", my response will continue to be "SEZ
so, I will continue to
offer my professional TIME, my best efforts and my devotion to patients
appreciate that commitment. That is my Plan B, while those
stagger through OBAMACARE.
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Response for TUESDAY through
THURSDAY, June 18 through 20, 2013
FOLLOWING LM HOSPITAL STAFF MEETING, JUNE 20, 2013
reductions imposed on
2.Bundled payments and
other changes imposing
the risk of health care outcomes onto the health care providers.
reduction in patient volume.
impediments to maximizing
economies of scale in the recent hospital merger.
tracking which really
turns out to be cost tracking, with payors incentivizing their
patients) to enter a race to the bottom.
Records: A Mess….
7.A large loss of
patient care to tertiary
centers (eg. Yale, 40% of whose patients come from here!)
8.Yale romancing this
hospital…a change in
has no logical means of paying for
its Christmas tree of gifts without making the Health Professions pay
bill…thereby hastening the demise of private medical care and the
a one payor system: the Government, and resultant lower quality, higher
and reduced access.
2.Imposing the risk of
patient health care
results on the providers is unethical, pitting the physicians’
against those of his patients: a conflict of interest totally at
the doctor-patient relationship.It
places hospitals against physicians and physicians against fellow
should be prohibited as
3.There are several
reasons for a reduction
in patient volume.But
I believe that
this is temporary and that it will reverse to a mis-match between the
for patient care and the reduction in availability of that care by
should be one bright
spot in efforts to secure a future for the Practice of Medicine: the
Supply and Demand.But
be remembered: a) the First Rule of
Service is Survival; b) if you are losing on every
make it up in volume; c) “fast nickels are as good as slow dollars”; d)
all comers as patients, but devise a more efficient means of taking
them…specifically by using more physician extenders in broadened roles
good physician in an outpatient setting can supervise as many as four
4.Appeal all adverse
sector – know little about the requirements of proper Medical Care,
including their academic advisors.Therefore, the reply to the demand from Washington
be “How High”, but “Sez Who?”The
corrosive current laws and regulations must be challenged and changed,
the Courts and through the Legislative process.HOW LONG HAVE I BEEN SAYING THIS TO WHAT PASSES FOR OUR
“LEADERSHIP” THAT WILL DO ANYTHING TO BE “AT THE TABLE”…AND WHICH FINDS
ITSELF UNDER THE TABLE.Also,
regulators and politicians don’t give a
damn about what doctors think…only about what the public thinks.SO, EDUCATE AND MOTIVATE
YOUR PATIENTS TO
DEMAND FOR THEIR OWN BENEFIT.(Again,
how long have I been saying that?)
5.And what did you
6.A pigin a poke.Take
the penalty and
reported benefit in coding
and charging, particularly by hospitals, has been detected and is about
7.A lesson for those,
business-types, who think that there is such a thing as a “Win-Lose”
negotiations, particularly when there is a disparity in negotiating
“Loser” will find a way to
get justice, even if only rough justice.So, cultivate and don’t abuse your new
they are temporarily vulnerable.
8.This is not the past.Are there current opportunities for “Win-Win”
NEXT THREE YEARS WILL BE CRITICAL FOR THE HEALTH CARE INDUSTRY.THOSE WHO SURVIVE WILL
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Response for SUNDAY, October 5 and 6, 2012 PERSONAL SUMMARY, THE
LEADERSHIP RETREAT, OCT. 2012
The following are based upon the speaker's
contemporaneous comments, a review of his slides and my
comments are presentedin
away from episodic
fee-for-service reimbursment and toward accountable forms of risk-based
payment, involving case managers or population
Risk-Based is based
upon perverse incentives andconflict
of interest between "Providers" and patients...inherently
Unethical. Case and population managing can be performed now
patient and provider incentives and dis-incentives.
Competition". I've been
doing that for 55
withhold starting now,
based upon a) 70% Process Measures...Good,based upon hard research;
30% based on patient surveys...overweighted,
subject to manipulation.
rates: progressively 1-3%, even re-admissions for totally different
diagnoses from the original admission...CRAZY.
