Tag Archives: capitalism

Tower of Babel Part 3: Solutions


There are solutions to the Tower of Babel health care crisis that our medical profession and patients currently face. Those solutions, in some cases, are already in place. Years ago, a federal law to guide self-funded health insurance plans helped reduce disparities in the health care system. The Employee Retirement Income Security Act of 1974 (ERISA) was designed by the federal government to impose limits on health care litigation. Under this act, no individual can receive compensatory or punitive damages. Beneficiaries are entitled to the costs of medical benefits.

The uniformity of a national system succeeds under ERISA because health funding plans were not required to write fifty separate and distinct documents in accordance with state laws. Indeed, from an administrative standpoint, it is easier to work through the federal court system for health care reform. The federal court promulgates one universal common law standard, rather than wrangling with laws that differ on a state-by-state basis. Uniformity sometimes works best through simplicity.

The key solution might be uniform national legal standards. Such standards could bridge the gap between the legal and medical professions. Uniformity could improve care and reduce injury and malpractice expense, and case law exists to demonstrate this. In Helling vs. Carey (U.S. Supreme Court 1974), a young patient lost sight in one eye because doctors failed to test for glaucoma. The medical standard at the time was to not screen for the disease in patients under age 40, because of its rarity in this age group. The court found that reasonable, common-sense medical testing for glaucoma must be performed, regardless of age. The case serves to illustrate the confusion that can arise in the absence of a global standard of care. Physicians assume that they are governed and protected by practice standards, established by specialty societies and medical training. However, mere compliance with practices considered to meet the medical profession’s standard of care is not enough to insulate practitioners from medical liability. A global standard of care must reach across not only state lines, but also age, race, education and socioeconomic barriers. We must blend the teachings of law and medicine to educate all providers with one standard that raises the quality of care across the nation.

We also must remove medical decisions from the influence of government, corporations or HMOs, and return control of treatment to doctors’ hands. This point is emphasized in Wickline vs. State (California court of Appeal 1986). That case concerned a patient who was discharged too early from the hospital because the patient’s HMO insisted. The early discharge resulted in the patient losing a leg, and, consequently, a slew of medical costs that were ultimately shouldered by the U.S. tax payer. No savings resulted from the early discharge. We, as tax payers, face the unintended drain on our collective resources from such actions. In our quest for a national standard of care, we must be mindful of the harmful ramifications of cost-containment and make physicians, and not insurance companies, the decision-makers in patient care. After all: Physicians are the ones who have been trained to provide care, with specialized knowledge and skills for practicing medicine.

A uniform health benefit policy and reimbursement structure is also necessary to reaching a solution to the current health care crisis. The truth is, doctors cannot just be doctors anymore. Physicians are obligated to consider insurance payment issues when administering treatment. Yet, it is impossible for physicians to know and understand the rules and limitations of hundreds of different insurance policies, particularly when those policies themselves vary inherently from state to state. If we had a uniform health benefit policy and reimbursement structure, it would be easier for physicians and patients to work through the seemingly endless maze of restrictions and regulations that characterizes our current health care insurance system. This maze extends to multiple parts of the system. For instance, enrollment is costly to businesses that must re-enroll new employees who are already enrolled in insurance plans from their previous employers. Business, including private and public employers, could save thousands of dollars if employees were allowed to keep their insurance plans, even across state lines and employers.

Another solution can be found in the concept of a health care “team.” In Sword vs. NKC Hospitals (Supreme Court of Indiana 1999), it became clear that the public views hospitals’ staff as a “team” of providers that share responsibility for care. The case established the public’s expectation that a medical institution and its staff work as a unit, and that care delivery is no longer about the individual acts of doctors and nurses. This “team” approach characterizes health care today. Like a symphony orchestra, the health care team must work together in concert. Yet unlike the symphony, health care providers rarely, if ever, practice together as a team. This is the reality of health care today as evidenced by agency nurses, contracted therapists, temporary rental equipment, locum tenens emergency room doctors and the new crop of residents and interns every year. No one knows each other, and this lack of familiarity impacts patient safety. Airline industry studies have demonstrated that flight crews that refer to each other on a first name basis have the best safety records. Those good records could be due to the comradeship developed by working closely together on the same flights, according to experts.

