Tag Archives: Healthcare Reform

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.

Bookmark and Share


Tower of Babel Syndrome: Part 2 Lack of Uniform Standards

Part II

Lack of Uniform Standards

Costly and restrictive regulations impact providers’ ability to practice in more than one state. Most medical residents, after completing a rigorous training program in their chosen specialties, opt to stay in the state where they trained. They do so, in part, because it is easier. During residency training, they obtain the license, hospital privileges and numerous certificates that are required to practice in one state, and do not want to duplicate the time-consuming effort elsewhere. The bureaucratic roadblocks to begin work as a licensed medical professional in another state hinder underserved hospitals’ efforts to attract new staff.

States and health care organizations are devising incentives to attract health care workers to underserved regions, but the task is an uphill battle.

In contrast to inconsistent regulations, standards for medical education and training in this country are fairly uniform, with advancement in medical science remaining irrelevant of state lines and public laws. Physicians take a national examination and fulfill certification requirements that do not vary by state. Medical school admissions criteria and curricula adhere to the same basic and uniform standards for specialty certification.

So, cardiologists in one state expect to have the same medical knowledge and expertise as their counterparts in the adjacent state. Case law supports this “national” standard of quality in physician training. If this were not the case, the disparity would drive health care consumers to seek their care in states with higher standards. I postulate that it is a disparity in technology and resources, not in provider expertise, that drives consumers across state lines to centers with state-of-the-art equipment.

It is illogical to think that geography impacts the treatment of a fever of 104°, a heart attack, a high-risk pregnancy or a pediatric seizure. State borders, socioeconomic status or education levels do not impact a physician’s ability to handle such cases. The practice of medicine is – or should be – standard. Yet we allow laws and insurance regulations to complicate the billing, payment and even medical management of these same conditions. Worse, the malpractice insurance premiums for treating these conditions vary inordinately from state to state.

The fragmented nature of the current system would not and could not be applied to other professions. Imagine the chaos if pilots were only licensed to fly over specific states, or if truck drivers needed separate licenses to cross state lines. Think of the devastating effect such bureaucracy would impose on our economy and public welfare. If we truly value universal health care, we must work toward uniform laws and standards that transcend state lines and institutions.

In addition, the lack of a uniform federal system of health care law blocks progress in health care delivery. Whether by phone, e-mail or voice over Internet protocol, communication is the cornerstone of health care delivery and essential to administering quality care. The health care world has become smaller, in part, because of advances in communication technology. However, legal obstacles block the lines of communication between health care providers and their patients. If patients seek advice from an expert in another state, that expert must be licensed in the patient’s state of residence. Policymakers are stuck deciphering whether the patient has gone to the physician via phone or Internet technology, or if the doctor has legally left his/her state and visited the patient’s location, thus requiring separate licensure and approvals.

Imagine the chaos if similar restrictions applied to telecommunications. It is absurd to consider that one would need to complete special applications to listen to one’s favorite radio station transmitting from another state, or to talk to a friend in New Jersey from one’s cell phone in Delaware.

Why Uniformity Makes Sense

Picture a trauma surgeon licensed and practicing in Delaware who is driving through Virginia on vacation. He sees a serious accident on the roadside and knows he can help, but is hesitant to stop because he is not licensed to practice medicine in that state. If he stops and assists, he might be held liable for his actions. Thoughts of state regulations, licensure and the risk of a lawsuit all rush through his mind as he considers whether to stop and help… or just pass by.

Good Samaritan laws were enacted to protect caregivers from liability when providing emergency medical care. These statutes, which should be uniform throughout the country, are not. They vary state-by-state. Variations in these laws are the moving targets that foster fragmentation and confusion, rather than promoting harmony and uniformity in our health care system, thus continuing the Tower of Babel phenomenon. Once, doctors and nurses did not hesitate to help the sick and injured, wherever they were. Now, physicians and nurses first consider legal issues when rendering medical care.

Studies have shown that Good Samaritan laws make no difference in the providers’ willingness to help. This should come as no surprise, given that most health care providers are innately conditioned to help people in need. Their core nature and specialty training transcends the limits and qualifiers put in place by manmade laws and regulations. Imagine the chaos if National Football League or National Collegiate Athletic Association sports teams could not play tournaments across state lines, because rules and regulations to play that same sport were different on a state-by-state basis. That is the condition of the health care delivery system in our country today.