Containment. For example, L&M estimates that it must
its costs by $35 Million over the next 5 years. At what cost
quality and in availablitry of care?
and cowardly effort by our national"leaders"
to force the Medical Profession into being Rationers of Care - a worthy
principle that should be decided broadly by the public and by public
policy. It is done by placing MD incentives opposite to
needs: Unethical, undermining a learned Profession and
against Public Policy. This must be litigated right up to the
and MD Allignment is
BET!! Hospitals had bettertake care of their physicians,
especially now when
they could "stick it to them" in the short-term. We are in a
year Transition period, full of uncertainties, with MD's in a weak
bargaining position. Then will follow a long period of MD
ascendency...based entirely on MD shortages and population
demographics. A word to the wise.
to reduce patient and
provider utilization? We
passive in the form of HSA's and
increased self-payment; and in the form of active penalties for
continuing to pursue unhealthy life-styles. And we need to
the 20-25% of health care costs that physicians produce because of
DEFENSIVE MEDICINE in the current litigious malpractice
Madical Mal-practice reform is crucial, changing perhaps to Health
are the main market
movers? And what do they want?" Of
Employers should get out of the business,
certainly abandoning "Defined Benefit" for "Defined Contribution"
plans, with prominent patient-employee contribution. Insurers
will survive and thrive as Wall Street does: by expanding into markets
that approximate Las Vegas activities. And what about
They want to provide quality care with adequate reimbuserment and
little hassle. Patients have long wish lists - as long as
else pays for them, and as long as they don't have to change their
ways. Enough of That!
uncertainty. Great expansion of Medicaid, with little concept
who will pay for it, Changes in Medicare. The Election: a
referendum on "Entitlement" spending. A very difficult
budget debate right after the Election. And there will be no
clear winner, resulting in the losers being enraged - more
grid-lock. All the more
in the Heath Care Industry to base their
current decisions not only on the transition period of the next few
years, but especially on the subsequent decades - a different paradigm.
is a Penalty program, not
a Reward program. The deck
assisted now by venture capitalists, may be better than Hospital /
Physician programs. PHYSICIANS:
NOT VICTIMS,,,if you don't "sell your soul
to the company sto" during this Transition period.
some programs, consumers
(patients) are being Paid to pick the lowest cost providers! "Caveat
Emptor"...and don't expect medical malpractice lawyers to get you out
of this one. Your Choice got you in trouble.
of Health Care is
the vital missiong link in this scenario. This
can be done by "any willing
or specialist...with proper financial support. It should also
provided by Home Care (both transitional and permanent), by
para-professionals (physician extenders, very valuable), by sharing
resources and expenses through smart alignments, and by providing
perceived quality and convenience to patients. Regarding the
point, every in-patient in a hospital needs an advocate / ombudsman to
negotiate the day-to-day uncertainties of the hospital experience and
this "Crisis" is truly
one comprising both danger and opportunity, This hospital
carfefully nurture its rerlationship with its Medical Staff, providing
a true "Win-Win" situation...short-term and long-term. And it
should continue to develop itself as "sui generis" in this locale and
region...and not try to follow the methods of larger, distant and
different areas, which will likely be totally inappropriate to our
needs and opportunities.
I have been speaking and writing on this
subject - Health
Delivery - since the mid- 1970s. Several of these
available on this website (www.asthma-drsprecace.com).
And any one of
be re-published with very little change at this
"Now is the time for all good men
to come to the aid of
George A. Sprecace, M.D., J.D.
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CARE REFORM: A PRIMER
As a practicing physician
for 55 years, and as
attorney practicing and studying Health Care Law for the last 28 years,
been writing and publishing on this subject for decades.Muchof this production is available on relevant sections of my
In fact, an early
publication, dating back to
be re-published with only minor revision…reflecting how little progress
society has made in addressing the real issues of Health Care Reform.
The “Accountable Care Act” (aka ACA
ObamaCare) is a
Christmas Tree of “wants” that gives short shrift to the real needs
health care reform.As
such, that ode to
political expediency needs to be repealed and replaced.
