MONDAY-TUESDAY OBAMACARE BLOG

On year ago  Tuesday Sandy hit. One week from Tuesday we have the General elections as well as the Board of Education. One was one of the greatest disasters to hit this part of earth; the other could be.

Another disaster which may also turn out to be one of epic proportions has been the roll out of the Insurance Exchanges.

 
I did wish to post this subject Monday afternoon; but PT and a needed trip to the market, then  Petsmart for cat food that Mick might not turn up his nose at and instead of howling (he does that when he is mad) he might eat, plus a stop at Staples for an ink cartridge took up too much of the afternoon.

However, I do want to get back to the Obamacare story. Really there are at least two radically different ones depending on whether you believe the Times or the Wall Street Journal and their respective columnists. These papers do reflect in their news columns, editorials and columnists their orientation; thus it is important to read both and try to strike a median.  Or don’t read either and understand that the TV broadcasters are also prejudicial in their comments.

I have been writing for several years my fears about the impact of the ACA on our disintegrating health delivery system. That is an issue I will get back to in the near future but rather than creating links to any specific blog I would suggest that if interested open the right side sidebar and scan each month back to the start for blogs related to Health Care.

The problems that have befallen Obamacare due to the multitude of system failures are not in themselves indicative of the unsoundness of the concept. All they highlight is the sloppiness involved in the computer sciences that are essential for functioning.

However, if we are unable to trust the competency of the underling software how can we be sure that our personal data is safe or if information we are receiving is correct?   

Those are issues we must be concerned with as well as what “quality care” will means when financial constraints will force limiting even rationing. That will not only be for material services but also the availability of physicians and hospitals.

Already United Health Care the carrier used by AARP has delisted some 10% of the physicians its policy holders can use; as well as some hospitals. In New Jersey Horizon according to the Medical Society of NJ is quietly culling the number of doctors on its panels, by not renewing their affiliation and without warning.

This is an economic factor and has nothing to do with the quality of care those individuals rendered. The intent is to renegotiate contracts down with a smaller group who have become dependent on the insurer. Hospitals will also be put under pressure to accept smaller reimbursements.

The impact upon you will be that your favorite doctor or hospital will not be in the system and you may not receive any reimbursement if you use them. Even if your carrier will pay you it will be at their lowest rate.

This process happened when the HMOs entered the field and began dictating what services performed by whom that you could receive.

On the financial pictured by the small turnout of completed applications as a result of the computer crashes there can be a result that the Administration is blacking out any mention.

 
The Success of the Exchanges depends in part on the number of carriers offering programs. More important is the need of healthy young people who will put little use of their policy. There will be no lack of desire for those who have illnesses to sign up for one of the four levels of coverage.

Insurance companies base their premiums on actuarial facts derived from age and potential use by the insured. If there is an older mix of subscribers including many who would be considered uninsurable today and very few younger individuals who will not make demands on the system the premium will have to rise and may do so substantially. People may find that there are no bargains in the exchanges.

Although the proponents of Obamacare  have stated that those with insurance will not have to give up their present carrier and policy, there have already been many in California for example who have had their policies terminated when the Company found it did not meet all the “basic requirements” of the ACA.

 
These are just a few of the non-medical issue that make the ACA a flawed program.(continued sometime in the hear future)

BLOGLESSLY

No blog today but lots of excuses.

The good ones; (1) No real outstanding news local or otherwise for comment, (2) Any commentary about Obamacare needs a thoughtful documentation which takes time, (3) Only one Candidates' Forum, the LWV on 10/30/ at Emerson School worthwhile. That is not to denigrate Sunday's NAACP forum which Benice (Plaintalker II ) covered but hoping ALL candidates will be at the professionally conducted League of Women Voters shindig.

The bad but true excuses; (1) a horrible UVA football game, five Georgia Tech turnovers and not a single point earned. Once again could not score from the "red zone", (2) an atrocious Jets game,the less said the better, (3) a ridiculous Giants game in which they could not score a touchdown but did beat a team without a quarterback, (4) Two good World Series games; one the House of David (Red Sox) won with one hit, the other they lost on an historic never before game ending decision making "Blocking call", (5) a good honest hour nap during the Jets game , (6) anticipation of PT today, (7) a cat who has decided that he does not like any of the can food offered and regurgitates the dry food which he overeats, (7) recurring computer problems with external hard drives (time frustrating) and a disc drive that seems to seize the computer any time a disc is loaded before start up. That is a non-problem except with the boss. (8)best of all overslept.

