HCI@healthcare-consulting.com

The government, which was designed for the people, has got into the hands of the bosses and their employers, the special interests. An invisible empire has been set up above the forms of democracy.

--- President Woodrow Wilson

It is time for us to be patriotic about something other than war.

--- Former Senator John Edwards, 1/31/07

... too many times, after the election is over, and the confetti is swept away, all those promises fade from memory, and the lobbyists and the special interests move in, and people turn away, disappointed as before, left to struggle on their own. --- Senator Barack Obama, 2/10/07

Irreverence is the Champion of Liberty if not its only sure defender.

--- Mark Twain

President George W. Bush's 2008 State of Disunion Speech proposed non-solutions to America's healthcare access, cost, and quality crises. At best, they are delusional. At worst, the 2008 State of Disunion perpetuated deceptions and misrepresentations of the root causes of our most adversely consequential domestic challenge --- structuring a cost-effective, high quality healthcare system accessible to all Americans. Either way, our national disgrace --- the prioritization of insurance and other corporate interests over the public interest, lack of access to affordable healthcare for all, and failure to develop an infrastructure to ensure consistently high quality care for all Americans --- remain unresolved by impotent activities long after the President's speech. President Bush's State of the Union 2008 is primarily happy talk, spin, and ... tax breaks. Tax breaks are meaningless to people who cannot afford to pay for expensive monthly premiums, high deductibles, and co-pays.

President Bush's plan to help Americans make more informed decisions is long on rhetoric and short on details. Somewhere between being toothless to enforce quality and patient safety standards and secure unmassaged data from healthcare providers, it is destined to fail to enhance healthcare access and reduce or control healthcare costs. His executive order begs the question, What has the JCAHO been doing for the last several decades?

Healthcare policy in the United States has been significantly subordinated to the financial interests of major healthcare industry organizations, their executives, and within for-profit environments, their shareholders. Healthcare policy-makers have failed to create an accountable, organized, cost-effective, consistently safe, and efficient delivery system for the benefit and well-being of all Americans. The current non-system is rooted in healthcare policy, which is designed to ensure the most profitable opportunities for executives and shareholders.  The nation enables its leadership to rationalize and misrepresent the crises of healthcare costs, safety, and quality, which adversely impact the nation. President Bush and the current administration respond to these crises with absurd proposals, which further enrich healthcare industry insurance and investment interests.

The most comprehensive and effective reform would be for the public to demand public finance of Congressional and Presidential elections (through tax revenues) and the termination of political campaign funding by special interests, which are indistinguishable in principle from payoffs in exchange for political favors. Current campaign funding practices invariably result in systemic corruption in our electoral processes. They have established co-dependencies among office-holders and special interest lobbyists. They favor corporate financial interests over the public interest including universal healthcare access, ensuring consistently high quality care, and controlling costs. 

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President George W. Bush, Presidential Debate #3, October 13, 2004: "Health care costs are on the rise because the consumers are not involved in the decision-making process ... And there's no market forces involved with health care . That's why I'm such a strong believer in medical liability reform ... Thirdly, one of the reasons why there's still high cost in medicine is because ... -- they don't use any information technology ... People tell me that when the health-care field is fully integrated with information technology, it'll wring some 20 percent of the cost out of the system .... And finally, moving generic drugs to the market quicker. And so, those are four ways to help control the costs in health care."  The President is wrong on all points.

CBS Marketwatch October 15, 2004: "U.S. health insurers have raked in earnings at a far greater pace than the rest of corporate America, with annual profits and margins doubling in the last four years ... insurers spent less on medical costs but ate up more of America's health-care dollars in profits and claims processing ... Profits for the 17 top U.S. health insurers rose 114 percent to $414 million from $193 million on average in 2000, according to research by CBS MarketWatch. Profit margins doubled to 5 percent -- the highest level in at least a decade for the industry's top 10 insurers -- and revenue climbed 21 percent to $9.3 billion on average ... average pay for the five top executives at 16 of the health insurers almost doubled to $3 million a year from $1.6 million, based on data from insurers' annual reports and proxy statements ... The insurers' improved fortunes came as more Americans were pushed onto the rolls of the uninsured, and a growing number of small businesses dropped coverage due to high costs ... There's no sign the profit growth will cool."

Medicare & Medicaid Fraud: In FY 2006, the Department of Health and Human Services, Office of Inspector General reported the exclusions of 3,425 individuals and organizations for fraud or abuse of Federal health care programs and/or their beneficiaries; 472 criminal actions against individuals or organizations that engaged in crimes against HHS programs; and 272 civil actions, which include False Claims Act and unjust enrichment suits filed in district court, Civil Monetary Penalty settlements, and administrative recoveries related to healthcare provider self-disclosure matters. Nothing was new in healthcare fraud enforcement in FY 2006. Numbers of this magnitude have been evident for years.

Since 1999, the drug industry has spent a fortune on political contributions, and it spent hundreds of millions more on an army of more than 600 lobbyists to pursue and protect its financial interests. The investment has achieved an extraordinary level of success. Pharmaceutical companies are consistently the most profitable corporations in the United States.

Less evident to healthcare consumers and purchasers are behind-the-scenes systemic corruption and anti-competitive practices, which also drive healthcare costs. Even group hospital purchasing has been a study in how common business practices and 'market forces' detrimentally affect the health, safety, and cost to healthcare consumers. Much of America's healthcare crises are self-induced by default. We are complacent in the face of electoral finance practices. We often accept lies and deceptions as facts and truths.

Greed is the cancer that fuels our healthcare crises and prevents America from having a rational universal healthcare system. Every time we open new opportunities for healthcare organizations and businesses, the cancer metastasizes and additional financial resources are exploited. We must stop this opportunism, the government complicity which fuels it, the deceptions which accompany it, and make sure that resources go for the care of people, not for the further enrichment of healthcare industry shareholders, executives, and the proliferation of unnecessary facilities and services.

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The Healthcare Cost Crisis:

Public Policy & Co-Opting Healthcare Purchasers

Healthcare policy should address at least two significant problems: access to primary and specialty care services, which is contingent upon affordable costs, and improving healthcare quality and patient safety.  

Healthcare costs is a term that is bandied about as if it is universally understood. In addition to the conventional understanding of billings generated by healthcare providers for services and medications, healthcare costs include many other less apparent expenditures. These include, but are not limited to:

• administrative costs, compensation, marketing expenses, and profits of thousands of healthcare providers, insurance companies, managed care organizations, brokers, equipment and product manufacturers, information systems vendors, and other suppliers;

• money or gifts given to doctors to induce them to prescribe new pharmaceuticals, purchase new surgical equipment, lease new diagnostic equipment, etc.;

• commissions paid by managed care and cost control mechanisms to brokers for procuring business for them from large public or private sector employers;

• fees paid to consultants, public relations firms, advertising firms, and other service professionals by thousands of healthcare organizations; 

• defense attorneys' fees, penalties, and fines for billing and other forms of healthcare fraud; 

• expenses to sponsor exhibits, distribute gifts at trade shows, host lavish dinners and hospitality suites, ensure high visibility, maintain organizational memberships, and fund golf outings at hundreds of healthcare industry conventions and trade shows annually;

• money paid to lobbyists, to pay for junkets for legislators and their staff, and to invest in political campaigns to ensure that the financial interests of healthcare industry organizations are promoted and preserved;

• hundreds of other expense elements in a market-driven healthcare environment, most of which would not be necessary or prudent in a single payer universal healthcare system.

