Tag Archives: Trenton

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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New Jersey, Burzichelli and You – Not a Good Match

Assemblyman Louis Greenwald, D-Camden, quipped and Burzichelli agreed, “If you don’t like the budget, vote us out.” You should consider that suggestion. Here is a sample of what they’ve done to you. New Jersey’s median household income declined by $7,214 between 2006 and 2008, the largest dollar decrease in the nation, according to newly released US Census Bureau statistics. This represents a 10.1% decline in median income (as opposed to Pennsylvania which had a 1.1% decline). True to form, Burzichelli, your elected representative, had the gall to raise taxes by one billion dollars.

New Jersey taxpayers already pay $7,000 a year on average in property taxes, or about twice the national average. Under the current budget just passed by our elected representatives, the property tax rebate program, which can put up to $1000 back into homeowners’ pockets, will be limited to households earning less than $75,000. Last year the threshold was $150,000 and two years ago it was $250,000. About 1 million homeowners will no longer get rebates because of John Burzichelli and these elected officials.

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 has raised taxes on each resident by $2,601 — the highest in the nation. Taxpayers in this state spent 211 days a year working to cover the cost of government thanks to Mr. Burzichelli. New Jersey has the highest state and local tax burden, the second highest business tax burden (the current budget extends the 4% corporate tax surcharge), and the highest property tax burden per capita. The budget even raised taxes on health insurance premiums and Burzichelli voted to tax medical facilities 3% of gross revenues!!! He is part of the reason that many can’t afford healthcare.

In the end what does this accomplish? New Jersey has suffered a massive exodus of residents every year for the past 10 years. The state has 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 dollars in income and wealth. The death spiral of ever increasing taxes causes taxpayers to flee and businesses to relocate, thereby destroying jobs.

Assemblyman Louis Greenwald, D-Camden, quipped and Burzichelli agreed, “If you don’t like the budget, vote us out.” That is one of the better suggestions I’ve heard coming from our elected representatives. Grant their wish; vote them out.

Doctor Bob Villare-­-­
District 3 Assembly
Web-­‐site at:
Contact Robert Villare, M.D. via e-mail at: votevillare@votedocbob.com

For any questions or further information, please call 856-423-4515

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Doctor Bob Villare :The Silent Majority – No Longer Silent

It is beginning to look as though the people have had enough. The political talking heads are predicting major incumbent losses in the next election. Approval ratings for the entrenched political class are at record lows. 

This is not necessarily due to an overarching ideology. What is the explanation for the animus against politicians in general? Perhaps it is the sense of an oncoming financial Armageddon—the unyielding onslaught of national deficits. Perhaps it is the sense of utter distrust of anything our elected officials say. The constant force-feeding of focus group gibberish meant to brainwash. Perhaps it is their arrogance that we the people serve them—they forget they were elected to serve the best interests of the people. 

This is the first time in 20 years that the unemployment rate in Gloucester County has hit ten percent! This is in large part due to an entrenched political class that won’t stop spending and taxing. They won’t incentivize growth – which increases employment. Many states, including NJ, have raised taxes, often on business, which only chases them with their employees and tax revenues to lower cost, enterprise friendly locations. The continuing death spiral of ever increasing taxes will not be a winning strategy for the future. New Jersey will have to undergo a downsizing, or relinquish itself to a permanent decline. Sadly, many New Jersey politicians exist to enrich themselves and their supporters (including the state bureaucracies). 

New Jersey’s current budget requires ten unpaid furlough days for state workers. But furloughs do little to address fiscal problems such as bloated pension costs. In fact, they are a benefit to politicians who must placate public sector unions, while dealing with taxpayers who are outraged that government employees have not shared the pain of a recession that has cost 6 million private sector jobs. The bottom line is that New Jersey is non-competitive as a state to do business (and thereby create employment)! 

But there is a new wind blowing. The people have had it with their government’s fiscal obesity. They are fed up with the lies and half-truths promulgated by their leaders. All of this was on full court display evidenced by everyday citizens voicing their frustration at their representatives’ town hall meetings.

This movement is a worldwide phenomenon. The long-standing governing parties of Japan, Germany and the UK have suffered total meltdowns in recent elections. The only countries in the world which have reduced their debt as a percentage of GDP are Canada, Australia and New Zealand. It is not a coincidence that Canada generated 27,000 jobs and the U.S. lost 216,000 jobs in the month of August. 