Hopefully I will have a subjective blog  for Tuesday. 

WEEKEND BLOG

The last three months of the year are exceptional ones for the couch athlete, especial the weekends. With the World Series (baseball) , college and professional football, both college and pro. Basketball, as well as hockey and still not excluding soccer which can be seen if not on limited channels of the TV  but streaming through ESPN3 on the computer; what chance does an innocent have to expound on the material things of political and economic life?

Regarding the World Series; How many of you remember the House of David baseball team? The Red Sox are a reincarnation of that notorious “travelling team” of the days when there were itinerant profession teams in all sports among them the Harlem Globe Trotters who played local semipro and pro teams.

The House of David had no religious connection but all its players sported heavy beards. I supposed that the name would be considered politically unacceptable mow or offensive.

At this time the Seminole Indians have no objection to Florida State using the nickname “Seminoles” or to the students chant or the pre-game ceremonies.

However; there are active groups pressuring for the Cleveland Indians tto change its name as degrading. Those objecting to the Washington pro. football team being called the “Redskins” may have a case not because the name which was intended to reflect strength and fortitude, was derogatory as a reference  as an “inferior race”; but as a result of its record.

I am sure that there has not yet been a similar objection to the baseball Washington Senators name perhaps because the Senate does project the same picture of ineptitude.

 Ups! I just received this news flash.

Now that that is resolved; for those who were busy with important stuff  the first game of the World Series had two memorial plays that will be remembered for years. 

The first one was Beltran's catch robbing Ortiz of a grand slam  and the second on was the Cardinal pitcher and catcher standing about three feet from each other gazing into their eyes while a pop fly drops untouched between them for a hit.  

Enjoy the weekend and remember that a week from Tuesday (Nov.5) is election day.

WHAT WILL BE -(2)

To continue on the changes in the health delivery system that are going to impact on our city’s future.

There are other changes in the relationships of doctor and patient. With the increase need to see more patients in a given day pushed by reduced reimbursement per unit visit; doctors have tended to have longer in office hours. They have also tended to become “8-5” doctors.

The Hospitals in their merchandizing all aspects of medicine have found that it was profitable to employ in hospital doctors; at first super specialist and increasing to all aspects of care. In some hospitals there were restrictions on outside physicians treating patients in the hospital.

PCPs and others found that including travel time it was less cost effective to see a patient in the hospital than in the office. With the hospitals encouragement more doctors turned their hospitalized patients over to a hospitalist.

There is no longer a real doctor patient relationship throughout all an illness. Moreover there is an increasing shortage of PCPs and certain specialists in many areas such as urban New Jersey. Part of the shortage of PCPs in group practice is met by use of Nurse Practioners and Pas. However good as many are their training does no equal by any means that of an MD or DO.

Taking the above into consideration and for the purpose of this paper I am not addressing the issue of physicians restricting the number of patients in their practice. This is a problem which will become more prevalent as the ACA impact is felt.

But we are discussing a new use of Muhlenberg’s property. I have heard many talk of a “Medical Mall”. I do not have any concept as I wrote in a previous blog what is meant. I also believe that those who speak of such a thing also do not have any true concept except in a flight of fancy.

The reality is that we are five years too late and as I wrote in the previous blog we missed any opportunity to obtain any replacement of even a part of Muhlenberg’s services.

To start from scratch a hospital will need a core of physicians; PCPs and Specialists who have restricted their in hospital care are not going to change for a local hospital.

If the new institution comes staffed for all problems the overhead will be unmanageable for prolonged period of time until doctors are willing send patients there and people are willing to go. 

At best the hospital could only serve short term (a few days) care of patients that do require exotic elective or emergency surgery.

That leaves the Mall to be composed of a walk-in facility or urgent care and a true emergency care facility plus doctor’s and ancillary services offices.

With the increasing shortage of practioners and the decreasing reimbursements, I find it unlikely for anyone to start an office in Plainfield with the already concentration of new office buildings in Edison and Warren/Watchung.

The above does not mean that we should not make an all-out effort to bring some profit oriented operation to replace JFK.