There are layers upon layers upon layers of beneficiaries of bloated healthcare costs, which have nothing to do with cancer treatments, surgeries, medications, home health care, and thousands of other patient care products and services. 

Any discussion of the healthcare marketplace should include an understanding of the term co-opt, which means to convert, neutralize, or win over decision-makers who would naturally be opposed to one's position.  Politics makes strange bedfellows, but pales before the peculiar relationships among healthcare purchasers and providers. Healthcare providers, managed care organizations, broker/consultants, and innumerable vendors routinely co-opt healthcare purchasers, politicians, and government bureaucrats. They use a broad spectrum of public relations perks, invitations to conferences and forums, paid trips, professional sports' event tickets, campaign donations, and inclusion in innumerable 'net-working' opportunities.

How can the nation's largest employers and healthcare purchasers be so naive? They are no different than many Americans, who rely upon the news media to keep them informed and consultants to help them to determine the truth about many significant issues important to their organizations. Many healthcare benefits 'consultants' have conflicts of interest. The media operates within a culture of distortion and secrecy. Secondly, consumers suffer, often unknowingly, from an information deficit, which is cultivated by special interests. Special interests are at once dynamic and subtle, manipulative and sincere, spontaneous and choreographed. Healthcare purchasers experience capture so subtle that they frequently fail to penetrate the trees for the forest. Their vision is often obscured by benefits vendors, consultants, accountants, insurance brokers, politicians, and others with common vested interests in sustaining the status quo --- albeit with new accessories and cosmetics to sustain the pretense of change and the illusion of cost savings. 

At co-opting events, sponsors easily use their knowledge advantage to intimidate, exact deference, and thus, set the agenda and influence healthcare purchasing decisions. For example, the 'consumer-directed' healthcare conferences and expos staged in the last several years are essentially opportunities for healthcare providers, managed care organizations, pharmaceutical companies, brokers and others to market to employers the latest panaceas for controlling healthcare costs. Notable for their absence at these 'consumer-directed' net-working opportunities are organizations representing the interests of consumers.

Legislation drives public policy. Senators and Representatives must choose to vote for or against a legislative bill or not vote at all. Counter-productive amendments or provisions are rarely purged from the final legislation.

Public support for a universal healthcare system has never been more evident. Twice as many American are more concerned about healthcare costs than being victims of terrorist attacks or losing their jobs.

The Bush-Cheney Healthcare Plan and Track Record

The association health plan (AHP), which is a cornerstone of President Bush's healthcare plan, as a means of controlling healthcare costs for small businesses, is absurd. In June 2004, General Motors CEO G. Richard Wagoner called upon Presidential candidates and the federal government for help in the post-election period in controlling healthcare costs. "It is well beyond time for all of us to put partisan politics behind us and get together to address this health care crisis," Chairman and Chief Executive Officer G. Richard Wagoner told the Detroit Regional Chamber's annual conference on the state's economic future.

On July 19, 2004, Vice Chair of Ford Motor Company Allan Gilmour called for a broad coalition to permanently develop a solution for the nation's healthcare crises at the National Governors' Association Conference in Seattle. Ford spent $3.2 billion for its 560,000 employees, retirees, and their dependents. The costs of healthcare has added $1000 to every vehicle produced by Ford, up from $700 three years ago. Big 3 American automakers spent $9.9 Billion on healthcare in 2003.

On August 12, 2004 in Las Vegas, the President told the United Brotherhood of Carpenters and Laborers of America: "Most small businesses have trouble affording health insurance. Large businesses are fine. It's the small business sector that is having trouble providing health insurance for our fellow citizens ... I think small businesses ought to be allowed to ... get the same discounts for health insurance that big companies get." President Bush tells voters that large businesses are doing fine; they are doing so well in controlling healthcare premium costs that small businesses should organize AHP's and derive the same group purchasing benefits.

"For many years, U.S. employers were quite confident that they could take this on themselves and didn't want the government involved," said Larry Levitt, vice president of the Kaiser Family Foundation, an independent, nonprofit foundation focusing on the major health care issues facing the nation. "They felt that market forces and negotiating leverage would address the issue," he said. "But when you have enormous companies like GM and Ford saying they're powerless, it tells you something. If GM tells you they can't do anything, how is the corner grocery store supposed to cope?"

America's largest employers are unable to control healthcare costs. Recently, GM announced a layoff of 30,000 employees and closing of 9 manufacturing plants, partially attributable to GM's failure to seriously address high healthcare costs and partially attributable to GM's failure to compete successfully with Toyota and other manufacturers. Tens of thousands have been paid to retire early. Clearly hundreds, perhaps thousands of small businesses banding together to purchase health insurance will have no greater success in controlling costs. Since group insurance has failed major employers in controlling costs, many of them have applied a more effective solution. They have moved jobs to Canada and other nations with universal healthcare systems. All citizens are covered in national healthcare systems. 

Many American politicians have touted the U.S. as having the best healthcare system in the world. Only some Americans receive the best healthcare in the world. Wealthy Saudis and other wealthy foreign nationals can afford America's best healthcare at America's best medical facilities. Many other nations in the world have surpassed us in several healthcare quality indicators. Millions of Americans receive no healthcare or not enough until it is too late; by then, their illnesses are very expensive to treat often with poor prospects for optimum medical outcomes. 

President Bush's proposed health savings accounts (HSAs) are impractical and dangerous. With higher deductibles, higher co-pays, more cash needed to pay for medications, and more money deducted from workers' paychecks for their premium share and their HSAs, the cash flow drain on people living paycheck to paycheck is untenable. Most people simply won't use HSAs because they cannot afford them. Nevertheless, President Bush proclaims that "We are doing fine ... strong and gaining steam."

On December 8, 2006, a study conducted by The Commonwealth Fund confirmed that 'consumer-driven' health plans lead to higher consumer debt, less timely care, and inadequate information. For individuals or small businesses, HSAs are the ideal inducement for the cottage industry of unauthorized and fraudulent health insurance agents. HSAs tied to small group insurance policies with high deductibles and co-pays will have the effect of encouraging small employers to save even more money by hiring younger employees, who are less expensive to insure. They may destabilize the small group market. HSAs will encourage age discrimination employment practices.

Health savings accounts will not help most middle class families. HSAs are mostly staying empty. On August 13, 2004 in Portland, OR, President Bush enthusiastically encouraged small business owners to offer them to their employees. He frequently encourages consumers to take "ownership" in their healthcare coverage. "Consumer-driven" advocates, mostly insurance agents, insurance companies, and investment firms, are happy with President Bush (insurance firms had donated $3,203,672 to his campaign). HSAs may inadvertently succeed in directing some consumers right into early graves, impoverishment, or both. Even the President's home state hospitals are finding that the 'consumer-driven' have increased bad debt.

HCI is concerned that HSAs could go the way of some pension and retirement funds --- their owners could become victims of poor investments and untrustworthy opportunists. To date, at least one of the investment firms offering HSAs in conjunction with insurance carriers has been fined in the past by the SEC for various unscrupulous business practices. The 'consumer-driven' aka consumers are finding that higher deductibles are driving them away from healthcare coverage. The President didn't mention these hazards in his speeches to voters last year.

