DocHoc: Letter to President Obama

Joel Simon Hochman MD

Psychiatric Medicine since 1970

Pain Management since 1990

1714 White Oak Drive

Houston, TX 77009

(713) 862-9332 voice (713) 862-7677 FAX

jfshmd@gmail.com

July 29, 2009

President Barack Obama

The White House

1600 Pennsylvania Avenue

Washington, DC 20500

Dear President Obama:

I am writing to offer this physician’s views on National Health Care.

I have been a physician for 43 years. I participated in Medicare and Medicaid for 32 years, until 3 years ago. I opted out when I could no longer put up with pennies on the dollar for my services, endless paperwork, the constant threat of "investigation" by ambitious bureaucrats who cared absolutely nothing for the patients, and the endless, mindless, requirements, regulations, audits, and registrations.

At the same time I bailed out of all HMOs, physician "panels" and quit accepting insurance assignments. I told my patients I would do everything I could to help them get whatever reimbursement they could battle out of their insurers. I pointed out that I was now of an age when I could no longer be sure I'd live long enough to see any money from their insurer. Not a single one of my patients had any problem with my decision. Every single one (including the Medicare and Medicaid patients!) stayed with me and became self-pay, and happily so in exchange for my deep dedication to their well-being. I still battle with insurers to obtain "prior approval" of their medications. What a joke! Imagine having to argue with a high school graduate that the prescription you wrote was medically necessary (do they think I write prescriptions for a lark or as a hobby? Right!)

We all know that there is an inherent conflict of interest for insurance companies in health care. Insurance companies are about making money (by loaning it out at interest), and paying health care benefits takes money away that they'd rather keep to loan out. So they spend hundreds of millions figuring out schemes to deny, delay, defer or reduce the benefits they have to pay. They are NEVER going to get right with the patients. The conflict of interest is irresolvable. They have NO business being in health care. Knowing that is why they are spending hundreds of millions lobbying to keep a strangle hold around the throat of health care. I say this is the opportunity to rescue Health Care from them.

Everyone is sick of them, doctors AND patients. The insurers already admit that almost $.33 of every dollar spent on health care goes to insurance company overhead. But when one gets under the skirts of the big insurance company corporations, one finds that the story is far more egregious. When one includes all the special commissions, bonuses, golden parachutes, corporate perks, privileges disguised as business expenses (corporate jets, political contributions, lavish board meetings and management retreats, billion dollar corporate facilities) one discovers that the actual “overhead” of health care corporations approaches 70%!!

Further, objective examination of the “investment” activities of these corporations reveals that they are generally financial calamities. They invest in the projects of their golfing buddies, country club cronies and good old boy networkers. It doesn’t matter if the investments are doomed from the start. The insurance companies then need only to go to their State Insurance Commission (members appointed from the same clubby network by Governors to whom they have made tax-deducted contributions) and cry crocodile tears about their operating losses. Their Commission buddies then hold their tear-stained hands and reassure them that things will be all right. They simply need to increase their rates and premiums to make things work again for the next year of mismanagement. Having no alternative option, consumers bear the additional burden.

So, the point I want to make is that when it comes to government run Health Care, and Health Care ravaged by corporations – “A POX ON BOTH OF THEIR HOUSES!”

To be constructive, it is abundantly clear to any objective observer that TWO goals must be achieved to save Health Care in America and to provide it equitably to every citizen.

First, balance must be established in the world of corporate health care insurers. Currently there is NO true competition in the industry. There is not 5% difference in the premiums or practices of the major insurers. On the golf courses and in the privileged retreats of these self-declared entitled elite they plan and conspire. Thus they all pursue the same strategies and policies – to charge basically the same premiums, to cherry-pick the public, to deny, defer, delay and reduce health care insurance benefits - and to maximize the profit from health care insurance premiums. Only when there is a REAL source of competition, such as from the Government-sponsored alternative you have proposed, will balance and genuine competition occur. Only when the private corporate insurers have to really compete, will they.

