Category: Health Care

Since publication of our paper, “Lack of Transparency for New Mexico’s Not-For-Profit Hospitals Cost Taxpayers Dearly,” we have engaged in an extensive dialogue with various representatives of UNM Hospital. They have brought to our attention some concerns relating to the paper. This document is intended to offer a critique/correction of errors within the paper and clarify the issues presented within. It is also designed to offer an update on public meetings that have been planned to discuss the proposed expansion.

1)      UNMH is not a not-for-profit hospital; rather UNMH is a government-owned and-operated facility. This is true and, although UNMH does have a not-for-profit fundraising arm, it is technically a government-owned entity. This actually worsens some of the issues with UNMH potentially moving into new areas of care (taxpayer-funded institution competing with a for-profit, tax-paying institution) outlined in our paper.

UNMH is funded in part through a Mil Levy that is voted upon by the citizens of Bernalillo County every 8 years, with the last vote being in 2008

2)      In the RGF paper on UNMH, concerns were raised over the types of treatments to be offered at the new facility and why taxpayers should be asked to fund care targeted at non-indigent and non-native populations.

UNMH responded that it “distinguishes between emergent and elective care. Emergent is defined as immediate threat to life or limb if care is not provided quickly. Elective care, which might be better defined as scheduled, is defined as all other care. Cancer patients are treated as elective care patients because their care needs are urgent, but not emergent.”

While the distinction is welcome, RGF remains concerned that UNMH will be using taxpayer dollars to compete with existing, tax-paying, for-profit hospitals. More information on the specifics of this new project and how it will serve the Hospital’s existing mission (as opposed to expanding it) is needed. Some third-party analysis may be needed in this area.

3)      RGF expressed a great deal of concern about transparency and the new UNMH wing.

UNMH responds that UNM Hospital is a part of the University of New Mexico and is a governmental organization. It is subject to the New Mexico Opens Meeting Act and the New Mexico Inspection of Public Records Act. It posts its financial information and its Board agendas and minutes on its Hospital web site. Combined with voter approval of bond measures and regular updates to Bernalillo County Commission, UNMH states that transparency has been adequate

RGF responds that while meetings have indeed been public and in keeping with New Mexico law, there is a need for additional public input from various stakeholders throughout the Albuquerque area and the state as a whole prior to making such a large investment.

This project may ultimately be deemed necessary or it may be modified somewhat in order to address the concerns of RGF and others in the community. Before we invest $146 million taxpayer dollars in the construction of a new hospital wing (not to mention annual operating expenses), we need to have a more thorough discussion.

According to this document from UNMH, the Hospital has agreed to hold a series of meetings at which the public will be provided additional information and given the opportunity to offer input. The schedule and locations of those meetings are as follows:

Oct. 2, 6–7:30 p.m. Indian Pueblo Cultural Center
2401 12th Street NW, Chaco I and II

Oct. 3, 6–7:30 p.m. Jewish Community Center
5520 Wyoming Blvd. NE, Auditorium A

Oct. 4, 6–7:30 p.m. – Alamosa Community Center
6900 Gonzales Rd SW, Room A

We are encouraged by UNMH’s willingness to hold these hearings. It is our hope that the community will turn out both to receive information on this project and to be allowed to ask questions and express their own concerns.

How can anything be both earth-shattering – monumental – and unimportant – irrelevant? The Supreme Court of the United States will shortly announce its decision about the Patient Protection and Affordable Health Care Act of 2010.

That decision will have profound policy implications regarding the reach and scope of federal government and at the same time have little impact on our daily lives in terms of health care.

The time to consider this paradox is before the decision is announced. Afterward, all anyone will talk about or even think about is political and financial effects, winners and losers. Any thoughts about how the ACA will affect you, me and our health care needs will be ignored in the scorekeeping, especially effects on the general election in November.

While we can do so, let’s consider how the ACA will impact Mr. and Mrs. Everyperson and family.

Suppose the court strikes down the individual mandate that forces people to buy insurance and penalizes them if they do not. This takes away a large revenue stream from Washington. Otherwise, it changes nothing.

Will striking down the individual mandate change the availability of health care service? Since the number of insured people will not change from what it is now, the answer is no. Since ACA cuts in Medicare reimbursements are unaffected (unless they go up), there will be the same shortage of providers able to care for Medicare patients.

