If you
turned on the news over the holiday weekend, chances are you saw
something about the looming disaster called Obamacare. This is
because, as the Heritage Foundation put it, "Last week, the Obama
Administration attempted to spin its announcement of a one-year delay in Obamacare's
employer mandate as an effort to implement the law 'in a careful,
thoughtful manner.' Don't be fooled. Even Democrats have admitted the law
has turned into a massive 'train wreck,' with delays, glitches, and
problems aplenty."
Meanwhile, Michael Ciampi, a family doctor in Maine was able to reduce
his prices and improve service by no longer accepting health insurance. I
strongly encourage you to read this article explaining Ciampi's own personal attempt
at health care reform.
Dr. Ciampi shared with us an important letter he sent to close friends
and family when he decided to change the structure of his practice. Here
is what it said…
Maine Doctor Shares Reasons for No Longer Accepting Health
Insurance or Medicare
By Michael Ciampi
Monday, July 08, 2013
We have decided to make some radical changes in our practice. I have a
feeling people may be very curious to know why, so I thought I would give
an in-depth explanation.
My father got out of medicine in 1999 in part because of an ever
increasing amount of paperwork and requirements put on him by the
government and insurance companies. Unfortunately, since he retired, they
have gotten exponentially worse. We have to spend a lot of time and money
filling out forms, maintaining very expensive software systems, and
constantly dealing with prior authorization requests, and appealing
denials for services that we have provided in good faith, etc.
We have never been able to accept Medicaid patients because that
population in general requires a lot of intense care, but the state
(under both Democrat and Republican administrations) pays little or
nothing. With their rules and requirements, we would have actually lost a
fair amount of money for every patient we would have seen on Medicaid. It
has been easier for us to see established patients who go on Medicaid for
free, and hope they get regular insurance back at some point in the
future.
Medicare has been a little better, but they have not increased their
reimbursement rates in about 10 years or so. Every 6-12 months, an
automatic formula, the SGR (Sustained Growth Ratio?), which was
established by Clinton/Gingrich, mandates that Medicare rates be reduced
in order to keep Medicare spending flat. Each time a cut is looming,
Congress, usually at the last minute (or sometimes a few weeks retroactively),
postpones the cut. Each time they do, the next time it comes up, the cut
is even deeper. This past New Years, with the whole fiscal cliff fiasco,
the cut would have been over 26%. It was postponed, but will likely be
close to 30% the next time it comes up at the end of the year. We are
currently being paid 30 cents on the dollar by Medicare. Our revue has
been flat for 10 years. Our expenses have gone up by at least 30% or
more.
With no end of this vicious cycle in sight, we cannot make any long term plans.
We work to cut our overhead as much as we can, but we are getting to the
point that we cannot anymore if we are to meet all the regulatory
requirements placed on us, and still pay our employees, pay for their
insurance, and maintain a practice that people would want to come to (You
can only lower the heat so much).
The commercial insurance companies are not much better. They base most of
their payments on Medicare rates. They pay more, but they also require us
to do more paperwork to get the money.
All these things have been going on for years. They have made it very
hard to stay in practice. The upcoming implementation of Obamacare was
the last straw for us, both financially and ethically.
When we established our independent practice, we joined the Maine Health
Physicians Health Organization. It started as a collaborative so that
small practices could do collective bargaining with big insurance
companies, and to share experience and resources. The organization has
changed. Instead of working for the physicians, they take the view that
the physicians work for them. This organization now requires all member
to be part of the "Accountable Care Organization" (ACO) model
which was established under Obamacare. We believe that it is immoral and
we will not participate. Because of this, we are being forced out of the
organization.
FYI: The way an ACO supposedly works is that for every patient that
consents to be in this program, Medicare gives Maine Health (Maine
Medical Center's parent organization) a lump sum of money per year. If
the doctors and Maine Medical Center spend less than that sum on the
patient, they split the profit. If they spend more, the doctor and MMC
must pay Medicare the difference. We cannot afford to take on this risk
given that our profit margin is non-existent.
The stated goal of this program is to save money by forcing the hospitals
and doctors to take better and more efficient care of patients. What is
more likely to happen is that doctors and hospitals will start cherry
picking only the healthiest patients to take care of, and do everything
they can to limit the amount of medicine and care they give to the oldest
and sickest of patients. We refuse to cooperate with such a system.
We have done a lot of research and thinking. We looked at the concierge
model, where a patient pays $1500-$2000 per year to a doctor as a
retainer fee, then has to pay for visits on top of this. If you succeed,
it is very profitable, but that is not what we were comfortable doing.
After having worked as an employee of a hospital owned practice in the
past, and hearing how unhappy my colleagues are that continue to work in
"big box" medical practices, I would never go back to that.
They are not treated with respect by their administrative overlords. They
are constantly being pushed to see more and more patients and charge as
much as they can. This may be good for the practice's bottom line, but it
is not what I would consider good medicine. I even talked to a doctor at
the VA about their system, but they have it even worse.