Imagine if you took a group of professional musicians and informed them that they would have to perform together at an extraordinarily important concert, but without first rehearsing. Their response would most likely not be positive. The same principle applies to health care. To achieve higher quality standards of care and patient safety, a team effort must be established to create uniformity, thereby meeting the same standards across the country, from the smallest towns to the biggest cities. It is not only patients’ health, but also their lives, at risk.

In addition, a federal liability system could serve to reduce the burden of high cost malpractice insurance, lifting the expense from a few providers to multiple providers, by spreading the risk to larger health care enterprises across the nation. Under this national enterprise scenario, we would not sue individual doctors and nurses, but would instead hold larger health care organizations responsible for quality care or lack thereof. Such a scenario paves the way to simplify the insurance underwriting process, and helps reduce the burden on good doctors who must pay for the actions of bad doctors. In a federal system, if a nominal amount of tax dollars contributed to a liability fund, our medical malpractice crisis might subside. Those who deliver and those who receive health care then become vested in quality care, making health care a team sport instead of a superstar sport.

Another effort, telemedicine, might also be a solution to the lack of uniform standards. It serves as a catalyst to create standards across the nation through direct communication in different states. An array of diagnostic and treatment data can be transmitted – even from orbiting spacecraft – to the most remote areas, ensuring that new technology and services reach even the most underserved of populations. In line with this trend, the Veterans Health Administration has adopted a set of uniform standards for the electronic exchange of clinical health information across the nation. Interoperability between computer platforms and web-based programs is essential to cross the translational barriers inherent in these systems. The future lies in standardized information exchange, allowing public health officials to identify emerging threats and approach them swiftly and efficiently, such as in treating the H1N1 flu. Standardized information exchange also makes possible the prospect of portable electronic medical records. Rendering the health care process more orderly and uniform throughout our country imparts momentum to tertiary care centers, enabling them to deliver advanced care to even remote locations.

Uniformity helps balance the glaring disparities across state lines. Federal doctrines of health law could help guide educators and providers to deliver quality care by clarifying exactly what constitutes the expected universal standard. It helps us to simplify. I believe that encouraging the trend for standardization, uniformity and simplicity can lift us out of the quicksand of bureaucracy, toward a more truly universal standard of health care.

While the government is surely to blame for the current health care crisis, and corporate private health insurers have helped contribute to the mess, the confusion of competing languages in health care’s Tower of Babel syndrome could be quieted by creating a universal health care language, understood by all.

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Healthcare Reform: Tower of Babel Syndrome Part 1

Tower of Babel Syndrome: Lack of uniformity plagues health care delivery in U.S.

Part I

Vague laws, inconsistent regulations and lack of uniform health care standards contribute to the “Tower of Babel” syndrome in our nation’s health care system today. This modern-day Tower of Babel is causing chaos and disorder in our medical system. Different rules and standards apply across the U.S. for nearly all aspects of health care, with standards even differing among statewide organizations.

Bureaucratic red tape overburdens our health care professionals, hindering their work and driving up health care costs.

This article discusses our disjointed system and offers a model for solution.

A real world example of a modern-day Tower of Babel occurred in the aftermath of Hurricane Katrina. The Federal Emergency Management Agency, U.S. Department of Health and Human Services and state government officials argued over jurisdiction and control in their own bureaucratic languages, similar to how multiple languages caused confusion in the Biblical story. While victims of the hurricane could little afford to wait, bureaucratic red tape thwarted relief efforts. No victim cared about laws or insurance regulations or legal jurisdictions. All that mattered to them was receiving adequate health care.

Our health care system is currently no different than the bureaucratic Tower of Babel in New Orleans. A maze of red tape exists everywhere within the system, but several parts stand out:

Each state requires a separate license for doctors, nurses, technicians and therapists.
Continuing Medical Education (CME) requirements differ on a state-by-state basis.
Malpractice laws and health laws also differ on a state-by-state basis.
Insurance claims, rates, rules and regulations and payments differ in every state and change with every insurer.
Physicians must pay duplicate staff dues and process cumbersome applications to every hospital and state where they work.
We, the tax-payers, are paying a high cost for lack of uniformity in the health care system, and yet are reaping few, if any, benefits.