The second goal has to do with the government sponsored alternative. If it is a governmental bureaucracy, peopled by career bureaucrats, it will fail utterly. The sad reality is that when people work for the government they rarely have the same values and goals of people who work in the private sector. Career workers in government conform to the institutional imperatives of governmental agencies – not making waves, conforming to the political priorities of the moment, making their bosses look good, staying within budget, hanging in there for 25 years to get to retirement, with benefits. They have no desire or need to provide services or compete for consumer satisfaction. When confronted with pleasing management or pleasing the consumer, choosing the latter is the kiss of death for a bureaucrat. And the culture of bureaucratic institutions is not likely to ever change (and certainly not in just eight years of your administration).

To succeed, the second goal must be to create a governmental alternative insurance for health care that is truly consumer oriented. That can only be achieved by creating a semi-governmental entity – where the executive level of management is appointed, with consent and advice of the senate, but in which the employees are private sector people – whose professional and career success depends on efficiency, intelligence, objectivity, and maximum service to the consumer.

Currently we see a feeding frenzy of “swift-boat” propaganda. The insurers (and Big Pharma) are spending tens of millions of dollars on fear-based propaganda to try to sabotage the reform of health care. They know that they must succeed in this if they are going to be able to continue the rape and pillage they have so long enjoyed.

We only need to look at the debacle of the “Part D” medication benefit of Medicare to see what unfettered corporations will do. Let me be specific:

1. 64% of all prescriptions physicians write every year are written for “off-label” indications. Example: The most commonly prescribed preventative for migraine headaches is Topirimate (Topamax). However, the only FDA approved indication for Topamax is seizure control. The Part D Medicare law specifically states that Insurers do not have to pay for any prescription that is written “off-label”. So, the law effectively allows insurance corporations to NOT have to pay for 64% of all the prescriptions written every year.

2. The second most commonly prescribed category of prescriptions written every year is for benzodiazepine medications (Valium, Klonopin, Xanax, etc.) Under the Part D Medicare medication law, NO INSURER has to pay for ANY benzodiazepine prescription! (Saving them hundreds of millions of dollars, the cost of which is transferred to Medicare patients.)

3. By law, under the Part D Medicare Medication Act, Medicare CANNOT negotiate with any drug manufacturer over the price of medications. This guarantees that every Medicare beneficiary (53 million of them) MUST PAY RETAIL for all of their medications (the very same drugs, from the very same manufacturers, cost 40% less in Canada.)

4. After insurers pay for approximately $3,000 for medications, the next $3500 must come directly out of the Medicare beneficiary’s pocket (retired people on fixed incomes who then have to choose between the medications they need and buying food.) If half of the Medicare beneficiaries reach the “donut hole”, this relieves insurers of having to pay 25 million X $3500/year in benefits ($87.5 Billion).

5. Insurers, under Medicare Part D, with a stroke of Mr. Bush’s fountain pen, gained additional income of 53,000,000 X $35 per month ($22.26 Billion per year, guaranteed).

If corporate insurers and corporate drug manufacturers are allowed to write the National Health Care Insurance legislation (as they did with Medicare Part D) you can absolutely guarantee that the corporate party will go on. We spend approximately $3 trillion dollars a year on health care. The REAL overhead insurers suck out of this is from 50 to 70%. That is $1.75 to $2.45 TRILLION a year to the insurers. That is why they are in a Swift-boating frenzy to sabotage an alternative.

So, Mr. President, I'm hoping that you are the guy I thought you were when I voted for you. Forget politics, compromise, and the middle way. Just do the right thing. Tell the people the truth. Don’t be distracted by the fear-mongering propaganda (“government takeover of medicine; take your doctor away from you; rationing of health care; Socialized medicine; etc., etc.”) Just tell the people the facts and the truth, and be clear in the two essential goals for a successful National Health Care Plan. Don't apologize for it either. Just tell them it's the right thing to do and your principles just don't give you another choice! We'll all respect that (and screw the insurance companies AND the bureaucrats).