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We decided that the right thing for us was to go to the direct pay model.
It is really the way medicine had worked for thousands of years, up until
the past few decades. It will reduce our overhead a great deal. We do not
expect to get rich doing this, but we are hopeful that we can do well
enough to stay in business and be happier.
I know this is a long rant, but I thought it better to give more details
than less. I have done my best to make this as non-political as possible.
Both parties are to blame for the situation.
That being said, I am convinced that Obamacare will make it much worse.
In fact, I believe that it was actually designed to fail. When it does,
and there are no more insurance companies left in business, and we truly
have a health care crisis, they will institute socialized medicine. Some
may welcome this, but those systems do not work, and many countries that
have them, including Canada and Great Britain, are trying to find ways to
increase privatized health care. It is my intention to skip this entire
mess, and start working for patients directly right away.
I am done with my rant.
____________________________
The Project to Restore America
Every email is important to us. We can't always respond individually, but
we read and consider everything. Please email your question, comment or
complaint to john@theprojecttorestoreamerica.com or wendy@theprojecttorestoreamerica.com.
I continue to ask people just
what has been disclosed by Snowden? Is there any real information or is
this the Orwellian "Goldberg" hate day thingy? Regards. –
Anonymous
Grenell comment: NSA officials have said Snowden has disclosed
only 1% of what he stole from classified U.S. Government computers.
Nevertheless, he has already released, among other items, detailed
information on our intelligence gathering operations targeting
international organizations and countries – as well as specific details
about equipment used and the locations of offices targeted. The leaked
details have clearly damaged our intelligence gathering techniques and
may have imploded some of them altogether. Current and former U.S.
government officials, like myself, are hesitant to comment in detail
about the implications of the classified leaks because we are sensitive
to not further damage our intelligence strategies.
Snowden is not a traitor and
did not take the easy way out. He cannot come back to America right now
and that is devastating. He is a patriot who risked his life so we
could be aware of the links on how crooked and twisted the government has
become. Someone needed to do what he did and we should praise and thank
him. Remember the American Revolution! – Kathy
Bidwell comment: Ric Grenell will address another aspect of the
Snowden discussion. Since approximately 70% of our young people believe
Snowden is a hero, and the majority of both liberals and
libertarians do as well, Grenell will dissect how this plays
into our foreign policy decisions. Keep an eye out for the sequel to the
Hero Versus Traitor discussion this week.
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Recent
Articles
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By Thomas Sowell
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Friday,
July 05, 2013
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A
never-ending source of grievances for the left is the fact that some
groups are "over-represented" in desirable occupations,
institutions and income brackets, while other groups are
"under-represented."
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By Thomas Sowell
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Wednesday,
July 03, 2013
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Most
Americans with incomes below the official poverty level have
air-conditioning, television, own a motor vehicle and, far from being
hungry, are more likely than other Americans to be overweight. But an
arbitrary definition of words and numbers gives them access to the
taxpayers' money.
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By Thomas Sowell
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Tuesday,
July 02, 2013
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At
least as far back as the 18th century, the left has struggled to
avoid facing the plain fact of evil — that some people simply choose
to do things that they know to be wrong when they do them. Every kind
of excuse, from poverty to an unhappy childhood, is used by the left
to explain and excuse evil.
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By Richard Grenell
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Monday,
July 01, 2013
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Though
Snowden clearly violated U.S. law when he broke his non-disclosure
agreement, a reasonable debate has arisen as to whether or not his
motivations justified his actions. Many have portrayed the young
Snowden as a hero; having seen the extent to which the U.S.
government was going to obtain intelligence information. They believe
Snowden was so horrified that he decided to blow the whistle. They
also believe Snowden sought the quickest way to remedy the situation
and inform the public of what was going on – no matter the
consequences. For many, his ends justified the means.
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By Wendy Bidwell and Curtis Stith
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Friday,
June 28, 2013
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Republicans
renounced the idea that progressive groups had also been targeted.
For instance, Dave Reichert (Rep. WA) said, "Do you know how
many progressive groups were flagged? I do. Our investigation shows 7
were flagged. Do you know how many were approved? All of them were
approved."
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In The Daily
Crux
Monday,
July 01, 2013
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This
did not happen in the 1990s bear market… or the crisis of 2008…
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Monday,
July 01, 2013
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A
must-read for anyone with cash savings…
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Monday,
July 01, 2013
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"It's
always when it looks least likely, that a major trend change
occurs…"
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Tuesday,
July 02, 2013
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"The
protests may be the largest in all of human history…"
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Wednesday,
July 03, 2013
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"Representatives
of Barrack Obama and Vladimir Putin met in Washington, D.C., and not
a single U.S.-based news source reported it…"
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2 comments:
I don't understand why Snowden is such a big deal. He didn't tell anyone anything that they probably didn't already know.
America think back to Clinton days. I remember when he gave our secrets to China - nothing was done about that.
You go Snowden.................good luck.
Nice post. Great info. Thanks for sharing.
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