Back to the Future: What's in Store

[Hat Tip: Ace of Spades]

The Yes You Can Health Insurance Plan [UPDATED & BUMPED]

[Welcome LGF readers!]

[ed: Updated - individual medical plans outlawed - please scroll down]

Would you like to know what your new, change you can believe in health insurance will look like? Here are some tidbits from the House version translated for humans.

For starters, if you don’t have health insurance you will pay a tax.

If your coverage is not acceptable, you will pay a tax.

If your coverage does not meet federal guidelines at ANY TIME DURING THE YEAR you will pay a tax.

How much tax?

2.5% of your MAGI (modified adjusted gross income).

Sounds like a tax on the middle class to me.

So what are these federal guideline for coverage?

The policy must cover hospitalization, outpatient care including ER, doctors visits, medical supplies, prescription drugs, rehabilitative and “habilitative” services, mental health and substance abuse services, preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services, maternity, wellborn care including health, vision and hearing including supplies until the child reaches age 21.

I have no idea what habilitative services are and I doubt anyone in Congress does either.

By requiring all policies to meet these standards, including the guaranteed issue mandate (explained later), the cost of health insurance will increase dramatically.

Maternity, especially without a pre-existing limitation, could easily add 30% or more to current premiums for some age groups. Mental health parity another 15% and covering all care on children to age 21 another 5 – 10%. That’s adding 50% in costs to current premiums.

So much for health insurance that is affordable.

But hey, this is Washington. They don’t know the meaning of the word affordable.

How about some of the other provisions in your new change you can believe in health insurance policy?

Your policy cannot discriminate because of pre-existing conditions, will be guaranteed to be issued and is guaranteed to be renewed as long as you pay the premiums. Your new policy cannot be rescinded except for incidences where you have committed fraud.

There are currently 4 states where carriers are not allowed to take into account your health history for rating purposes. Those states are NY, MA, ME and VT. Rates in those states are 2x to 3x higher than for comparable coverage in neighboring states where medical underwriting is allowed.

If this trend holds for the new policies, plus the requirements above for maternity, mental health parity and coverage on children to age 21, you could see an initial increase in premiums over current rates of 150% at a minimum.

That is change you can believe in.

Your premium can vary by age but in no event will you be charged more than twice the “normal” premium as defined by the Health Choices Commissioner.

Who is in charge of setting parameters for health insurance?

There will be a new level of bureaucracy termed the Health Benefits Advisory Committee consisting of no more than 26 members.

They will include 9 (who are not federal employees) appointed by the president, 9 (who are not federal employees) appointed by the Comptroller General plus some even number (not to exceed 8) who are federal employees.

But wait, there’s more!

The HBAC is presumably temporary and would only be in place to set the initial guidelines. The day to day grunt work would be handled by the Health Choices Administration.

There will also be a federal Health Insurance Omsbudsman who "shall, in a linguistically appropriate manner - receive complaints, grievances and requests."

I wonder who determines what is linguistically appropriate and what is not. What are the consequences for being linguistically inappropriate?

But I digress . . .

Good news for transparency advocates! The Health Choices Commissioner (or perhaps the Health Choices Administration) will require full transparency with regard to the cost of procedures and services.

Under your new change you can believe in health insurance policy you are free to find the lowest price for brain transplants.

And carriers will have mandated loss ratios for their business. Any carrier that has a better than required loss ratio will be required to rebate those extra earnings to the policyholders.

Nothing is said about what happens if the carrier has a worse than expected loss ratio.

All policies and marketing material must meet “plan language” standards as set by the HCA.

Plain language means anyone, including those with “limited English proficiency” who could be a prospective policyholder must be able to read and understand the material .

Too bad that requirement was not imposed on this 1018 page bill.

How are you liking this change you can believe in health insurance plan so far? Come on. You can tell me.

ADDENDUM [HGS]: As Bob says, "But wait, there's more!" According to financial journal Investors Business Daily, the House's reform bill would outlaw individual medical insurance (outside the as-yet-to-be defined 'Exchange" system):

"The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law."

If this bill flies, folks who already have individual coverage could keep it, but couldn't switch plans if (when) premiums increase. And folks coming off group plans would be barred from purchasing individual cover.

That's right: when individual health insurance is outlawed, only outlaws will have their own insurance.