The President's tax credits may work for businesses and individuals that can afford to cash flow monthly healthcare premiums. Here again, most self-employed people and small businesses can't afford prohibitively expensive monthly healthcare premiums atop high deductibles and increased co payments. 

President Bush has touted federally funded community health centers (CHCs) for providing services to the uninsured in rural and inner city areas of the nation. He promises to add more. They have been inadequately sized and staffed for the number of patients seeking care. Nevertheless, CHCs have filled an extremely important role in providing primary healthcare services to the medically indigent. CHCs and hospital emergency rooms share the safety net for uninsured patients. However, CHCs have been unable to keep pace with the number and complexity of uninsured patients needing care in recent years. According to Modern Healthcare, August 9, 2004, "fewer than one in 10 applications for new community health centers have been approved so far in 2004 despite a larger stream of federal funding for such facilities  ... And for approved providers, federal funding has been slow to arrive ... even though in recent federal budgets, Congress and the president committed an additional $2.2 billion to community health centers through 2006 ... states have reduced direct funding to community health centers by millions of dollars over the past two years in light of budget pressures, and more state funding cuts are likely ..." CHCs contribute to tiered levels of healthcare and ensure that more affluent, healthier, and younger patients are retained by private sector insurance organizations.

Reductions in funding for state Medicaid programs and the refusal of most hospitals and specialists to treat the medically indigent are insurmountable problems for CHCs without the infusion of massive financial resources.

Medical malpractice liability tort reform is another of the President's vehicles for controlling costs. It won't. The President has known or should have known that this is a red herring for at least six years. Despite easily accessible and contradictory factual information , some employers and some of the media have reached the pinnacle of parroting disinformation.

Denying legal remedies to patients or their families who are killed, injured, or infected because of healthcare professionals' errors in healthcare settings or at home is unfair.  A life, a leg, an arm, HIV, a coma, innumerable other injuries and illnesses ... a father, mother, child, brother, sister, son, daughter, any age ... all people would be valued a maximum set amount for their deaths, pain, suffering, loss, emotional damage, etc. The vast majority of medical errors are committed by a tiny minority of repeat offenders. The total cost of malpractice insurance premiums and litigation is less than $21 billion annually; the total cost of healthcare is $1.7 trillion/year and growing 7-10% annually. Capping jury awards at any maximum amount on non-economic damages will have no impact on healthcare costs.

Insurance cost escalation for malpractice liability, property, and auto insurance stem from the same source --- poor returns on insurers' market investments, mismanagement, reinsurance costs, and greed. 

Nevertheless, healthcare providers should purge their ranks of incompetent and impaired offenders (like the physician dropped by Vice President Cheney for narcotics addiction), use technology to reduce medical errors, and train staff and physicians to be more diligent in the care of patients. For decades, accreditation and membership organizations --- for physicians and hospitals --- have been trying to 'educate' their members in an effort to reduce medical errors. It hasn't worked.

Our healthcare non-system is the third leading cause of deaths in America. The United States suffers more than 200,000 deaths (exclusive of non-hospital data, which has never been accurately gathered for nursing homes, home health care agencies, ambulatory care centers, clinics, dialysis facilities, etc.) and hundreds of thousands of injuries, infections, readmissions, and hospital days annually because of medical errors, most of which are preventable. More Americans are killed and injured each year because of medical malpractice and negligence than were killed and injured during our entire decade of involvement in the Vietnam War. Federal and state medical liability caps have and will establish disincentives to quality care. Doctors and hospitals have become advocates of "Tort Reform", which would reduce their liability exposure, but have no impact on improving healthcare quality or the cost of their malpractice premiums. Tort Reform is a fiction created by the insurance industry and promoted by politicians and healthcare providers to the detriment of healthcare consumers and payers.

Humana paid $14.5 million in federal Medicare fines. It was the first HMO to over bill the government, but we don't know if it won a prize of some sort from its trade association for this feat. It over billed thousands of patients in South Florida. Then, it dumped some patients without proper notice. About 2 weeks before Christmas, one family learned that their 4-year old with cerebral palsy would no longer have benefits for her physical therapy. Palm Beach Circuit Judge James Carlisle already found Humana liable for breach of contract, fraud and bad faith. It had failed to respond to repeated court orders to turn over documents.

Humana was also ordered to pay $8 million to settle allegations that it charged both Medicaid and Medicare for the same services. Humana received duplicate payments from both Medicare and Medicaid for the same individuals.

The hands-down champion of alleged fraud amongst Medicare RX drug program contractors is Tenet Healthcare Corporation. It paid $900 million in fines and penalties for settlement of "mistakes" recently. Tenet is also the defendant in a class action lawsuit in California for marking up its prices for RX drugs an average of 1038%. Tenet was National Medical Enterprises several years ago before it was fined $379 million as part of a settlement in a case involving alleged Medicare and Medicaid fraud at psychiatric and substance abuse hospitals in over 30 states. The charges involved kickbacks to doctors.

The good news for Tenet is that Jeb Bush, former governor of Florida, and Geoge's bro has been appointed to serve on its Board of Directors at compensation of $474,000 for 13 days of work.

Medical malpractice and negligence is an international problem. Project Hope has completed and published a research study of the self-protective culture of Australian, British, Canadian, New Zealand, and American healthcare organizations. One of its major conclusions was:

"... major failures in health care are ... a product of ... the health care professions, and the health system ... There is endemic secrecy, deference to authority, defensiveness, and protectionism. Despite much rhetoric about the primacy of patients’ interests ... (they) are too often subordinated to the needs and interests of health care organizations and professionals ... the most effective actions ... to prevent future major failures will be those that help to create a more open, transparent, equitable, and accountable health care culture. This will require changes in medical and health professions education, greater public demand for accountability, continuing advances in the measurement and reporting of health care quality and patient outcome data, and more principled clinical and managerial leadership of health care organizations."

Ironically, President Bush continues to tout computerized medical records, which "...can save money and save lives." He has admonished Congress to establish medical liability caps to deter what he and Vice-President Cheney have repeatedly called 'frivolous lawsuits' to the detriment of consumers while acknowledging that medical errors cost money and lives. Apparently, he fails to see or acknowledge the inherent contradictions in the two positions, which cannot be reconciled unless and until the federal government establishes a successful program to curb the extraordinary number of medical errors, which harm and kill hundreds of thousands of Americans annually. Meanwhile, it has become abundantly clear that doctors and nurses frequently commit and witness medical errors and fail to report them.

Medical malpractice liability tort reform is the most publicized in a series of efforts by greed merchants to introduce no-fault liability into the scheme of American life. Once successful, the slippery slope leads to the abdication of responsibility for deaths, injuries and illnesses caused by the negligence of all organizations and people within them. The slope hits bottom when people go to their work sites one day, a ceiling caves in, people are killed or injured, and no one is held accountable or responsible --- neither the owner of the building nor the contractor who built it.

Democrats and moderate Republicans in the U.S. Senate have retained the votes to kill the President's medical malpractice liability 'reform' proposal.

By excluding or limiting liability from insurance products, policy-holders and the insurance industry reap incalculable cash savings. By limiting liability exposure, preventable errors will become just another cost of doing business --- a relatively inexpensive one at that.