“With what”, you say.Alright: ONCE MORE, WITH FEELING.
half of health care
expenditures in this country are directly life-style related:
obesity, tobacco use, alcohol abuse, illicit drug use, irresponsible
motor vehicle practices, the governmental support of unhealthy personal
practices like abortion, children out of wed-lock, defending failed
practices should be
heavily taxed and otherwise discouraged instead of being supported as
large percentage of health
care costs incurred by individuals and by society occur during the last
6 months of a person’s life.This,
while a strong majority of adults support Advanced Directives…and a
small minority of them actually have such “personal choice”
instructions to guide their loved ones and their physicians.Furthermore, physicians
should recognize that
they have an ethical obligation to refrain from offering “futile care”.
least 20% of health care
costs represent “Defensive Medicine”, defined as actions
health care providers predominantly to protect themselves from
allegations of “medical mal-practice” adjudicated in a lucrative and
unnecessarily adversarial system.The
current practices should be replaced by Health Care Courts similar to
Patent Courts and Bankruptcy Courts.Only
in that way can Justice be achieved and defensive medicine minimized.
great need in the existing
system of health care delivery is Coordination of Care among
increasing number of medical specialists and other health care
providers involved in much if not most of current patient care.Such services are
time-consuming and require a
broad - based knowledge of Medicine to be effective.They can be provided by any one of a patient’s
who is willing and who has the necessary level of insight and expertise.And they must be
paid for adequately!
must be established and
enforced – by society as a whole and not by the Medical Profession – a
system of Prioritization (Rationing!)-
among the many services and potential recipients of those services.Coverage of cosmetic
surgery and of Viagra
does not rise to the level in importance of immunizations.Right now, cynical efforts
are being made to force
physicians to make such decisions through unethical mechanisms such as
“accountable care organizations” which place a physician’s
self-interest in direct opposition to the interests of his or her
for all medical care,
subject to clearly defined exceptions for indigence and serious medical
necessity, should require at a 20% co-pay by the patient.The patient must be a
decision-maker in his quest for medical care.For,
once a patient enters a physician’s office, the cost is generated and
the service is provided.The
cannot and will not be the arbiter of the “need” for the care requested
– or demanded.
A comment about the
have been given a
very high priority and much pressure by our “leaders”…not because they
important, but because they are the easiest of the above issues to
but not in-expensive
and definitely disruptive of the vital eye-to-eye physician / patient
physician / physician relationships on which all good medical care
so, what is the prognosis of the
above 6 vital areas of reform being addressed and implemented any time
to Grim.Meanwhile, actions in the direction of
ObamaCare and of “Universal Health Care” will produce the opposite of
goals: lower quality, higher cost, and reduced access.Folks, it’s your choice…and your life
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ON THE RECENT BOARD RETREAT
attendance…a teachable moment?
were fair, but could have
been more probing and less repetitive.
for a sustained effort at
that time of day.Lost
some control at the
all of the discussion was
reactive, not pro-active.Don’t
“Jump”, don’t say “How High?”Say
better than the
academicians regarding what is really needed in Health Reform.
little or no discussion
regarding PATIENTS, their needs, their expectations (rational and
otherwise)…and their ultimate unique power to effect change (vs. we
“health care providers”).
government interests and goals
are all about COST CONTROL…at all cost, and much less about coverage.The only ways to get cost
provoking at least the passive aggression of health care providers are:
Rationing / Prioritization, decided upon with broad public input and
not imposed by the government through physicians; Medical Malpractice
Reform to minimize the now substantial Defensive Medicine costs; end of
life issues; motivating people, positively and negatively, regarding
life-style changes that drive 50% of health care costs.
of Care, vital and to
be performed by – and reimbursed to – any willing physician and not
just “primary care” physicians.“Specialists”
now do a great deal of “primary care” and are often in a comparable
position to effect coordination of care.
should be enlisted to
help, and not demonized.Ultimately,
are far from powerless.
hospital must commit to a “WIN
– WIN” game plan with their medical staff.The
alternative is only “LOSE – LOSE” !
allow the marginalization
of any of our Staff physicians, either by neglect or intent.Again, they are far from
hospital must encourage and not
block the effective reorganization of the Organized Medical Staff that
is in process with the development of the PAC, the re-alignment of the
MEC, and their coordination as the eyes and ears of the Organized
Medical Staff as the ultimate governance body.
must be, in fact and in
perception, a true Partnership between the Hospital Board –
Administration and the Medical Staff.And
it must be realized and accepted as such by the Community we all serve.That is not the current
perception…and that is
WE CAN DO ALL THIS !