MORE FROM BOB: From the House Ways and Means markup, page 17 & 18 . . .

(c) LIMITATION ON INDIVIDUAL HEALTH INSURANCE COVERAGE.—

(1) IN GENERAL.—Individual health insurance 2 coverage that is not grandfathered health insurance 3 coverage under subsection (a) may only be offered 4 on or after the first day of Y1 as an Exchange-participating health benefits plan.

6 (2) SEPARATE, EXCEPTED COVERAGE PERMMITTED.—Excepted benefits (as defined in section 8 2791(c) of the Public Health Service Act) are not 9 included within the definition of health insurance 10 coverage. Nothing in paragraph (1) shall prevent the 11 offering, other than through the Health Insurance 12 Exchange, of excepted benefits so long as it is of13 offered and priced separately from health insurance 14 coverage.

This is beginning to look like the No You Can't health insurance plan . . .

New Health Insurance Plan

For those who do not like to read . . .

Health Care Reform in 1,000 Words...

[ed: Click to enlarge]

[Hat Tip: Lyndsi Thomas]

Live Right, Save More

[Welcome Industry Radar readers!]

The Senate want's you to be healthy and promising to cut your health insurance premiums in half if you comply.

Workers who quit smoking, lose weight, and eat right could have their health insurance premiums cut by as much as half, possibly saving them thousands of dollars per year, under a measure inserted with little notice this week into the Senate healthcare overhaul bill.

Cutting premiums in half is fantasy.

“Money talks,’’ Senator Judd Gregg, the New Hampshire Republican who helped broker the deal reached Monday night, said in an interview. “People react to incentives that involve cash.’’

This is true that money talks, but try getting folks to stay on the program. And who is going to monitor them?

Will big brother send a case worker to your home to make sure you don't have Moon Pies in the cupboard and that your running shoes actually show some wear?

Previous measures aimed at convincing Americans to get in shape and lead healthier lifestyles have had mixed success. While the smoking rate has dropped dramatically in recent decades, the obesity rate has doubled since 1987, according to Ken Thorpe, a professor of health policy at Emory University. If the country could return obesity levels to the 1987 rate, it could save $225 billion per year, going a long way to paying for other measures in the healthcare bill, Thorpe said.

According to my driver's license I do weigh what I did in 1987. Doesn't that count?

Of course my hair was black and I had more of it back then.

That is the kind of change I can believe in.

Seasoned Citizens in the Crosshairs

As we continue to rush headlong toward a system modeled after the MVNHS© [Much Vaunted National Health System], it's becoming increasingly apparent that seniors will bear the brunt of the reductions in both access to, and availability of, health care. As Mike pointed out last month, "mandatory, private long term care insurance would be “primary” to NHS." The point of that exercise is to wean folks from the public trough, at least as regards funding of long term care needs.

But that's only the most benign of proposals. In what can only be ascribed to that British penchant for dry humor, "elderly people could pay up to £25,000 [ed: about $40,000 at today's exchange rate] to guarantee basic social care under proposals aimed at ending the "cruel lottery" of old age care."

The problem, you see, is that British seniors are perceived to have been getting a "free ride" for far too long, and the time has come to pay the piper. Of course, those who have been paying their own way are among those to be penalized; Health Secretary Andy Burnham "admitted the present care system was "flawed", with inconsistencies across the country and people penalised for prudence."

Ooops.

And yet that's precisely the kind of flawed system being touted here. As former Clinton advisor (and pedicure enthusiast) Dick Morris notes, "Obama’s health care proposal is, in effect, the repeal of the Medicare program as we know it." He bases this on the fact that, under the President's plan, Medicare beneficiaries will enjoy the least access to medical care, and cherished end of life decisions will be taken out of their hands.

Of course, AARP, the 800 pound gorilla of senior care lobbying organizations, is hard at work fighting for its members' very lives.

Right?

Well, not so much.

It's probably a good thing that my mother's not still around to see this. Of course, if she were, it apparently wouldn't be for long.

Cavalcade of Risk #82 now up!

Louise and Jay Norris host this week's edition of the Cavalcade of Risk. Be sure to stop by for a great edition!

And something new to the Cav: you can twitter it, facebook it, digg it, reddit, stumbleupon it, or del.icio.us it; just look for the handy buttons at the bottom of the post.