These examples are only a few of the many overlapping standards and confusing regulations in our current health care system. Other examples include licensure in health care. It too varies on a state-by-state basis, but for no obvious reason. The licensure process does not address the special needs of each state’s population, including those with specific health issues, such as high cancer rates or prevalent respiratory problems.

The complexities grow even more confusing when examining health insurance. Some states approve more than 1,000 different health insurance plans for providers and patients. Many of these plans evolved from managed care, more aptly called “managed money,” with neither providers nor patients looking favorably on the health maintenance organizations (HMO) that helped create this albatross. The insurers and HMOs that sell the complex list of benefits to the public (called health insurance) get entangled in their own web, and must rely on legions of attorneys to sort through regulations — which differ in all 50 states.

A 2004 study by the Cato Institute reported that health care regulations cost Americans approximately $169 billion per year – or $1,546 per average household – and that the costs of the regulations outweigh the benefits by a ratio of 2-to-1.

One out of six uninsured people has excess regulatory costs to blame for their lack of health care.

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New Jersey Economic Disease–Autopsy Findings

New Jersey’s median household income declined by $7,214 between 2006 and 2008; the largest decrease in the nation according to the U.S. Census Bureau. This represents a 10.1% decline in median income (as opposed to Pennsylvania which had a 1.1% decline). Despite being an economic basket case, our elected representatives raised taxes by over $1.2 billion dollars during a recession.

New Jersey taxpayers pay $7,000 a year on average in property taxes, twice the national average. Under the budget just passed by our elected representatives, the property tax rebate was limited to households earning less than $75,000. About 1 million homeowners no longer get rebates, thereby increasing their property taxes AGAIN.

The budget just passed also increases the top personal income tax rate to 10.75%, one of the highest in the nation. Two thirds of small businesses pay this tax rate. Since 2002, New Jersey raised taxes on each resident by $2,601 — the highest in the nation. Taxpayers spent 211 days a year working to cover the cost of government. New Jersey has the highest state and local tax burden, the second highest business tax burden, and the highest property tax burden per capita. The budget even raises taxes on health insurance premiums!!

In the end, what does this accomplish? New Jersey had a massive exodus of residents every year for the past 10 years. The state lost 335,000 people since 1997 — one of the highest outflows in the nation. The top destination for these Garden State exiles is low tax Pennsylvania and Florida and along with them $13 billion in income and wealth. The death spiral of ever increasing taxes causes taxpayers to flee and businesses to relocate, thereby destroying jobs.

Assemblyman Greenwald, D-Camden, Burzichelli, D-Gloucester and Riley, D-Gloucester, mockingly challenge voters “if you don’t like the budget vote us out.” That is the best suggestion coming from our elected representatives. TAXPAYER ALERT TO THE GARDEN STATE: WE ARE NO LONGER YOUR ATM MACHINE!!!

Doctor Bob Villare– District 3 Assembly Candidate

856-423-4515 559 Mantua Avenue Paulsboro, NJ

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Career politicians gave you: the highest taxes in New Jersey history, wasted spending, property taxes twice the national average, ruined healthcare, corruption, pension abuse, a 7 to 10 billion dollar deficit spending, record high unemployment, the second highest business and corporate tax in the nation, nearly $40 billion in debt to hand down to your children, and eminent domain abuse against our soldiers.

After 10 years of nothing but empty promises, it’s time to give them (Burzichelli/Riley) a vacation from politics.

TAXPAYER ALERT TO THE GARDEN STATE POLITICOS: “WE ARE NO LONGER YOUR ATM MACHINE!!!!!! We the voters are YOUR employers. You are not our rulers. We are coming to the polls to get rid of you.

