Tuesday, September 1, 2009

To insure, or not to insure: that is the question

On August 6, 2009, Zane F. Pollard, M.D. posted his view on the current health care crisis. In his view, nothing should change. His posting, "ObamaCare and me" is at

Reply to Dr. Pollard, by Gerald R. Prettyman, J.D., LL.M. (Intellectual Property), B.S.M.E, Certified Quality Engineer (1999-2001), Medical Laboratory Technician and Hospital Corpsman, U.S. Navy (1976-1982).

"I have been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me to bring some clarity to the table by explaining many of the problems from the perspective of a" guy that actually pays the full cost for his family's private insurance.

As usual, the distractors are distorting history and overlooking facts to predict a false future as certainty, and making unsupported conclusions.

Dr. Pollard first cites "three young children on Medicaid who had corneal ulcers" and complains that" the antibiotic needed for the eradication of the infection was not on the approved Medicaid list." He overlooks that they were on Medicaid because of poverty or disability (the requirement to be on Medicaid), so that means that their mother did not have and could not afford or qualify for private insurance.

Dr. Pollard also overlooks the fact that the private health insurers also have "approved" medication lists. A drug is not prohibited if not approved. It has less or no subsidy from the insurer. My private insurer constantly sends me letters demanding that I drop my life-saving brand name medication and suggests I take an almost useless generic drug. I'm lucky enough to afford the higher out-of-pocket cost - at least for now. My private insurer also suggests that my doctor should write an illegal prescription for more than one-month's worth of medication. How's that for ethical behavior?

Dr. Pollard cites a doctor that quit the practice of medicine. Some doctors are happy with the current private insurer system. Many are not. One of my doctors (and a good one too) quit medicine in 2001 because the private insurers coding program (a.k.a. DRG) and different forms for every insurer were just too much work. One of the network news programs just last week (around August 24th) interviewed a doctor who has a staff of 5 people - just to handle private insurer billing. That alone significantly drives her expenses to overwhelming.

Some persons are very happy with their private insurer - many others and I are not. As a self-employed person, my family's private insurance costs me $11,640 a year - this year. Based on "past performance," my cost next year will be $12,200, and a thousand dollars more each year thereafter. By 2020, my private medical insurance premiums will be about $25,000 per year.

So, where does my premium money go? Here's some fact.

In 2001, Anthem's CEO Glasscock got $3.1 million in salary and bonuses, as well as a $12.4 million long-term incentive payout. (A doctor challenged this at a board meeting).

Here's a chart of Health Care CEO compensation in 2002.
First line: Company and Executive
Second line: 2002 Salary, Bonus, Other*, 2002 Compensation
Aetna, John W. Rowe, MD chair and CEO
$1,000,000 -----$2,500,000 -----$89,490 -----$3,589,490
Anthem, Larry C. Glasscock, chair and CEO
$980,000 -----$2,352,000 -----$3,525,839 -----$6,857,839 (big drop from 2001)
CIGNA, H. Edward Hanway, chair and CEO
$1,021,900 -----$0 -----$1,169,100 -----$2,191,000
Health Net, Jay M. Gellert, president and CEO
$754,808 -----$700,000 -----$72,011 -----$1,526,819
Humana, Michael B. McCallister, president and CEO
$700,000 -----$612,500 -----$336,472 -----$1,648,972
PacifiCare, Howard G. Phanstiel, president and CEO
$917,309 -----$1,690,000 -----$398,472 -----$3,005,781
WellPoint, Leonard D. Schaeffer, chair and CEO
$1,246,155 -----$5,690,916 -----$347,724 -----$7,284,795
UnitedHealth, Group William W. McGuire, MD, chair and CEO
$1,896,154 -----$5,275,000 -----$2,286,243 -----$9,457,397
* "Other" may include long-term compensation payouts of either cash or restricted stock, 401(k) matching contributions, transportation such as cars and plane travel, expense allowances and insurance premiums.

Here are some of the numbers for 2003.
Company, CEO --- 2003 Pay (millions)
Anthem Inc., Larry Glasscock --- $50.9 million (guess the drop in pay didn't last long)
Coventry Health, Allen Wise --- $14.6 million
Wellpoint Health, Leonard Schaeffer --- $27.4 million
Sierra Health, Anthony Marlon --- $3.6 million
UnitedHealth Grp., William McGuire --- $30.0 million
Amerigroup Corp., Jeffrey McWaters --- $2.9 million
Wellchoice Inc., Michael Stocker --- $6.9 million
Aetna Inc., John Rowe --- $16.2 million
Pacificare Health, Howard Phanstiel --- $10.2 million
Oxford Health, Charles Berg --- $5.4 million
Health Net Inc., Jay Gellert --- $7.9 million
Humana Inc., Michael McCallister --- $6.6 million

Private insurance premiums DO NOT go to the doctors.
Family practice, $47.28 per hour
Internal medicine, $51.38 per hour
Neurology, $63.00 per hour
Ob-gyn, $79.58 per hour
General surgery, $83.74 per hour
Otolaryngology, $84.99 per hour
Cardiology, $96.31 per hour
Physicians Search 2002 survey (physicians with three or more years experience).

Dr. Pollard also says that the new plan will drive physicians out of specialties. As shown above, specialists earn more than family practice doctors, who are supposed to be our front line to medical care. We already have a tremendous shortage of family practice physicians because of the pay disparity. The wait time to see a family practice doctor can be as long as two weeks or more. The lack of general practitioners in some locations causes people to use the emergency room when a general practitioner is better suited - but there just isn't a family practice doctor available for two weeks. This drives up hospital costs so hospitals close their emergency rooms. Trauma patients in Galveston, Texas have to be airlifted to Houston because there isn't an emergency room at the hospital anymore.