George A. Sprecace, M.D./,
November 1, 2011
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ONCE MORE, WITH FEELING.
"ObamaCare", as enacted last year, is a Christmas Tree of wants,
without dealing with true needs for health care reform. And
supposedly "paid for" through gimmicks and slights of hand.
What follows is a list of true needs for reform, from a practicing
54 years experience...and counting.
Are you ready for this?
"capitation" as an
unethical abrogation of a physician's fiduciary responsibility to his
patient. A perverse incentive if there ever was one, this
of payment places a patient's needs in direct conflict with the
physician's. It should be rejected as against Public
effective Tort Reform,
including Medical Mal-Practice Reform, in order to markedly
the practice of "defensive medicine", which now accounts for 20-30% of
health care costs. Specialized Health Courts, like those used
Bankruptcy, Patent and Construction controversies, would be the best
way to go.
- and pay for -
Coordination of Medical Care, by one physician for each
this function performed by primary care physicians or by properly
Health Care Accounts
to restore patients' interest in the cost of their desired and needed
medical care...and in their personal health and life-style.
and approach physicians as
part of the solution, and not as part of the problem...as is
the general attitude.
reimburse physicians in
the broad use of paraprofessionals in their
practices and under
their direct supervision.
Require that all
members of the
public carry a minimum amount of Health Care Insurance.
expect that that provision of the current law will survive US Supreme
Court scrutiny as being in accord with the public policy goal of
covering all potential patients.
between "the deserving
underserved", between the honestly indigent and their lazy
greedy counterparts with regard to subsidized health care.
drug costs, currently
uncontrolled and abusive, while allowing sufficient return on
company investments to promote good research...and not mainly
Stop trying and
expecting physicians to
ration care, through various underhanded mechanisms - like
"capitation" and "bundled payments". A system of
and prioritization is needed, to separate health needs from wants, and
to exclude "futile care". But that is the purvue
policy, arrived at through the political process and not by physician
fiat, another example of abrogation of fiduciary
At the same time, "futile
defined by two physicians in a given case, is neither obligatory or
even permissive on the part of the treating physician.
must be educated regarding this bedrock concept of the practice of
Stop enacting and
repeal rules and
regulations that inevitably promote "gaming the system" in
self-defense: Emergency Room practices that may be
"offensive medicine" in order to produce profit centers for hospitals
so inclined; declaring as "Never Events" occurrences
actually not under the reasonable control of the physicians and
hospitals, but whose occurrence results in non-payment for the care;
promoting through over-emphasis on electronic health records
imaginative billing practices while ignoring the communication needs of
physicians at the bedside and on the wards; a blizzard of
regulations, sometimes internally contradictory, that promote
ever-increasing number of hospital administrators, each of whom has to
justify his or her presence on the table of organization.
famous the phrase " Ah feel yo pain". Physicians have been
trying to shield their patients from the pain of the last 25 year of
"health care reform", with poor results. It is time for
patients and the public to feel their own pain in order finally to
motivated toward their own self-help and against the often craven and
self-serving actions of their elected leaders. The
course we have already begun with "ObamaCare", is lower quality, less
access, and higher cost.
The choice is yours, folks.
- - - - - - - - - - - - - - - -
CARE REFORM – A
articles in recent months in
NEJM, JAMA, WSJ
New Value On Provider
“Value”, Treatise by Alice Gosfield in Health Law Handbook,
Paul Ryan’s Critics Don’t
Know About Health Economics”, by Alain Enthoven, WSJ June 3,
Medicare – Toward A
Modified Ryan Plan”, by Gail R. Wilensky, Ph.D., NEJM May 19,
another update on your future health
care. This industry and the related
undergoing a revolution
whose outcome is very much in doubt: for the ever - increasing number
severity of sick people, for the physicians and other health care
provide that care in return for progressively reduced reimbursement
last twenty years, and for the economic health of the
Nation. Obama-Care is a Christmas Tree of "wants" without hardly any
consideration of health reform "needs" that are begging to be
addressed. This is tantamount to returning to the "bleeding"
treatment of the Middle Ages instead of the judicious use of
To document some of the problem, I offer several readings:
Editorial of the WSJ Thursday, May 12, 2011, pA14;
Shakes Up Hospital
Payments", by Janet Adamy, WSJ Monday, May 16, 2011, pB1;
Millionaire Retirees Next
Door", by John Cogan, WSJ Thursday, May 12, 2011, pA15...an
effort to promote generational strife, in my opinion. What is
value of $500,000. contributed by and for an average worker over 30 or
40 years of gainful labor, and invested as a fiduciary on his promised
behalf by the Federal Government over that time? At least $1
Against Accountable Care
Organizations (ACO)", by myself. See below.
folks. This is your welfare...and your life.