Finding Meaning in Cancer

While we generally focus on insurance issues, we're also classified as a health blog (at #11 in those Wikio standings, for those keeping score at home). While we've talked about cancer-related insurability and claims issues, we haven't spent much time on the non-financial side.

My better half, who is generally more in tune with this area than I am, just sent me a link to a WSJ story on a new kind of therapy for those with cancer:

"The unusual program ... aims to help cancer patients find a sense of meaning, peace and purpose in their lives, even as the end approaches. “For many cancer patients, the biggest challenge is, ‘How do I live in the space between my diagnosis and my eventual death?’” says William Breitbart, a Memorial Sloan-Kettering psychiatrist who developed the program, known as meaning-centered psychotherapy, and has tested it with more than 300 patients since 2000."

The part that really hit home, however, is how Dr Breitbart first conceived of the idea. He based the treatment on the writings of Dr Victor Frankl (who pased away about 12 years ago), an Austrian-born psychiatrist and Holocaust survivor. We are both very familiar with Dr Frankl's writings. In describing how he survivied the horrors of Auschwitz, he observed that the Nazis could imprison, torture and starve him, but he always maintained control over how he would react to, and deal with, his suffering.

This form of therapy seems a natural outgrowth of that ideal; perhaps it will be adopted by other institutions, as well.

[Hat Tip: Gail S.]

Electronic Health Records...How to really blow it...

The German electronic health records system has had a minor setback.

The master internal security key was accidentally erased. Unfortunately that very large random number is needed to authenticate the ID cards. It wouldn't be much of a problem if they had a backup copy, but they don't.

Every first generation card has to be replaced. It's a good thing that the system was still in the testing phase.

Needless to say, everybody's pointing fingers at everybody else.

Line in the Sand

"It's 106 miles to Chicago, we got a full tank of gas, half a pack of cigarettes, it's dark, and we're wearing sunglasses."

Just like Jake and Ellwood, except there is nothing funny about this.

Obamaman has drawn a line in the sand and challenged the Senate to come up with something, anything, by this weekend.

The topic?

The health care crisis of course.

The virtual deadline underscored Obama's determination to push legislation through both houses of Congress before lawmakers go home for their August summer break.

"Don't bet against us. We are going to make this thing happen," the president told reporters earlier Monday, fresh from an overseas trip during which the momentum behind his health care agenda slipped.

Congress has already spent $1 trillion more than they will take in via taxes, but why should that stop them? Put anything together just to get it out the door before the artificial deadline.

Mr. Fixit is at it again.

Scott Mulhauser, a spokesman for Baucus, said the senior Democrat has stressed that his committee will be ready when it has completed a proposal "that can ensure quality, affordable care for every American, lower costs _ and pass the Senate."

For his next trick, Obamaman will walk on water and feed 45,000,000 hungry souls from a picnic basket.

Majority House Democrats expect to introduce legislation Tuesday that would prohibit insurance companies from denying coverage or charging higher premiums on the basis of pre-existing medical conditions.

As we have discussed before, this is not a problem. Double the premiums to cover the additional risk and it is a done deal.

Of course that moves the goal posts on affordability . . .

The measure would spend billions of dollars subsidizing lower-income individuals and families who cannot afford coverage in an attempt to cut dramatically into the ranks of the uninsured.

Expand Medicaid eligibility to 200% of the FPL and you clear two thirds off the roles of the uninsured.

Its total price tag remains unknown,

Only in Washington does thinking like this come in to play.

Did I say thinking?

but to comply with another presidential priority, it would rely on cuts in Medicare and Medicaid to begin slowing the rate of growth in health care spending overall.

So their solution is . . . to cut spending on M/M.

The result is predictable, unless you work inside the beltway.

Fewer medical providers willing to participate, less accessibility, more out of pocket for M/M beneficiaries.

That is a tax increase on the middle and lower class no matter how you choose to spin it.

The measure is expected to impose a fee on large companies that fail to offer insurance, and individuals also would have to pay a penalty if they refused to purchase affordable insurance.

Ah yes. Pay or play.

Companies who are assessed the fee will pass it on in the form of higher prices for their goods and services. These higher prices will ultimately be paid for by consumers, the bulk of whom are middle class and lower.