Will striking down the individual mandate change the expansion of the bureaucracy? Will it stop the creation of the Independent Payment Advisory Board and five other whole new federal agencies? No.

Will striking down the individual mandate stop the development of accountable care organizations, which are “accountable” to everyone except the patients? No.

Will striking down the individual mandate halt the creation of health exchanges, which impose further federal control of health care on the states and suppress competition? No.

Will striking down the individual mandate expand the number of jobs? Yes and no. It will massively increase the number of administrative, legislative and regulatory oversight positions, but not one new doctor or nurse. Quite the contrary, as the Medicare reimbursement cuts take effect. The job expansion will do nothing to improve access to health care. It will in fact reduce care as money is taken from care providers and given to managers and overseers.

ACA does of course spend money, huge sums of it. Estimates range between $1 trillion and $2.7 trillion.

What do We the Patients get for all those expenditures? Answer: no more, or better, or safer, or quicker health care. Just more regulations and more bureaucrats.

If your teenager goes to the store and spends cash, she cannot spend more than is in her wallet. If she uses your credit card, the sky’s the limit. The same is true for the federal government. The loss of the revenue from a struck-down individual mandate will not slow down the general spending spree because it can do one thing that you and I and the 50 states cannot: print money. So whether the Supreme Court upholds or strikes down, nothing of substance will change except the size of the bill we are passing on to our children.

We need to realize that the justices, whatever they decide, will not save us from the harmful effects of the ACA. Only repeal can do that. And of course repeal alone still leaves us with a critically ill, dying in fact, health care system. Stopping the bad medicine – ACA – only reduces the rate of decline for health care. We need to start practicing good medicine on health care, something we have never done before.

Keep all this in mind when the hysterical reactions to the Supreme Court decision – whatever it is – take over the airways. Everyone will be talking about politicians, justices and bureaucrats. No one will be paying any real attention to We the Patients.

Dr. Deane Waldman is a professor at the University of New Mexico as well as the author of “Uproot U.S. Healthcare” and “Not Right!”

The U.S. Supreme Court will shortly discuss the ACA, the latest abbreviation for the Patient Protection and Affordable Health Care Act of 2010, pejoratively named Obamacare.

In Monday’s Journal, State Sen. Dede Feldman, D-Albuquerque, defended the ACA, saying it is good for both New Mexico and the United States because it: a) brings lots of money into our state; b) creates new jobs; c) increases insurance coverage; and d) eliminates the exclusion for pre-existing conditions.

ACA may bring millions of federal dollars into New Mexico, but that money will be spent on bureaucracy, not on patients. ACA is likely to increase jobs – 38,000 to 47,000 new bureaucrats, regulators, insurance adjusters, IRS investigators and compliance officers, but not one new nurse or doctor.

In 2008, President Obama said that the U.S. health care cost spiral was unsupportable and was contributing significantly to our soaring national deficit. Then he pushed through a bill – ACA – that will spend an additional $1 trillion to $2.7 trillion, money we do not have and we will have to print or borrow.

Feldman applauded New Mexico’s “quiet implementation” of ACA, building a whole new IT system for insurance authorization and compliance, not for medical information and care. Isn’t that just what we need – a whole new layer of complex bureaucracy overlaying an already bloated, user-incomprehensible insurance system?

Feldman claims that ACA is good for us because it extends insurance coverage to people who currently do not have it. Insurance is not what patients want. What patients want is health care. Under ACA, they won’t get it.

If the doctor cannot afford to accept your insurance, such as Medicare, having insurance coverage is worthless. If the insurance carrier doesn’t authorize the care you need, when and where you need it, having insurance does you no good.

In day-to-day health care reality, government insurance is no different from private. First, they make money or stay within budget using the 3D strategy: Deny, Delay and Defer.

If by some miracle the procedure or drug that you need is covered, the insurance will contract for the cheapest they can find. This is generally not the level of quality that you need. As a pediatric cardiologist, I fight this battle every single day, and so do virtually all of my colleagues.

Then there is the ACA’s IPAB (Independent Payment Advisory Board). Just as in Great Britain, IPAB will say what is cost effective (meaning available) and what is not (not available.) In England, kidney dialysis and heart surgery are not considered cost effective over certain ages, so they are not available. If you need them, you die.

Even if you can keep your insurance with your pre-existing condition, you will wait and wait and wait, as they do in Canada, for a procedure that is approved but scheduled months or years in the future.