The Medicare RX drug 'discount ' program (aka Medicare Modernization Act) illustrates why the Bush-Cheney healthcare plan isn't a credible vehicle for expanding access or controlling costs. The program's contractors hit the healthcare trifecta. The contractors don't guarantee price savings. Discounts can be changed at any time. Profits can be whatever the drug companies and contractors determine for themselves. Insurance companies determine which drugs to make available. The pharmaceutical manufacturers significantly jumped prices again in 2006. 

Billions of dollars were allocated to the program to attract PPOs and other contractors. Several of them had dumped millions of Medicare enrollees within the last several years. Unsurprisingly, most Seniors weren't fooled by the hype. 

Medicare enrollees won't realize much benefit from the Medicare RX drugs program because of substantial annual increases in the prices of medications. 10-20% discounts won't mean much to people on fixed incomes who must keep pace with constant annual RX medication cost increases. This program, more appropriately referred to as the Managed Care & Pharmaceutical Companies' Enrichment Act, is already legend for being the most ill-conceived Medicare 'reform' in history. The Bush Administration threatened to veto a huge budget bill if Congress withdraws $10 Billion set aside for insurance companies participating in the Medicare program. "Critics call the $10 billion a "slush fund, but the White House said the money would induce managed care plans to enter rural areas, thus expanding choices for some Medicare beneficiaries. The veto threat came in an official statement of administration policy."  

The federal government is prohibited by law from negotiating prices for RX medications for Medicare. It has successfully negotiated prices for the Veterans' Administration, Department of Defense, and federally qualified CHCs for many years. It seems to us that any executive in any corporation or government would be fired if he failed to negotiate best prices with his vendors. For more than $500 billion over several years, the United States bought a program with no set prices for medications, no limits on cost increases with the frequency of price hikes left to the discretion of sellers, no exclusion of vendors known to have defrauded Medicare and Medicaid in the past, no ceiling on contractors' profits, and broad vulnerabilities to fraud scams. Americans should never again under-estimate the ability of the majority members of Congress to take a much-needed healthcare benefit concept and screw it up for the sole purpose of protecting the financial interests of the healthcare industry. HHS Secretary Leavitt opposes Democrats' plans in 2007 to negotiate prices with drug companies.

The American Association of PPOs gave its Leadership Excellence Award to former HHS Secretary and wannabe 2008 GOP Presidential Candidate Tommy Thompson in June, 2004. They appreciated his work on the Medicare RX drug program legislation. Iraqis like him too. He supported universal healthcare for Iraq ... he didn't support universal healthcare for the United States. American tax revenues have financed and rebuilt the Iraqi universal healthcare system. Millions of American taxpayers are without healthcare coverage.

The AMA opposed Medicare for many years, but LBJ was determined and doctors ultimately adjusted lucratively to what the AMA called 'the march toward socialism'.  Tens of thousands of physicians marched grudgingly to affluence and wealth under the Medicare program. Under fee-for-service payment arrangements, physicians were both the providers and purchasing agents for Medicare patients. Massive fraudulent billing for unnecessary and excessive services ensued and DHHS changed the payment structure to DRGs (diagnosis-related groups) in the mid-80s. Nevertheless, Medicare providers adapted and the comparatively better policed Medicare program endured with greater, if imperfect, control over invoices from hospitals, physicians, and other Medicare contractors.  

The President proposed to spend $100 billion or more to go to Mars and other planets. It was a boon to the aerospace industry and guaranteed votes and campaign cash during his 2004 election campaign.

Millions of uninsured Americans will suffer preventable illnesses, treatable injuries, and impoverishment attributable to lack of healthcare coverage and fourth-class healthcare options if our tax money continues to be diverted to programs that take precedence over our healthcare needs.

On July 30, 2002, President Bush condemned corporate fraud in the East Room of The White House. He said, "... No more easy money for corporate criminals, just hard time ... The era of low standards and false profits is over; no boardroom in America is above or beyond the law ... in the aftermath of September the 11th, we refused to allow fear to undermine our economy and we will not allow fraud to undermine it either." Yet in the 2004 election cycle and following his speech condemning this behavior, President Bush accepted campaign contributions from the biggest stock investment defrauders and healthcare fraud perpetrators in American history.  

Through the 2004 election cycle, President Bush received more than $20 million from grateful and expectant healthcare professionals (physicians, dentists, chiropractors, pharmacists, etc.), insurance industry executives, executives of hospitals and nursing homes, and investment firms. Some of his biggest donors, several investment firms, were collectively fined a record $1.4 billion by the Securities and Exchange Commission. Fines and penalties levied against Bush-Cheney campaign donors for Medicare and Medicaid fraud exceed several billion dollars.

Many of the 73 contractors selected for the new Medicare RX medications program are or have been under investigation for previous Medicare and/or Medicaid fraud. Many of them have already paid fines and penalties for fraudulent activities over the last 2 decades. Together they donated tens of $millions in support of President Bush and GOP candidates who ran for re-election this year.      

PacifiCare paid the federal government $87.3 million a few years ago to settle alleged violations of the Federal False Claims Act. It means that executives did something related to fraud.

Even with its second name, Tenet must be very disappointed that it will unlikely surpass Columbia/HCA aka HCA, the largest alleged fraud perpetrator in Medicare history. HCA is the poster organization for systemic corruption relative to other elements within the healthcare industry. HCA's executives are among the most generous political campaign contributors.

In June 2002, the Hospital Corporation of America (HCA), the largest proprietary hospital organization in America, received an award from the Board of Directors of The Healthcare Financial Management Assn., a membership organization of 32,000 of the nation's healthcare accountants and financial executives. HCA founders, Dr. Tom Frist, Dr. Tom Frist, Jr. and Dr. Bill Frist (former United States Senate Majority Leader 2002-2006) received the HFMA Board of Directors Award, which is "... bestowed on those who make remarkable contributions to the healthcare financial management profession ..." and for " ... the development and significant growth of the investor-owned sector of the healthcare delivery system. Their innovations and foresight have created a significant new source of capital, introduced competitive market ideas, and developed many best practices in the financial management of healthcare facilities." 

Alas, federal prosecutors failed to share the HFMA's perception of and admiration for HCA's 'best practices in financial management' and creation of 'a significant new source of capital'. HCA (formerly Columbia/HCA) was fined and penalized a total of $1.7 billion dollars by December 2002, after almost a decade of well-publicized federal investigations involving Medicare and Medicaid fraud. It is the largest fraud settlement ever by any U.S. government contractor.

The federal government doesn't require that these companies to acknowledge wrongdoing publicly. So they don't. Apparently, from their perspective, paying millions in fines and penalties has nothing to do with wrongdoing. Alleged defrauders really become attached to the alleged part of their criminal charges and don't want to let go. Alleged means never having to say you are sorry. A kid that robs a 7-11 for a few hundred dollars goes to jail. Healthcare corporations that get caught stealing millions from Medicare ... well their executives mostly write checks to pay fines and penalties. From the perspective of these and other healthcare providers, they have simply committed 'billing errors' (in the tens of billions of dollars) and 'the Medicare billing requisites are confusing'.

Major fines and penalties assessed against healthcare organizations include Tap Pharmaceuticals $875 million, Abbott Laboratories $600 million, Pfizer/Warner Lambert $430 million, and Schering-Plough $345 million. 

