Dr. Kordonowy Thought You Should Know

Today’s WSJ article highlights the future of government sponsored health care delivery planning. The link to the WSJ for those who don’t subscribe the journal, explains how the private insurance companies are going to cut doctor rates 50-30% going forward with PPACA. This is the new exchange-nice. Access to care is going to get continuously worse and they are going to hammer the doctors every step of the way.
Last night I attended the Lee County Medical Society’s General Membership meeting.  The doctors listened to the many and sundry ways that we can “react” to what I consider other people’s agendas. At the end of the discussion, I openly challenged the premises that the doctors are going to have to tow the line, cut costs, ration care and all the other centralist garbage we are floating through.
Doctors are also not to blame for the United States expenditures for health care versus the rest of the socialized world. We are down to 7-13% of the total health care costs despite double digit insurance premium hikes on an annualized basis. Does this make any sense?
Perhaps our cost, relative to other nations are excessive but I suggested the differential in cost has more to do with Americans subsidizing the other nations. Also our level of ingenuity, forward thinking inventions and medication advances do cost more and should if we wish to have these things. If there is no profit to the inventor there is no reason to bother with the work. I do think the patent protection of big pharma lends to added costs but that comes at the benefit of excellent innovations. A free market pricing structure instead of a “hide behind the insurance company billing procedure”would do more to fix the costs of care than trying to force doctors and patients into a box that limits access and lowers rewards for all parties involved.
I think the American public is being insulted when the government and health insurance industry tells you and me that you aren’t getting quality and don’t recognized it when we get it.  I also think it is untrue that it is the doctor’s fault. If quality is dropping, I submit it is because of the involvement of everyone but the patients and doctors in the market place. The PPACA scheme is resulting in rapidly expanded cost to the individual while simultaneously robbing the doctor for the work they do. It is flat out wrong and I am encouraging my colleagues to just say no. The following paragraph was highlighted to our local doctors.
If you are looking forward to 50% decreased reimbursement and complex patient care for these rates, you are going to love the “planned future”.  
We doctors are going to have to get out from behind and start leading. The excuse of “I am too busy” is not an acceptable position to take. We are approaching a critical loss of mass due to physician apathy. We need to design the market of health care.  Health care is a cottage industry, contrary to what the public is being told. Doctors need to start explaining this and acting accordingly. I don’t wish to tell the public how the nation should be “designing ” health care.  I believe we can only deal with our local market issues and respond to that.  This is why IPALC is so vital to those of us remaining in private independent practice. Let’s offer our services directly to the public. Whether the patient has insurance contract x, w, z or no insurance we should be and can be available to serve.
I and my partners haven’t had an inked contract with any of the health insurance companies for over 10 years.  I can tell you now that the current situation (see the WJS link above) highlights the virtue of that decision. The system cannot falsely advertise my participation nor coerce me to come to work. The whole exchange is predicated on borrowing networks via existing contracts. If you don’t have a contract, they can’t borrow you and advertise your availability to the Medicaid for All program which is PPACA.
Most of you are probably not aware of a video interview that I had given to Frank Gluck, who is the health care correspondent for the Fort Myers NewsPress.  I encourage you to listen to this, as I explain to the public the errors inherent in the government sanctioned corporatism of health insurance company pandering.  We physicians who are and will be patients need to stand up to this nightmare, not cower in our beds at night fretting about who to sell out to, in order to perpetuate a lie/myth being sold to the average citizen.
My call to action for patients is to get and stay informed about the issues at hand. PPACA is a disaster not yet fully implemented. It is intentional that after the Presidential election they removed the Patient Protection preface and now call it the Affordable Care Act-it is now all about cheap care not patient/consumer driven care. This is because we are allowing insurance companies and the government to be the buyer of the care you need and want. You/I/we are who is desiring the care. We value our lives and health and no one is more qualified to look out for your interest than yourselves. We need to be sending the money to the market directly as much as is reasonable. Insurance really should be called upon rarely, not from the first point of purchase. Where else in the entire economy do we not stroke the check at the point of service, as opposed to sending it to some nebulous clearing house, where accounts are settled based upon the premise the service provider and the consumer were fraudulent in their claim for services rendered?  This situation is completely out of hand.
Medicare access is dropping fast. Most of you are seeing non-doctors instead of your physician not necessarily because you want this but because this is the only way doctors can remain profitable under the government forced payment structure. The cure to this problem is to ask you representatives and our president to return balanced billing/private contracting to the Medicare market. This means you and your insurance company may pay more for any particular service but at least you would have the opportunity to decide if you want the service. It also solves the governments budget problem by allowing them to have a predictable cost contribution to Medicare.  The program could not possibly have known when it started what today’s health care options/costs and supply/demand issues would be playing out.
The fairest way for all of us to have the care we want and need is to subsidize only what we can budget for and let private payment cover the rest.  If we break away from the payment dependance upon the government and the insurance companies, more competitive and ingenuitive ways of paying for and providing services will result. This will allow the rest of the country to break away from the first dollar insurance coverage model and insurance dependency. Folks, under the PPACA plan the government and the insurance companies see citizens as liabilities.  I and businesses like mine see you as an asset. Which would you rather be?  An asset or a liability- think about it!
Raymond Kordonowy MD
Internal Medicine Of Southwest Florida

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