And the penalty to consumers is . . . another tax on those earning less than $250,000. So much for campaign pledges.

Define "affordable".

Especially after ratcheting up the price to cover pre-existing conditions.

This is like taking a company that earned a profit on large, gas-guzzling cars, trucks and SUV's. Putting them through bankruptcy, and then telling them to earn a profit by selling small cars that are not profitable.

GM will be in trouble inside of 3 years under this new game plan.

A new income tax on the wealthy, estimated to raise more than $500 billion over the next decade, would help pay for the bill.

But the wealthy always have ways to legally avoid paying taxes. Don't those folks in Washington study history?

In the Finance Committee some highly controversial issues remain unresolved, including how to pay for the bill and a Democratic demand for the government to sell insurance in competition with private industry

The government selling insurance.

Will it be like the Post Office? Take a number, get in line. Or will they dispense policy's from an ATM?

This is both hilarious and frightening.

EMR: Panacea or Pandora?

According to The Washington Monthly (a DC-based magazine which purports to be non-partisan, but which lists as its contributors former Enron advisor Paul Krugman, outspoken media personality Rachel Maddow, and former president Bill Clinton), the answer to all the waste and inefficiency in our health care system can be traced to one source: medical records that aren't computerized. On the one hand, I admire this bold assertion, and the fact that it could be made with a straight face.

On the other, one presumes that the WM is read by at least a few folks, some of whom may well be in positions of authority. Which is a shame, since the premise is so far off base, and the lack of actual, you know, data to support the assertion is so glaring.

Let's start by granting that digitizing records could help in a number of ways: fewer dead trees, of course, but also more easily accessible patient info, the ability to quickly cross-reference treatment modes, and potentially speed up billing and payment. All of these are worthy goals, none of them will dramatically lower health care costs. In fact, given that there's a demonstrable front-end captial expenditure to actually digitize the information, the actual payback time may be years out.

This is not to say that we shouldn't pursue this; there are obviously good and sufficient reasons to do so. But to claim that this will directly and substantively reduce health care costs is a pipe dream.

UPDATE: Be sure to check out Bill's report on what happens when EMR meets Westworld.

ADDENDUM: I'm more than a little annoyed with myself for having succumbed to suggestion; the email I received touting the linked article read, in part, "digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time," and I read the article with a pre-conceived idea of what it was saying. I still maintain that EMR is not a magic potion, but in fairness, the article doesn't specifically claim that it is.

Medicine, Technology, and Grand Rounds

Dr Joseph Kim hosts this week's Grand Rounds. Focusing on technology and healthcare, Dr Kim has a terrific roundup of posts.

Do check it out.

Oy Canada: Reality (TV) Bites

From a possible broken wrist to a simple blood test, count on long lines and more than a few unhelpful health care "providers."

And better eat your veggies, because you definitely don't want any circulatory problems (unless you have no further use for your legs).

But hey, it's "free," right?

Hold the Mayo

For those of you keeping score, it appears the Mayo Clinic isn't sold on the idea of a public health option.

Dr. Douglas Wood, who chairs the clinic's division of Health Care Policy & Research, said a public plan modeled after the Medicare system has the potential to do serious harm to health care in states like Minnesota where quality is high and costs are low.

"If it's a government-run plan with government price controls, that could be highly detrimental to states like Minnesota, Iowa, Wisconsin and all across the northern tier of the United States," Wood said.

Government price controls. That's exactly what Medicaid & Medicare do. Limit how much a provider will receive for a particular procedure.

As the health care debate ramps up, so have the efforts of the Mayo Clinic's Health Care Policy Center to get out its message that value must be part of the health care equation. Launched about four years ago, the center has consulted with 1,200 "thought leaders," as it calls them, and 1,400 patients to draft what it calls the four cornerstones for health care reform. They are: creating value to improve patient care, coordinating patient care, reforming the payment system to consider value and providing health insurance for all.

"Thought leaders" is so Orwellian. You would think they could come up with a better label.

The clinic has also put forward the idea of "value indexing" to determine how providers get paid. Wood said that the system would take into account patient outcomes and cost over a period of time. He added that the current bills in Congress contain "very little that reflects payment for value."

Sounds good on paper, but I wonder how many are willing to accept a position such as this.

"Yes, the proposed treatment has a chance of working but the greater prospect is that it won't. Therefore, it is not a covered expense. Next!"