Aetna agreed to pay $470 million for defrauding 700,000 doctors, who alleged in a class-action lawsuit that insurers wrongly cut payments to them and interfered with their recommended treatment for patients in 2003. In New Jersey, a judge has recently certified a doctor's lawsuit class-action against the state's largest insurer, Horizon Blue Cross Blue Shield, which may allow 40,000 physicians to collect damages from it. The suit was brought against Horizon and three other HMOs in April 2002 alleging that they routinely shortchanged thousands of doctors through late or improperly reduced payments.

There are many more contractors on the lists of Medicare and Medicaid defrauders, but these are some of the more interesting and generous Presidential campaign contributors, campaign fund-raisers, and innocent fine-payers among the new Medicare RX drugs program intermediaries. Medicare RX drug program contractors aren't the only fraud perpetrators. There are plain old garden-variety Medicare and Medicaid defrauders as well. They are managed care organizations, insurance companies, doctors, dentists, therapists, equipment vendors, home care agencies, hospitals, pharmaceutical companies, chiropractors, and many other types of contractors (partial listing).

HCI receives updated information from OIG-HHS frequently by Email. One of them is especially pertinent. It says that during the first half of FY2007 (September 2006-March 2007),OIG recovered $2.9 Billion, excluded 1278 people and companies from Medicare and Medicaid programs, prosecuted 209 criminal actions, and 123 civil actions. There is no question that without the Office of Inspector General of HHS and the Federal Bureau of Investigation to deter and prosecute fraud, the Medicare program would have been insolvent years ago.

Healthcare fraud has been underreported for far too long. Healthcare fraud is conservatively estimated to cost consumers more than $100 Billion in both the public and private sectors.  80% of all False Claims Act cases filed are against healthcare organizations. Without a common database, hundreds of private insurance payers cannot hope to be as successful as the federal government is in prosecuting fraud. The FBI and Office of Inspector General at Health and Human Services do a magnificent job of investigating and prosecuting Medicare and Medicaid fraud, but they really aren't mandated to fight healthcare fraud in the private sector. The investigations and prosecutions may take 2-6 years, sometimes much longer. The return on investment for the federal government is about 117:1.

In the midst of all of this cash flow gusher to legitimate and illegitimate recipients, 82,000,000 Americans were uninsured for some period of time in 2002-2003. At least 18,000 people lose their lives for lack of health insurance annually.

Some of us recall that the invasion of Iraq was largely attributable to a pre-conceived notion --- Bush, Cheney, Powell and Rice insisted that Saddam Hussein had WMDs. All of the 'evidence' was custom-tailored to fit this notion.  When it was confirmed that no WMDs existed, they produced other rationales.

Bush and Cheney have another pre-conceived notion --- the private sector will do a better job than government in administering and financing healthcare for America. We know that the private sector employer/insurance-based mess is rife with fraud, waste, and abuse. The private sector insurance system has failed to control health care costs and protect Americans from egregious malpractice and negligence.  Never mind that the private sector has had 6 decades to get it right.

We know that 46.6 million Americans are permanently uninsured and tens of millions more are temporarily uninsured for various periods of time for various reasons. We know that our hospital emergency rooms are jammed with people seeking both urgent and primary care services. We know that more people are bankrupt, impoverished, physically impaired or dead because of healthcare costs.

On July 24, 2004, The Chicago Tribune reported that the Bush-Cheney administration will work toward ending the Certificate-of-Need Approval Process. We know that this process, which required healthcare organizations to apply for approval to make large expenditures on healthcare facilities and equipment, was corrupted by politicians and healthcare organizations. Yet we also know from past, expensive experience that opening the floodgates to unbridled growth and proliferation of the healthcare industry will result in excessive costs for healthcare purchasers and consumers.

Normally, competition is healthy for any market. Consumer demand normally determines supply. In healthcare, supply drives utilization or demand. New hospital beds will be filled. Leased or purchased diagnostic equipment will be utilized.  New, more expensive medications sometimes replace older, reliable medications of comparable clinical value about the time that their patents expire on the less expensive medications.

Physicians and other healthcare professionals are the principal determinants of consumer demand because of their roles as diagnosticians, uniquely authorized purchasing agents, access points, and often service or product distributors. Unlike any other market, consumers cannot order, purchase or access most healthcare services and products without a physician's authorization. This leads to self-referral and unnecessary referrals for all kinds of diagnostic and treatment procedures at facilities or for services in which physicians or their hospitals have a financial interest. It also leads to excessive hospital admissions and diagnostic tests. In Florida, one study documented a 300% difference between Medicare patients referred to physician-owned facilities (clinical labs, radiology centers, etc.) and those referred to others. It is often difficult to determine if a physician is using sound medical judgment, practicing defensive medicine, or engaged in self-referral when he orders procedures, tests, etc.

Federal investigators have discovered that some healthcare providers have billed the government for patients who: died before the alleged dates of service; never existed; received unnecessary and excessive services; allegedly received treatments and procedures that were inappropriate for the patients' diagnoses; and, billing for more lucrative procedures and services than those actually rendered to patients. If the patient needs and receives a Geo, the government might be billed for a Mercedes. Since patients rarely see an invoice for service before it is mailed to Medicare or a Medicaid program (if ever) and most invoices are incomprehensible, it makes for extraordinary fraud opportunities.

On July 25, 2004, The New York Times reported: "The Bush administration has been going to court to block lawsuits by consumers who say they have been injured by prescription drugs and medical devices. The administration contends that consumers cannot recover damages for such injuries if the products have been approved by the Food and Drug Administration (FDA). In court papers, the Justice Department acknowledges that this position reflects a 'change in governmental policy,' and it has persuaded some judges to accept its arguments, most recently scoring a victory in the federal appeals court in Philadelphia. Allowing consumers to sue manufacturers would 'undermine public health' and interfere with federal regulation of drugs and devices, by encouraging 'lay judges and juries to second-guess' experts at the F.D.A., the government said in siding with the maker of a heart pump sued by the widow of a Pennsylvania man. Moreover, it said, if such lawsuits succeed, some good products may be removed from the market, depriving patients of beneficial treatments." Within a few weeks of this report, an FDA-approved medical device was recalled following the deaths of two patients. Products often have defects, which are not discovered until months or years after their FDA-approval. This is neither coincidence nor an isolated problem. Pharmaceutical companies have been investigated for their failure to disclose known hazards of their medications for children and adults.

Public Citizen, a national non-profit, public interest organization, has had a long and combative history with the FDA about consumer safety issues. The AARP and other organizations have had doubts about the FDA's consumer protection priorities.

The GOP-led Congress has supported the FDA's ban on the reimportation of RX medications from Canada. Last year, a report by the Congressional Research Service - the Library of Congress expert that Congress turns to for objective information - confirmed the safety of drugs from Canada. It found that medications manufactured and distributed in Canada meet or surpass quality control guidelines set by the FDA. Some Capitol Hill lawmakers assert that the agency is catering to the drug industry. "There's no question in my mind that the (FDA) is too dependent on the pharmaceutical industry for their attitudes and decision-making," said GOP Rep. Dan Burton (IN), who chairs a House subcommittee that studied the Canadian drug issue in 2003. "I had four hearings and I asked (FDA Associate Commissioner William Hubbard) to give me examples where people have been damaged by Canadian pharmaceuticals and re-importation, and he couldn't even give me one, not one." 

The President's former Medicare chief, Mark McClellan, the former FDA Commissioner, was a poor ally of healthcare consumers and purchasers. Politically astute and well-educated, Dr. McClellan was among the least credible and most consumer-insensitive government policy healthcare executives that our staff have ever seen testify before Congress. Crestor was approved on his watch. Mark McClellan resigned proving once again that there is a God, but we are confident that President Bush will reach into his bag of incompetents and replace him with a CMS Director as friendly to healthcare industry special interests.

