Tag Archives: obamacare

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.

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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

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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Doctor Robert Villare on the Campaign Trail

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Rational Health Care Reform

Protect your rights to free choice in healthcare and preserve your access to the best healthcare in the nation. Doctor Villare brings needed expertise to Trenton for advancement of healthcare to all New Jerseyeans.

Rational Health Care Reform

The current policies proposed in Washington would result in a government takeover of the health care system. These policies would remove all decision-making concerning personal healthcare matters.

There is agreement on many of the problems that plague our current system. They are a lack of accessibility, portability and affordability. The elements to a viable solution would address these issues, yet maintain quality and individual empowerment. They include:

Create tax equity by equalizing the tax treatment between employer paid health insurance and individual health care plans. Currently, employer provided insurance is paid with pretax dollars and individual health insurance is not. Replacing the current tax exclusion with a system of universal credits would make personal, portable plans market-driven and lower their costs. The government could then direct health insurance savings to help poor individuals and families, as well as those with preexisting conditions, purchase private health insurance.

One type of insurance that has proven to reduce costs is to combine health savings accounts with a high deductible health insurance plan. Typically, money not spent in one year (in the health savings account) rolls over to the next year and can grow over time. This creates an incentive to spend these dollars much more carefully. The premium cost for the insurance component is significantly less expensive.

Deregulate interstate insurance so insurance companies can compete across state lines. Health insurance should be able to be purchased from any insurance company in any state. Market based reforms would result, because costly government mandates are eliminated. Consumers could tailor their health insurance to their needs.
Establishing medical malpractice reform would reduce health care costs. Defensive medicine (when doctors perform every conceivable test to protect themselves from malpractice suits) cost between $100 billion to $200 billion each year. These costs are passed on to patients through much higher prices for health care. Higher prices for health care causes higher prices for health insurance.

Enact medical record-keeping through use of health information technology. Today, a card no bigger than a credit card can hold your entire medical history. This allows doctors and hospitals to instantly access needed medical information.
Adopt a healthy lifestyle. Unfortunately, many health related issues are self-induced. Cardiac disease, diabetes and obesity are often preventable if proper diet, moderate exercise, not smoking and other positive lifestyle choices are adopted.

Ensuring patients take their medications. There are many wonderful drugs that help fight chronic disease and cancer. These drugs increase our longevity and allow us to live a better quality of life. Often times, patients don’t take medications as prescribed by their doctors contributing to $290 billion a year in avoidable medical spending (including excess hospitalizations). The reasons for noncompliance vary from side effects, the challenge of managing multiple prescriptions, forgetfulness, reduced sense of need if patients don’t feel any symptoms and cost. Poor medication compliance is a major roadblock to healthcare efficiency. Solutions to this problem include delivering better care to seniors by offering assistance in the elderly patient’s home thus keeping them out of costly nursing facilities, patient education, simplify drug regimens, reducing the cost of drugs for chronic diseases and closer monitoring of patients to improve compliance.

Healthcare reform is essential. Whatever reforms are undertaken, it is mandatory that they be fiscally responsible. The result should not be a centralized, heavy-handed, massive, one-size-fits-all government system. Bureaucrats would ultimately control all healthcare decisions resulting in rationing and much higher taxes. Individuals and families should be able to choose their doctors and be the key decision-makers in their own healthcare.

Robert C. Villare, M.D.

Assembly Candidate, 3rd Legislative District

Visit our Web-site at: http://www.votedocbob.com

Robert Villare, M.D. via e-mail at: votevillare@votedocbob.com

further information, please call 856-423-4515

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