Accountability is the new mantra demanded by the masses. A government that exists by the authority of the people must be limited in its power over its citizens, or it will cease to be a government of the people, but one that dictates and controls the people. New Jersey is on the precipice. Its elected leaders are not listening to the people. The silent majority will no longer remain silent. Change for the good is in order. 

Doctor Bob Villare

District 3 Assembly Candidate  

To contact Robert Villare, M.D., please e-mail his campaign at: votevillare@votedocbob.com

For any questions or further information, please call 856-423-4515


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Limit government to cut corruption

Limit government to cut corruption
by Letters to the Editor Gloucester County Voices
Tuesday August 25, 2009, 3:00 AM

To the Editor:

An FBI agent has characterized New Jersey as the most corrupt state in the nation. The political culture in New Jersey must change. The only way to do that is to reduce big government in the state.

– From 2000 to 2007 New Jersey created 6,800 private-sector jobs, but created 55,800 public-sector jobs. The only growth industry in New Jersey is the. government.

– New Jersey ranks 50th in the United States in the job creation rate. About 79,000 private-sector jobs left the state in the last decade.

– An environment of high taxes and overregulation gives rise to excessive complexity for business to get funding and operate honestly. This foments a breeding ground for corruption. The result is that honest businesses get disgusted and flee the state.

The book, “The Soprano State: New Jersey’s Culture of Corruption,” states “there are all these little authorities that everyone has to go to for permission — too much government means too many opportunities for officials looking to cash in.

“Corruption thrives on unchecked conflicts of interest. A New Jersey mayor can also be a member of the state legislature and a partner in a law firm that benefits from legislation he writes. The public’s welfare is the last thing on the agenda.”

For example, former state Sen. Wayne Bryant, a Camden County Democrat, was found guilty of accepting a largely fabricated position at the University of Medicine and Dentistry of New Jersey, which enabled him to inflate his pension while he steered millions of taxpayer dollars to the school.

New Jersey has 566 municipal governments and 615 school districts, some of which don’t have students, but collect millions of dollars in local taxes and have paid administrations. New Jersey has more school superintendents than Maryland, Virginia and Delaware combined. According to “The Soprano State,” state government has 154,500 workers and local governments employ 444,000 workers.

In California, 36.7 million people pay $259 per capita to run their government, compared to $289 per capita paid by New Jerseyans — and California is going bankrupt despite paying out 10 percent less than New Jersey residents.

Pennsylvania pays only $182 per capita, or 37 percent less than New Jersey to run its government. Pennsylvania has a greater population approaching 12.5 million. New Jersey has about 8.6 million people. This is simply unbelievable.

Politicians employ their supporters and ensure their loyalty with good pay and pensions totally out of line with the private sector. The result is there are fewer people putting money into the treasury and more people taking money out. No wonder New Jersey is in a state of financial Armageddon.

The cancer that affects this state must change. A limited government and a freer economy promote an ethical government and a productive economy.

Robert Villare
Republican Assembly candidate
District 3
West Deptford Township

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Meet the Candidate : Doctor Robert Villare, M.D

Doctor Robert Villare, M.D., Masters Public Administration
Bob served as Chair of Department of Surgery Quality Assurance Committee at Thomas Jefferson University Hospital-Methodist Division and served as clinical instructor in surgery at Jefferson Medical College.

Bob benefits the 3rd District due to his presence in two counties. He works in Salem County where he serves as Chairman of the hospital’s HealthCare Quality Improvement and Patient Safety Committees while he resides in Gloucester County in West Deptford Township.

Bob is a strong advocate for patients and for physicians, nurses and technicians working in the “trenches” of patient care.

More than just a physician and surgeon:

With his graduate degree and studies at both Rutgers University and Johns Hopkins, Bob has gained insight into state policy issues and is a strong supporter of advanced education.

Bob has prepared a specific plan to reform healthcare delivery in New Jersey through his experience as a Senior Scholar at Thomas Jefferson University’s Department of Health Policy.

Bob’s experience on the New Jersey Board of Medical Examiners Advisory Committee on Continuing Medical Education where Rules & Regulations were drafted will be crucial in reforming Health Policy in New Jersey.

Licensed in Health & Disability Insurance, Bob gained knowledge and understanding of complex issues enabling him to make meaningful reforms for you.

Bob’s actions already benefited both the public and healthcare in general when his article in a New Jersey Journal on Health Policy helped persuade Senate President, Richard Codey to clarify rules governing physicians taking their patients to Ambulatory Surgery Centers. Imagine what Bob Villare can do for you, as your Assemblymen.

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