His brother, Scott, was the President's Press Secretary until Tony Snow was appointed. In the public sector many former government officials, both elected and appointed, have been hired to work in highly paid positions for various healthcare industry organizations and law firms. Having acquired contacts and influence in government, some of them are making big bucks in the private sector working for those they were previously positioned to investigate or regulate.

The FDA continues to signal concerns that terrorists could tamper with imported drugs. The new FDA Commissioner, Lester Crawford, cited bio-terrorism through imported drugs as one of his major concerns, but he didn't mention any specific threats. Dave MacKay, executive director of the Canadian International Pharmacy Association, called Crawford’s comments absurd. "He was speaking almost personally out of the side of his mouth without the proper evidence,” he states. “Clearly he doesn’t understand the Canadian drug regulatory system.” Congressional leaders from Trent Lott to John McCain to Ted Kennedy, agreed on re-importation, and it’s time the White House did also. President Bush may have already terminated any prospect of legalizing Canadian RX medications importation by pressuring the Canadian government to cease exports of less expensive drugs to Americans.  However, the issue still has resonance with the majority of Americans.

In their inimitable wisdom, the FDA has begun enforcing U.S. law prohibiting reimportation of drugs from Canada by seizing consumers' shipments. The FDA is consistent --- it rarely sides with the interests of healthcare consumers when the drug industry's interests are in contention. It has once again made it clear that special interests are dominant in much of the FDA's critical decision-making.

Dr. John Spritzler, in his fascinating article, "Market-Driven Health Care and Social Control", says, "The real effects of market-driven health care on people's lives suggest that the primary corporate motive for imposing this type of health care system is to make people more controllable." We believe that he gives corporate executives far too much credit for diabolical manipulation in a truly uncontrollable venue.

The fabric of the healthcare mess has been woven by a coalition of more fragmented interests. Money is the primary factor holding together and offering common ground to special interests. Politicians have acceded to their interests in the absence of public financing (tax revenue allocations) of political campaigns and dependence upon corporate financial support for their re-election. The unique nature of healthcare consumers' information deficits fuel sustenance opportunities unlike other market-driven services and products.  The majority of captains of America's commerce and industry have been co-opted by a myriad of conflicted advisory resources and betrayed by their own philosophical opposition to government as the sole healthcare purchaser in a universal healthcare system.

Yet stitching together additional illusory panaceas --- Association Health Plans, Health Savings Accounts, tax credits, medical malpractice tort reform, community health centers, eliminating controls on healthcare industry proliferation, working to eliminate consumer lawsuits for injuries or deaths caused by FDA-approved RX drugs and medical devices, etc. ---constitutes the President's healthcare plan. 

There have been other panaceas (not remedies, but temporary pacifiers, impotent measures, illusions for healthcare purchasers) concocted by healthcare broker/consultants and their insurance industry benefactors --- utilization review, case management, disease management, cafeteria benefit plans, wellness/fitness programs, HSAs, etc.  They present new opportunities for enrichment. Some have had limited value in deterring overzealous and unnecessary treatment.

Consultants, especially broker/consultants (perhaps the Kings of Conflicts-of-Interest) invariably surface the classic self-serving, " ... but for X (the remedy or panacea-of-the-year), healthcare costs would be even greater than they were last year ...", argument for the consumption of their clients --- large employers and government. It is analogous to the legendary statement, "I saved money by spending $5000 on clothes because they were all on sale." The prudent spouse never queries, "Was there a less expensive way of saving money today?" There are however, less expensive ways of saving money in our collective healthcare purchases.

Nevertheless, it is irrefutable that private sector panaceas combined have failed to expand access. Nor have they reined in healthcare costs to any level near the rate of inflation of all other goods and services. 

Special economic interests that profit from our current healthcare mess will profit even ore from the President's plan. It will not solve the nation's healthcare crisis.  If the purpose of a national healthcare policy is to ensure access, control healthcare costs, and improve quality and patient safety, the Bush-Cheney plan won't do the job.

President Bush has packaged his proposals in 'Ownership' rhetoric. He attempts to convince Americans that they are individually on a level playing field with pharmaceutical companies, doctors, HMOs and hospitals (they aren't). He will try to convince us to forget how badly millions of Americans got fleeced by investment managers and Wall Street crooks a few years ago. In the President's Ownership Society, consumers will soon discover that their lack of knowledge of the prices and quality of healthcare services enders ownership of their healthcare plans (HSAs) over-rated. Healthcare plan ownership is impossible to assess without other tools for consumers to determine the prices and quality of healthcare services. Privatization has its limits, never more evident than in his proposed healthcare plan ownership.

On September 2, 2004, the President accepted the GOP nomination for another term In his speech, he made no mention of a 17% increase in Medicare premiums, which was announced the following day, perhaps 12-15 hours later, on September 3, 2004 --- the start of the Labor Day Weekend and as a hurricane was about to hit Florida.  Automatic assault weapons, another significant health hazard, have been banned for a decade, but the ban expired on September 13, 2004.

The current Administration has made the wrong choices for controlling healthcare costs, expanding access, enhancing quality, and ensuring higher patient safety standards. Most recently, President Bush used his first veto to cripple federal support of stem cell research favored by 83% of physicians.

Our perspective is shaped through the prism of decades of consulting to more than 1400 healthcare provider and purchaser clients, studying the politics of healthcare for several decades, and discussing various solutions with thousands of healthcare consumers, providers, and purchasers. There are far too many variables and ambiguities in each plan. There are too many unknown levels of interest and participation in the plans by employers, insurance carriers, and consumers. Obviously, the cost estimates for the Iraq invasion and reconstruction were consistently inaccurate. The proposed healthcare plans and compelling need for universal coverage are even less subject to accurate cost assessments. Neither Presidential candidate in 2004 proposed an effective solution to the healthcare cost, access, quality and safety crises evident in America's healthcare non-system.

The Bush-Cheney healthcare plan omits any reference to a Patients' Bill of Rights. One of the most stunning and revealing differences between the Presidential candidates in 2004 was evident when the Bush-Cheney administration supported HMOs in their case before the U.S. Supreme Court to prevent patients from suing them when they wrongfully deny patients necessary medical care recommended by their physicians. Yet on July 31, 2004, President Bush told voters at a campaign stop in Canton, Ohio "... we will make sure the health decisions are made by doctors and patients ..." From his days as Governor of Texas, President Bush has done a flip-flop-flip in one of the most interesting episodes of his political career.  As Governor, he initially stood with HMOs, then tacitly assented to patients' right to sue HMOs, and most recently before the U.S. Supreme Court, in support of HMOs in denying patients the right to sue them for withholding necessary care. At best, his verbal assurances to voters and behavior at different times on this issue are contradictory. It may be coincidental, but unsurprising that President Bush's appointee to the U.S. Supreme Court, John Roberts, represented the interests of the HMO in Rush Prudential HMO v. Debra Moran, et al. when he was a practicing attorney and before his nomination by Bush to the U.S. Court of Appeals for District of Columbia Circuit.

On August 18, 2004, The State of Illinois became the first among several states to exercise leadership in the public interest and aggressively plan to facilitate drug importation for consumers in defiance of the Bush Administration.