And contrary to the bigoted viewpoint, 98% of these people are not illegal immigrants. Even Dr. Polland admits that he operates on only 2 illegal immigrants each month. I suspect he sees well more than 100 patients per month, so the true percentage of illegal immigrants is much lower.

Dr. Pollard also says that that the new plan will make it illegal for any doctor to accept more than the government-allowed rate. This is not true. The law applies to, and has for a long time, as Dr. Pollard admitted, a doctor receiving federal funds (e.g., Medicare). Don't worry about the rich, though. The rich will still have well-paid private personal doctors (just like Michael Jackson - his doctor received $150,000 per month!) So much for the 'best.'

Dr. Pollard also says that the current system is best. On the contrary, private insurance premiums DO NOT go for top of the line patient care.

In 2004, a good friend of mine suffered a massive stroke that has left him partially paralyzed. Before his stroke, he suffered several TIAs (a.k.a. mini-strokes), but his private insurance refused to pay for a diagnostic test that would have detected the source of his stroke risk. Lifeline Screening even warns that private insurance will not pay for such testing. (Not that they don't lie - the test is recommended only for persons over 60, but Lifeline Screening fails to add that bit of clarification).

After the stroke, the private insurer booted him out of therapy because his recovery was 'good enough' for him to survive. He still has trouble walking and cannot use his right arm, but that's good enough for the private insurer.

I was also stationed at the Naval Hospital in Oakland, California (Oak Knoll), albeit from 1977 to 1982. Dr. Pollard failed to mention that until mid-war, Oak Knoll had only the same barracks-style facilities that were constructed during World War II. From 1969 until its closure in 1996, Oak Knoll had a beautiful nine-story hospital with 20 plus wards and many clinics excelling at treating many, many thousands of patients every year - active duty, dependents, retirees and local civilian trauma patients.

Dependent care was a topic of concern then, as well during the Vietnam war. As Dr. Pollard alluded, the difficulty always was that Oak Knoll was first and foremost a facility for treating wounded active duty personnel who were not closer to Honolulu, San Diego, or Bremerton, Washington - Oak Knoll was responsible for a BIG area. During the Vietnam war, about 25% of the San Francisco Bay Area was eligible for care at Oak Knoll. All the while, Oak Knoll received many overseas causalities for long-term care and rehabilitation. At times, the onslaught of dependent civilians coming in for unnecessary or untimely treatment was ridiculous. The fact was treatment was free meant we had a lot of civilians coming in for treatment when they should have gone to the drugstore for an over the counter medicine. That Dr. Pollard's wife had a "private internist in Beverly Hills" merely demonstrates his bourgeoisie attitude towards the unprivileged.

It is also unfortunate that Dr. Pollard is a sexist. He says, "the US government has mandated gender equity in admissions to medical schools. That means that for the past 15 years somewhere between 49 and 51% of each entering class are females." He thinks women should stay out of medicine, because he says, "the average career of a woman in medicine now is only 8-10 years and the average work week for a female in medicine is only 3-4 days." Is Dr. Pollard really the person we want to listen to for public policy?

The bashing of foreign healthcare systems is both incorrect and irrelevant. Those lies were disproved TWO years ago, before Obama was even nominated to run.

After thirty plus years of working with many thousands of people both in the private and public sectors, I've learned that 99% of people are both honest and work for the benefit of society as a whole. There is, however, a one per cent of the population with such greed and self-interest, that they must feed on society in whatever form they can - by violence, deception, or sowing graft. Our society is well rehearsed at finding the first, somewhat uncertain in finding and handling the second, but only capable of even detecting the last only after enormous harm has occurred. Thus, I can conclusively say that BOTH SECTORS ARE BROKEN! (Expletive Deleted.) The distinction in either sector is always the people managing the organization and operating it on a day-to-day basis.

Dr. Pollard is likely a good person, and a great doctor. His detachment from his patients' condition, in spite of his service to them, is a disservice. Dr. Pollard is unpaid for some his services because those patients cannot afford private insurance.

The private insurance industry in the U.S. has an oligopoly, which is a near-monopoly, on health care. The high entrance costs bar small competitors from having an affect, but once they do reach such a size, they are bought out - capitalism at its best. Capitalism is best adept at providing goods and services at a price that suits most of society. Capitalism, however, is not adept at providing social services to all sectors of society. Our Dwight D. Eisenhower National System of Interstate and Defense Highways provides transportation access regardless of social and income strata. The private insurance system, on the other hand, will always leave some persons without ready-access to medical care. Medicare requires poverty or disability - for which the recent out-of-work or under employed do not qualify. Unfortunately, this country's finances have been stretched too thin by war, whether true or fabricated, graft by government contractors, and shoring of the finances of the wealthy and the well connected.

Irrespective of your political party and beliefs - the health care system is clearly broken, but obviously not broke. The top 12 health care CEOs earn collectively over $182 million annually. The Obama plan is not good for these 12 CEOs. They are spending millions against it - but they can afford it. Private health insurance started as a post-WWII incentive for workers to join a company. Instead of bartering with the doctor, people could pass the cost of medical care to the insurance company, which merely raised rates as expenses and CEO wages increased. As the recession goes on, more people will lose their jobs and their health insurance. At a cost of $12,000 a year, many people cannot afford private health care insurance. The question is whether as a society, can we afford to keep the current system?

Is there anyone intelligent enough and not in conflict to solve this?