CASE AGAINST ACCOUNTABLE CARE ORGANIZATIONS
SPRECACE, M.D., J.D.
Three tiers of ACO’s have been
following refers only to Tier lll,involving
partial or full
bibliography of supporting articles and
data is available.
QUESTION OF ETHICS.Tier
lll ACO’s, and
any other system involving “capitation”, a form of health care payment
the provider agrees to provide all necessary health care for a patient
period of time for a fixed and pre-determined fee – in effect becoming
insurer of that patient’s health or disease needs – is Unethical:
1) it is a breach of the physician’s fiduciary responsibility to the
that it is based upon an inherent conflict of interest that cannot be
the patient; 2) it properly undermines the critical trust of a patient
or her physician; 3) it undermines the integrity of a learned
should therefore be considered as against public policy; 4) it is a
on the part of the government to make the physician impose a rationing
health care, an action properly in the realm only of the public in a
5) it is an insane risk for any physician to take upon himself, given
that about 50% of all health care needs are life-style related, under
control of the physician.
invitation and expectation
for “bait and switch” tactics by the payor.
Transparency” can lead to
anti-competitive practices and even to increased prices.
can easily impact
the following laws: Stark Laws; Anti-Trust laws; Civil Fraud
Legislation; Fraud and Abuse statutes and their attendant “Qui Tam”
limitations of data and
indices used by the government in setting payment levels and other
DEMONSTRATION PROJECTS AND
ANALYSES SO FAR….
GOOD NEWS ABOUT U.S. HEALTH CARE
REAL NEEDS (vs WANTS) FOR HEALTH
my articles and
analyses dating back to the 1970’s, to be found on www.asthma-drsprecace.com
THE BASIC NEEDS IS COORDINATION OF CARE
AMONG A PATIENT’S MULTIPLE
PHYSICIANS…SOMETHING TOO OFTEN LACKING IN THE MEDICAL PRACTICE OF
SOMETHING THAT CAN BE UNDERTAKEN BY ANY ONE OF THOSE PHYSICIANS,
19, 2009 -
And now to the greatest preoccupation of the new Administration after
the Economy: "Health Care Reform".
best we can hope for is efforts at the margins of what really needs to
be discussed and resolved; electronic health records,
the least important but the most and most easily discussed; too
much health care, a veritable buffet requiring
rationing of needs vs wants; forced mediation ofmalpractice
disputes instead of litigation...a lose-lose
everyone except the lawyers; promote heavily Health
Accounts, thereby finally including the
patient in the decision-making process, instead of systematically
undermining that vital option; bring abusive
to heel; emphasize patient
responsibility, while half of Americans' illnesses
directly life-style related; emphasize and pay for coordination
of care, whether by the primary care physician or
by a caring
specialist; promote and encourage the activities of "physician
extenders", under the direct supervision of
physicians; and reach
out to physicians and other health care providers
partnership in the process...instead of reaching out with the stick for
the favorite pinata. And wouldn't that be a breath of fresh
air. Meanwhile, don't hold your breath.
Two articles in a
recent edition of the New
Journal of Medicine discuss "new developments": "Large Employers' New
In Health Care" (NEJM, Vol 347, No 12, Sept. 19, 2002, p939); and
Health Insurance Trends" (ibid, p 956). The latter article
the finding that 'on average, insured persons seek medical attention
often when they have to pay a portion of the cost out of
Imagine that! All such disclosures should be compared with
of my article published in the New London Day, May 27, 1978, and
"Don't Blame The Doctors For
Costs." Some things never change; and some people
More Relevant Offerings:
& Memorial Needs New
For The Future", by Robert A Linden, M.D., The Day, Tuesday, May 10,