In the 3rd Presidential Debate, October 13, 2004, President Bush stated that the U.S. may import flu vaccine from Canada. He didn't appear to have anxiety about the safety of the vaccine, the shortage of which came to light within a week of the debate. The President asked healthy Americans to forego flu shots, but former Senate Majority Leader Frist was dispensing flu vaccine two days later to his Congressional colleagues.

Quality healthcare should focus on optimum medical outcomes. Staff may be pleasant, wait times may be minimal, but the medical outcome is the most important indicator of quality healthcare. Medical outcomes for the same diagnoses and procedures vary from hospital to hospital. We can access tire safety ratings, but cannot easily access hospital medical outcomes data for specific diagnoses and treatment modalities in easily understandable formats. Nevertheless, it is possible to secure reliable information about healthcare providers, diagnoses, and treatment options (See Consumer Empowerment).

Other than utilizing technology to enhance healthcare quality and patient safety, neither Bush-Cheney nor Kerry-Edwards' plans addressed the human factor. No technology in the world will prevent medical errors if anesthesiologists drift between two or more surgical patients simultaneously to maximize their earnings. No clarity of charting will prevent staff from leaving hypodermic needles laying around after use where they can perforate another patient and infect the unsuspecting patient with AIDs or another disease. A computer is unable to ensure that temporary nursing staff have the requisite skills to care for burn patients or other patients requiring unique knowledge and training.

Government must do more to identify and purge the relatively small number of

impaired, incompetent, and chronically dangerous healthcare clinicians. Discipline can no longer be left to 'peer review' committees within hospitals or state professional licensure standards boards consisting of reluctant and protective peer practitioners.

The Bush-Cheney position on medical malpractice legislation is premised upon defective information sponsored and touted by healthcare industry financial interests. Doctors support tort reform legislation to minimize lawsuits against them. They oppose constraints on class-action litigation so that they can retain their rights to sue healthcare payers. On the other hand, hospitals all over the nation are being sued in class action litigation for charging patients without insurance more than those with insurance.

The public has a right to know that a plaintiff's attorney, most of whom work for their clients on a contingency basis because most people cannot otherwise afford to pursue their claims, is invariably working against very expensive defense trial attorneys. Litigation defense attorneys are paid hourly to defend their healthcare or corporate clients. Plaintiffs' attorneys must win a settlement or judgment to be compensated. Civil defense attorneys are paid by their clients win or lose. 

The President often talks often about 'junk lawsuits' or 'frivolous lawsuits'. Since the President is the beneficiary of significant campaign donations from thousands of doctors, hospital administrators, and health insurance executives, it must require excellent political skills to keep them focused on re-electing him first, and then fighting over healthcare dollars later.  Their common ground, in this context, is to ensure the election of candidates, who will relieve them of as much potential expense as possible when they or their staffs inadvertently cause deaths, injuries, or illnesses to patients. And for $1250 or more, any physician can buy a 'Congressional Physician of the Year' plaque from the National Republican Congressional Committee.

We need a progressive healthcare policy which allows that the health of our economy is tied to the health of our citizens. It is no secret that the costs of healthcare have been inhibiting hiring, driving companies to drop retirees' medical benefits, and further motivating large employers to ship jobs to other nations.  

Most Congressional House Members and some Senators remind voters that they brought them a brand new Medicare RX medications program. They sure did! Democrats and some Republicans proposed changes to the legislation. President Bush has threatened to veto new legislation, which would contain provisions to eliminate many of the more industry-friendly provisions in the law. In a belated political gesture under political pressure, Bush has directed the insurance carriers to help Seniors get their RX medications under the new Medicare fiasco.

Each of the elements proposed by President Bush serves to directly or indirectly enrich special interests. President Bush placed these features on display in 2004 for his re-election campaign --- AHP's, HSAs, tax credits, and medical malpractice tort reform. Under the guises of 'consumer-directed health care' and 'consumer choice', they will add further complexity and devastation to a fragmented, chaotic healthcare non-system in the process of implosion.  Thirty-Five months after the election, the Bush Administration has done virtually nothing to expand healthcare access, control costs, and to improve quality and patient safety. On October 3, 2007 Bush vetoed an expansion of the federally- funded State Children's Health Insurance Program (SCHIP).

Ending The Healthcare Crises:

A Single Payer Universal Healthcare System

"Never be afraid to try something new. Remember, amateurs built the ark.

Professionals built the Titanic."  -  Author Unknown  

Costs Could Be Reduced Substantially By Eliminating Fraud, Waste and Abuse and Establishing a Single Payer Universal Healthcare System With Consumer Education and Protection Features 

Today, more than 1 in 3 of all Americans now have government coverage through Medicaid, Medicare, the military and federal employee health plans. More than 10 million others are eligible for Medicaid but have not enrolled. Tens of millions more are not eligible for any government-funded healthcare programs.

A single payer universal healthcare system for all Americans would be the most cost-effective solution for the nation's healthcare crises. Healthcare consumers, their families, doctors, nurses, pharmacists, and thousands of employers would be much happier and experience healthcare with far less stress.  Employers and individuals would pay into a general fund. The risk would be spread throughout the entire population. The federal government would be the sole payer. The roles of some insurance carriers, if any, would be similar to those of closely monitored third party administrators regulated by and accountable to the federal government. The uninsured would be covered on a sliding scale basis. Consumers would select any healthcare providers they wanted that were qualitatively approved by the federal government including the Departments of Justice and Health and Human Services.  The Medicare and VA systems for our Seniors and veterans could be integrated into the most efficient healthcare purchasing infrastructure in the world while saving their best features and purging their undesirable characteristics. 47 million Medicaid beneficiaries and 41 million Medicare Seniors would benefit from a leveraged single payer universal healthcare system. It would eliminate the inherent healthcare treatment discrimination operative in our current non-system that is experienced by poor, aged, African-American, and Hispanic patients.

Quality information would be available through the Internet and accessible by all. Quality standards would be enforced by government oversight entities. The government would establish fair and equitable rates for services based upon diagnoses and procedures and products based upon negotiated prices. It would ensure that Americans had access to medical outcomes information among providers to ensure that they compete for business on the basis of quality or medical outcomes and other indices. Healthcare consumers would be empowered to make informed choices and decisions among the maze of healthcare treatment options and settings.

Layers of unnecessary waste, fraud, and abuse would be reduced or eliminated. There would be a single database with provider profiles and reimbursement fees for each provider. The savings in information systems maintenance and claims processing alone would be astounding. Under a single payer healthcare system, RX medications would be evaluated and prices would be negotiated directly with manufacturers. This would eliminate layers of profits and advance adherence to a formulary including only clinically superior and safe medications.

While there would be substantial challenges in planning and implementing a single-payer universal healthcare system, the fragmented and untenable non-system we have now must be ended. Is it a panacea? It is far superior to what we have now and the challenges it poses operationally are far more manageable. Most importantly, it would not exclude or bankrupt tens of millions of Americans.

Medicare has had much better success in controlling administrative costs than hundreds of private sector insurance operations including HMOs and PPOs. A single payer's administrative expenses would be a fraction of those currently evident among the myriad of private sector health insurance companies and managed care organizations. Hundreds of $billions could be reallocated to patient care. Physicians and other providers would cease spending valuable time on billing and other unrelated patient care administrative issues. A single payer universal healthcare system is the most efficient, least expensive, and most rational of all options. We can choose to be a society, which elevates healthcare to the status of a human right, or a society, which continues to market healthcare as a commodity for the profit and enrichment of private economic interests.