However, changing that system will first require a close look at why it exists in the first place. The incentives to keep health care complex and un-standard appear ridiculous on first impression, but a “freakonomics” perspective might yield some insight. Look at all the jobs created to decipher the chaos. Consider the alarming impact on our economy if we eliminated those jobs, not to mention the stress associated with change, if workers, formerly relegated to interpreting the system, were suddenly charged with tasks that truly benefited patient care.

Realigning common goals may narrow the medico-legal divide and reduce inconsistency in health care.

Bookmark and Share

Voters Speak Out !

It’s amazing how the state of NJ has declined. What’s more amazing is that as a people we haven’t reclaimed it. the current assemblypeople want to tell you they are now looking into the school districts, and they want to “freeze” spending. How pathetic, why did they let it get this bad in the first place? They did the damage, now they want you to believe they are going to fix it. Believe that, and I have a bridge to sell you

rosemary d


Calendar of Events

Fundraiser Ira Smith 2:00PM
Sunday, Oct 4, 2009
Cherry Hill
Fundraiser from 2:00 to 4:00 pm at Ira Smith home in Cherry Hill, NJ

Italian Heritage Festival
Sun, October 4, 12pm – 6pm


Doctor Robert Villare on the Campaign Trail



Calendar of Events

Swedesboro- Woolwich Day
Sat, September 26, 10:00am – 4:30pm
There are lots of booths and give aways. Phone number for information on website is 888-315-8009 x706.

Woodstown Fall Festival
Sat, September 26, 10am – 4pm

breakfast w/David Rodriquez,Puerto Rican Action Committee@Woodstown Diner
Tuesday, Sep 29, 2009
Woodstown Diner@10:00am (map)

Citizen’s For State Assembly
Wed, September 30, 10am – 1pm
Steps of State House in Trenton (map)
The Citizens for Assembly press conference will be Wednesday September 30 on the steps of the State House in Trenton. The event will start at 11:30 am. Please try your best to get to Trenton by 10:00am.




My opponents have done nothing of substance for seniors or soldiers in the last decade

Doctor Bob Villare for Assembly–District 3 pledges to:

PROTECT MEDICARE. NO CUTS IN MEDICARE, NO FREE CARE FOR ILLEGAL ALIENS AND DON’T CUT MEDICARE IN THE NAME OF HEALTHCARE REFORM: No cuts from Medicare, Medicaid or any other plan that funds seniors’ care. No free healthcare for folks who don’t have a right to be in our country. Medicare should not be raided to pay for another entitlement.

PROHIBIT GOVERNMENT FROM GETTING BETWEEN SENIORS AND THEIR DOCTORS: The government-run healthcare experiment will give patients less power to control their medical decisions, and create government boards that decide what treatments get funded. Doctor Villare believes in patient-centered reforms that put the priorities of seniors before government.

PROHIBIT EFFORTS TO RATION HEALTHCARE BASED ON AGE: The government-run healthcare experiment sets up a “comparative effectiveness research commission” where treatment decisions could be limited based on a patient’s age. I believe that health care decisions are best left up to seniors, their families and their well-trained and informed doctors.

PREVENT GOVERNMENT FROM INTERFERING WITH END-OF-LIFE CARE DISCUSSIONS: The government-run healthcare experiment mandates seniors meet to discuss end-of-life care. It is none of the government’s business to impose consultants to discuss your end-of-life advanced medical directive. Seniors with their family, their doctor and lawyer can help with this decision; not the government.

ENSURE SENIORS CAN KEEP THEIR CURRENT COVERAGE: As steep cuts are proposed in Medicare & Medicaid in order to pay for a government-run healthcare experiment, these cuts threaten millions of seniors with being forced from their current Medicare Advantage plans. Seniors will pay more for less. This will not happen in New Jersey under my watch.

PROTECT VETERANS BY PRESERVING TRICARE AND OTHER BENEFIT PROGRAMS FOR MILITARY FAMILIES: Democrat leaders recently proposed raising veterans’ costs for the Tricare For Life program that many veterans rely on for treatment. I oppose increasing a burden on our veterans and believe America owes it to them to extend payment to private university hospitals to provide our veterans the best care and give Veterans Freedom of Choice for their healthcare needs. After all, it is the soldiers who give us our freedom.

Bookmark and Share