Klobuchar said it is also critical that providers be rewarded for preventive care efforts, adding, "right now, doctors are paid to treat disease not prevent them."

That is such a silly premise.

Doctors don't prevent disease. People do.

Your doc can tell you to lose weight and get more exercise until the cows come home but that won't make it happen.

Wyden-ing Options

A while back, we were privileged to participate in a "blogger call" with Sen Ron Wyden. While I have some issues with many of Sen Wyden's proposals, I certainly appreciated his willingness to reach out to "new media" to help get his message out. As a result of that teleconference, we're treated to regular email updates from the Senator's office. One such recently hit our in-box, and it's quite intriguing. Basically, the Senator proposes to do away with the current employer exclusion for health insurance premiums, and replace it with a tax deduction for everyone who pays for health insurance (and, of course, pays taxes).

The plan would delete the exclusion employers currently enjoy, which makes health insurance more affordable for a lot of folks. And, of course, it helps businesses attract and retain employees. On the other hand, most folks who buy their own health insurance enjoy no such benefit, and must pay for that coverage with after-tax dollars, adding to the net cost. Sen Wyden would grant these individuals (as well as employees covered by insurance at work), a tax deduction for premiums paid, up to about $17,000 per family (or about $7,000 for individuals). This number is partially arbitrary; it's based on the "value" of the Federal Employees' Health Plan, plus an additional 10%. This method is very different from Sen Baucus' proposal, which simply caps the employer exclusion at that magical $17k, with no regard to individuals who buy their own coverage.

Needless to say, I have some issues with the totality of Sen Wyden's idea, but the basic premise is sound: why shouldn't individuals get the same tax benefits as employers? This seems fundamentally unfair and unsustainable. By extending those tax benefits to individuals, their net cost for health insurance decreases, making it more likely that they'll actually buy coverage. And I have no problem in principle with the idea of a cap: this may encouage folks to look for more effective coverage (e.g. HSA's) and to stop wasting money. I do have some problems with the actual numbers: while a $1400 ($17k divided by 12) a month premium certainly seems excessive, there are factors that go into the mix over which an individual (or family) have no control: where one lives, significant health problems, family size - all of these can affect one's premium. I'm not sure how to control for these, but they do need to be addressed.

The biggest problem I have with this proposal is the call for a so-called "individual mandate;" that is, requiring everyone to buy insurance. Yes, I think it's reckless to go "naked," but whatever happened to liberals' much vaunted "freedom of choice?" Aren't we supposed to be free to make (potentially stupid) decisions on our own? And, of course, that mandate implies other mechanisms: if one is required to buy insurance, it certainly follows that the market will be forced to offer it to them. And that, of course, sets up a whole 'nother set of issues.

There are those who will claim - perhaps correctly - that this will be the death knell for employer based (aka "group") insurance. To which I reply: "you say that like it's a bad thing." Employers don't make your mortgage or car payments, or pay your grocery bill. Why should the purchase of health insurance be any different? Of course, there are other advantages to group cover (e.g. guaranteed issue), but these are also what make that coverage so expensive. By extending the tax benefits to those without group options, we make the whole system less expensive, which seems to me a pretty good deal.

Sauce for the Geese

One of the little-known caveats in every piece of "health care reform" legislation exempts one small but particularly powerful group of individuals. These are folks who push for special legislation without regard to the impact it might have on others who don't have a job in that particular sector.

No, I'm not talking about the UAW, but an even more insidious collection of power brokers: our congress.

Well-known for passing onerous and expensive bills that they're unlikely to have to pay, these scions of honesty haven't mentioned that they, and theirs, won't have to actually live with the inferior health care they're attempting to foist on us.

The good news is, that may change:

Physician and US Representative John Fleming [R-LA] has introduced a bill that would require those who vote in favor of a nationalized system to "forgo their right to participate in the Federal Employees Health Benefits Program (FEHBP) and agree to enroll under that public option."

I like that: it's succinct, sensible and fair.

After all, if we're going to suffer, it seems only fitting that those whom we've elected to represent our interests suffer, too.

[Hat Tip: RedState]

Codependence

Codependence is a pattern of detrimental, behavioral interactions within a dysfunctional relationship which is regarded by some as a form of disease.