IPAB is even worse than you think. According to ACA, if Congress does not enact spending cuts in other areas – which are politically unpalatable and therefore will never happen – IPAB cuts in medical services automatically become law.

Is this what you would call “good” for New Mexicans or for Americans?

The ACA has been called magical thinking, snake oil, smoke and mirrors, a monstrous scam, and government takeover of health care. While all of these apply, the most appropriate terms are malpractice and exacerbation (the opposite of reform). ACA fails to treat the causes of health care illness. As a result, ACA makes both health care and us sicker.

Feldman called the Supreme Court challenge to ACA “more to do with politics than the Constitution.” Very clearly, the imposition of ACAon the American people had much more to do with partisan domestic politics than the health of either our health care system or We the Patients.

Dr. Deane Waldman is the author of “Uproot U.S. Healthcare” and a professor at the University of New Mexico. The New Mexico Rio Grande Foundation is an independent, nonpartisan, tax-exempt organization dedicated to promoting prosperity based on principles of limited government, economic freedom and individual responsibility.

In the Journal of Nov. 28, economist Robert Samuelson claims that health care costs are “out of control.” Quite the opposite: They are totally in control – by the government.
That is a problem.

Health care refers to goods and services delivered by hospitals and providers to be consumed by patients. Costs to providers and institutions are driven more by government regulation and bureaucracy than by labor costs or MRI machines. Meanwhile, payments to providers and institutions – what Samuelson calls “costs” – are controlled by government.

Note that when the Patient Protection and Affordable Care Act (“Obamacare”) cut “Medicare costs” by 21 percent, they cut Medicare payments to providers. Therefore, they cut services to patients. As Robert Moffit of the Heritage Foundation testified before Congress, “you cannot get more of something by paying less for it.”
Meanwhile, the spending on – the costs of – the federal health care bureaucracy went up by six whole new agencies, hundreds (thousands?) of bureaucrats added to the payrolls, and multithousands of new rules and regulations.
So the government controls and increases spending to/on itself, while it controls and decreases spending on patients.
Want proof? Of all the money spent on “health care,” 40 percent – that is over $1 trillion in 2010 – disappears. It goes to health care but provides no care.

That statistic is before adoption of the health care act, which could raise the disappearing dollars to half of all health care spending!

Samuelson goes on to use the recent Office for Economic Cooperation and Development report to explain U.S. overspending: steep prices and abundant provision of expensive services. Hogwash! As Samuelson knows, “price,” also known as charge or bill, is meaningless in health care, meaningless in terms of what gets paid.

As a doctor, I can charge whatever I like for a cardiac catheterization in a baby. The actual bill can read $2,000, $4,000 or as is commonly true, over $5,000. Regardless of my “price,” I get paid $387. That is what the government pays. So the price may seem steep, but the payment is peanuts.

For Medicare, just like for my caths, payments are now lower than the cost-of-staying-in-business. So if you want to know why you can no longer see your Medicare doctor, it is because the more Medicare patients she or he sees, the quicker the doctor goes broke.

The prices may seem out of control or steep, but payments to providers are tiny and shrinking.
How much of the true cost of health care (goods and services) to hospitals and providers is for administration and for regulations? No one knows because no one measures that, either. The administration guesses its own cost, and government conveniently ignores the costs of regulations. To make matters worse, the public sees rules and regulations as no-cost items.

Samuelson very rightly asserts that, “the system needs a fundamental overhaul to deliver more value for money.” No one disagrees – except those in charge. In order to determine value, one must measure cost and compare it to benefit. Does the government measure the benefits of health care? The answer is a resounding No! So how can you-the-consumer, whom I call We the Patients, assess value? If you know only part of the numerator and none of the denominator of a cost/benefit ratio, you can’t.

Finally, Samuelson practices really bad medicine. He jumps directly from symptom identification (overspending) to treatment plans (vouchers or single payer) without going through the critical step of root cause analysis.
If you want to cure something, be it a sick person or a sick system, you must treat the cause of illness. Financing is only one part of the sickness in health care. If we try to fix it (overspending) without recognizing its root cause as well as others, we are certain to fail, just as Obamacare – with its expanded control – is certain to make health care, We the Patients and America sicker.

Dr. J. Deane Waldman is the author of “Uproot U.S. Healthcare” and an Adjunct Scholar with the Rio Grande Foundation