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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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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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How Important Is YOUR Vote?

I am Dr. Robert Villare and I’m running for State Assembly in the 3rd District and need to ask YOU a few questions.

Did you vote to have your taxes raised until they are the highest in the entire United States?

Did you vote to approve oppressive regulations that drive businesses out of New Jersey?

Did you vote to have your property taxes doubled?

Did you vote to take casino and lottery revenues away from SENIORS for whom it was intended?

Did you vote to tax each businesses $15,000.00 for each new employee they hire causing businesses to leave New Jersey at an alarming rate?

Did you vote to cut charity care by millions causing the poor and uninsured to suffer and hospitals to close?

Did you vote for YOUR Insurers to cut benefits while raising your health insurance premiums?

Did you vote to spend $100 million of YOUR tax money for a parking garage and court renovation?

Did you vote to pay a retired part-time commissioner a full pay pension of $100,000.00 per year?

Did you vote for this same Commissioner to leave a $7 to $10 Billion deficit for your children to pay off?

Did you vote to spend $30,000 per student in the Abbott School program while local outstanding school systems like West Deptford spends around $12,000 to educate each student?

Did you vote to have the worst state Medicaid program in the entire nation [California Healthcare Foundation April 2009]?

If you answered YES, you got what you voted for. If you answered NO, then take back your government. Vote new representation. Democrat, Republican and Independent voters all suffer from failed leaders. If YOU are fed up and had enough…

Vote Robert Villare (Doctor Bob) for Assembly.

“Vote the Person, Not the Party”

A Call To Action

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

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