Are there precedents? The United States has many single-payer, public benefit systems, which function on the whole, quite well. They include: Drug Enforcement Agency, Environmental Protection Agency, Federal Aviation Administration, Federal Judiciary, Federal Reserve, Federal Trade Commission, Homeland Security Department, Internal Revenue Service, National Defense, National Highway Transportation, United States Postal Service, and dozens of scores of other government sole-source services.

The Lack f Universal Healthcare System - Not A Mystery

So why has the single payer universal healthcare system option been more rhetoric than reality for so many years?

A. Its a corruption-fest! Congressional leadership has strong and unshakeable ties to and economic co-dependence with the healthcare industry for legislative support in exchange for generous campaign funding.  The AP and Washington Post finally wrote about the former Majority Leader's conflict of interests. Many former Senators and House members become lobbyists for healthcare and other special interests. The FBI is investigating 2000 cases of public corruption.

B. The Democratic party leadership became gun-shy following the Clinton Health Care Security Act debacle of 1993-94, which was characterized by a $200 million campaign to kill it financed by insurance (remember 'Harry & Louise'?) and other healthcare industry special interests. Who would want to be ostracized for being 'tax and spend liberals' in the season of massive deficits, the insurgency and chaos in Iraq, and tax cuts?

C. A significant change in the status quo would reduce healthcare industry political campaign contributions appreciably. It would lead to economic disruption for many healthcare insurance organizations' executives. It would cause career dislocation for tens of thousands of non-clinicians throughout the healthcare industry inclusive of insurance brokers, marketers, administrators, and executives. In the current scheme of national priorities, dying and suffering Americans are simply no match for retention and growth of the revenue bases of healthcare industry 'leaders'.

D. The American public has an information deficit, which has paralyzed its ability to organize, develop, and direct its collective will upon its elected leadership. There is nothing comparable to the healthcare information deficit in American society. The best and the brightest have often been misled by elements of the media parroting special interests' press releases, public relations spokespeople, and politicians.

E. Consumers are primarily dependent upon the sellers of healthcare goods and services for diagnostic and treatment plans and treatments. Even the most sophisticated among us have been victims of medical errors. In effect, physicians serve as purchasing agents for most healthcare consumers. They hold the power to order diagnostics, prescribe medications, authorize patient referrals to specialists and hospital admissions. The Internet will eventually provide the most useful information to consumers in easily understandable format. Congress should authorize patients' access to the National Practitioner Data Bank to empower them to determine for themselves if physicians they are considering for consultation or surgery have been disciplined or have histories of malpractice and negligence.  Our government is complicit in denying information about the malpractice and negligence histories of physicians and other healthcare professionals.

F. Healthcare purchasers have been co-opted, manipulated, and out-flanked. Even now, healthcare business coalitions, healthcare roundtables, and group purchasing alliances include in their deliberations and memberships financial beneficiaries of the current healthcare chaos. The vast majority of healthcare purchasers (employers and government)often suffer their information deficits with complacency and deference to the beneficiaries of our healthcare non-system. .

Of the more than 10.5 million personnel within the healthcare industry, relatively few --- less than a million --- would be affected by a change to a single payer healthcare system. Although optimally beneficial to almost 300 million Americans, single payer universal healthcare is politically inconceivable to many of our Members of Congress and the President. They have been willingly co-opted or worse by a highly visible, well-heeled, influential, and very generous plethora of healthcare industry and insurance lobbyists and special interests.

Healthcare Decisions In The Midst of Crises

It is implausible, even in an HBO television script, that the FBI shares its surveillance methodologies with the Mafia at hospitality suites sponsored by the The Sopranos. 'Normal' is a creative tension between buyers and sellers to effect a win-win situation for all parties. Yet the largest, most influential healthcare purchasers in the nation are often co-opted. It is as bizarre as it would be if the Department of Homeland Security invited Al-Qaeda to their meetings to help it determine what it should do about terrorism. 

It is quite evident that healthcare purchasers have sought to work harmoniously with healthcare suppliers. However, the solution to our multiple healthcare crises would have evolved long ago if assimilation, cooperation, co-optation, and Kumbaya were the right implements for determining and implementing effective healthcare purchasing strategies.

Meanwhile, consumers must begin to accept responsibility for their lifestyle choices and behaviors. Obesity, diabetes, lung and heart diseases, chemical and substance abuse, skin cancer, and many other conditions may be deferred by lifestyle changes. If we teach kids to play soccer in our schools, we must also teach them how to care for their bodies and their minds when they are very young. Preventive medicine, contingent upon healthcare coverage, must have a resurgence if we are to have prudent healthcare policy.

The Business of Healthcare is Business

Even if consumers do everything conceivable to engage healthy lifestyles, they remain vulnerable to illness and injury.  When this occurs, government must protect them in their most vulnerable state --- when they are patients in America's hospitals and nursing homes. For decades, Congress has relied on the Joint Commission on Accreditation of Health Care Organizations to monitor patient safety in America's hospital facilities. There is no better example of conflicts-of-interest in healthcare than the JCAHO. Public Citizen Health Watch has cited it repeatedly for pandering to the hospitals it surveys and for failing to ensure patient safety and quality care in the nation's hospitals. We should be grateful that fire inspectors aren't paid by the owners of the buildings that fire departments inspect. We should be delighted that the Federal Aviation Administration isn't governed by executives of the major airlines. We must address why it it that the nation's hospitals are accredited by an organization that is paid by them to certify them; and, why it is that the organization is governed by a Board comprised predominantly of healthcare special interests.

Extraordinary disclosures about the JCAHO tells only part of its colorful history.   In the past, it has been a leading advocate for immunizing hospitals from liability exposure for injurious medical errors if hospitals disclose their errors. In other words, if a patient is maimed or dies as a result of medical errors and the hospital admits its mistakes, JCAHO encouraged Congress to immunize it from liability litigation. Concurrently, it was running radio ads touting the JCAHO's commitment to healthcare consumers. The JCAHO hasn't been a stalwart for healthcare consumer protection despite its rhetoric and public relations messages. Senator Grassley (R-IA) and Congressman Stark (D-CA) introduced legislation to bring the JCAHO under CMS oversight authority. To date, the JCAHO remains independent of government control.

The business of healthcare in America is largely about shareholders' dividends, organizations' profits and fiefdoms, hospital systems' competition, and executives' compensation packages (including those of 'non-profit healthcare organizations). For-profit or non-profit status are simply legal terms with tax and accounting implications. Tax status is meaningless in the context of healthcare costs, patient safety, fraud, waste, abuse, and executives' financial remuneration. Organizational 'mission statements' have public relations value, but are frequently inconsistent with certain behaviors inclusive of patient-dumping and overcharging uninsured patients. These facts are in no way disparaging of the dedication of millions of kind and highly skilled healthcare professionals and care-givers.

Healthcare professionals often seek to avoid information disclosure, even patients' medical records, from healthcare consumers. The underlying premise is that healthcare providers own the information. Patients are simply the bearers of symptoms, complaints, illnesses, injuries, manifestations, and of course, insurance coverage, cash, personal checks, or credit cards.

The Elements of America's Healthcare Crises