Vote Robert Villare, M.D. (Doctor Bob).
It’s not a party thing, it’s the right thing! Vote the person, not the party

An interesting wake-up call sent by a Russian author. As always, let me know your thoughts. Doctor Robert Villare, M.D. Assembly Candidate

American capitalism gone with a whimper

It must be said, that like the breaking of a great dam, the American decent into Marxism is happening with breath taking speed, against the back drop of a passive, hapless sheeple, excuse me dear reader, I meant people.

True, the situation has been well prepared on and off for the past century, especially the past twenty years. The initial testing grounds conducted upon our Holy Russia and a bloody test it was. But we Russians would not just roll over and give up our freedoms and our souls, no matter how much money Wall Street poured into the fists of the Marxists.

Those lessons caution the American populace for the surrender of their freedoms and souls, to the whims of their elites.

First, the population was dumbed down through a politicized and substandard education system based on pop culture, rather then the classics. Americans know more about their favorite TV dramas then the drama in DC that directly affects their lives. They care more for their “right” to choke down a McDonalds burger or a BurgerKing burger than for their constitutional rights. Then they turn around and lecture us about our rights and about our “democracy”. Pride blind the foolish.

The final collapse has come with the election of Barack Obama. His speed in the past three months has been truly impressive. His spending and money printing has been a record setting, not just in America’s short history but in the world. If this keeps up for more than another year, and there is no sign that it will not, America at best will resemble the Wiemar Republic and at worst Zimbabwe.

These past two weeks have been the most breath taking of all. First came the announcement of a planned redesign of the American Byzantine tax system, by the very thieves who used it to bankroll their thefts, loses and swindles of hundreds of billions of dollars. These make our Russian oligarchs look little more then ordinary street thugs, in comparison. Yes, the Americans have beat our own thieves in the shear volumes. Should we congratulate them?

These men, of course, are not an elected panel but made up of appointees picked from the very financial oligarchs and their henchmen who are now gorging themselves on trillions of American dollars, in one bailout after another. They are also usurping the rights, duties and powers of the American congress (parliament). Again, congress has put up little more than a whimper to their masters.

Then came Barack Obama’s command that GM’s (General Motor) president step down from leadership of his company. That is correct, dear reader, in the land of “pure” free markets, the American president now has the power, the self given power, to fire CEOs and we can assume other employees of private companies, at will. Come hither, go dither, the centurion commands his minions.

So it should be no surprise, that the American president has followed this up with a “bold” move of declaring that he and another group of unelected, chosen stooges will now redesign the entire automotive industry and will even be the guarantee of automobile policies. I am sure that if given the chance, they would happily try and redesign it for the whole of the world, too. Prime Minister Putin, less then two months ago, warned Obama and UK’s Blair, not to follow the path to Marxism, it only leads to disaster. Apparently, even though we suffered 70 years of this Western sponsored horror show, we know nothing, as foolish, drunken Russians, so let our “wise” Anglo-Saxon fools find out the folly of their own pride.

Again, the American public has taken this with barely a whimper…but a “freeman” whimper.

So, should it be any surprise to discover that the Democrat controlled Congress of America is working on passing a new regulation that would give the American Treasury department the power to set “fair” maximum salaries, evaluate performance and control how private companies give out pay raises and bonuses? Senator Barney Franks, a social pervert basking in his homosexuality (often praised as a virtue) and his Marxist enlightenment, has led this effort. He stresses that this only affects companies that receive government monies, but it is retroactive and taken to a logical extreme, this would include any company or industry that has ever received a tax break or incentive.

The Russian owners of American companies and industries should look thoughtfully at this and the option of closing their facilities down and fleeing the land of the Red as fast as possible. In other words, divest while there is still value left.

The proud American will go down into his slavery without a fight, beating his chest and proclaiming to the world, how free he really is. The world will only snicker.

Stanislav Mishin

The article has been reprinted with the kind permission from the author and originally appears on his blog, Speak your mind on Pravda.ru forum

Please tell me your thoughts. Email me or call my office with comments or suggestions. Robert C. Villare, M.D. Assembly Candidate, 3rd District

Email: votevillare@votedocbob.com

Phone: 856-423-4500.

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