This is exactly what the administration is fostering. A codependence on government to bail them out when they bought a home knowing they did not qualify for a mortgage. They ran up the balance on their credit card then complain because the bank increased their interest rate and they want government to slap the banks around. They believe health care is a right and they should never have to pay for anything.

This codependence on government is making us weaker as individuals and as a nation and we are playing into the hands of the power brokers.

But no need to worry about anything. Obamaman is assuring us the plan is working. Prosperity for all is just around the corner.

According to Bloomberg,

President Barack Obama said his $787 billion stimulus bill “has worked as intended”

Really? How so?

Has the unemployment trend reversed? Have foreclosures ceased? Are companies making profits and individual spending freely?

Not really. But . . .

“It has already extended unemployment insurance and health insurance to those who have lost their jobs in this recession,” Obama, who is traveling today in Ghana, said in his weekly Saturday radio and Web address. “It has delivered $43 billion in tax relief to American working families and business.”

Were it not for the stimulus program, the president said, “state deficits would be nearly twice as large as they are now, resulting in tens of thousands of additional layoffs -- layoffs that would affect police officers, teachers, and firefighters.”

How is that tax cut working for you? Are you taking full advantage of that extra $40 per month?

Are those unemployment benefits allowing you to keep your home?

Are you better off now that the Spendulus bill has addressed the issue with Mormon crickets, pig farts and library renovations for dead presidents?

Biden went into greater detail than Obama, ticking off the programs funded through the $787 billion economic stimulus measure. Thousands of jobs a day have been saved and interest rates have been kept low, saving middle-class families $1,200 to $1,600 a year in mortgage payments, he said.

How many thousands of jobs have been "saved or created"?

Don'tcha just love how the folks in Washington can say anything and make it sound almost believable?

These are the same folks who want GM to sell cars that are not profitable and Chrysler to sell Fiat's. The next big items are making fuel and anything associated with fuel more expensive via the cap and trade bill and then ration health care.

How is this working for you so far?

Selling Door to Door

If Obama's health care overhaul is so grand, why does he have to SELL it to the public?

In the last month or so we have had staged town hall meetings to hear his pitch, a scripted ABC news hour long "special", weekly addresses via the web and now his minions are fanning out in a door to door campaign to promote health care reform.

Organizing for America, the advocacy group that grew out of President Obama’s campaign machinery, is enlisting supporters to go door-to-door across the country to talk up the White House’s health care priorities.

Brad Woodhouse, a spokesman for the Democratic National Committee, where Organizing for America is housed, said the canvassing would start in earnest this weekend and could last through August, making it the most sustained door-to-door effort the group has had since President Obama was inaugurated.

This makes no sense.

I have never bought anything sold door to door. I see no reason why I should start now.

Doctor Shorts

Bigger government. Tax the rich. Tax health insurance premiums. Tax liquor. Tax snack food. Tax tobacco.

All in the name of free health care for everyone.

Sounds wonderful.

At least to some.

According to the Dallas News, it appears there is a hitch in Obamaman's lofty plans.

Since 1997, U.S. medical school graduates in family medicine and general internal medicine programs have fallen by nearly 50 percent, according to the American Academy of Family Physicians.

This doesn't bode well when you want to throw 46 million new folks into the mix who suddenly have free health care and plan on using it.

Six-figure medical school debt, the desire for a better lifestyle and regular work hours persuade an increasing number of students to specialize.

"I work 65 hours a week," (family physician) Walton said. "If I worked 55 hours I wouldn't make any money."

Walton, who sees 23 patients a day, said much of his time is spent away from patients studying their medical records for better care and handling business-related matters.

And so many think docs have an easy life.

According to Merritt, Hawkins and Associates (a Texas physician placement firm) the average PCP (primary care physician) earns $171,000.

At least they will be part of the middle class who won't see their taxes increase under the Obama administration.

General practitioners tend to see a larger percentage of Medicaid patients, requiring more paperwork for reimbursements. North Texas physicians have reported that in many cases Medicaid, the government health plan for the poor, reimburses only 40 percent of what private insurers will pay.

The state Legislature in May approved a $2.5 billion increase in general revenue funds to cover Medicaid's projected cost increases and caseload growth, but no money was allocated for payment rate increases for physicians or dentists.

More work for less pay. That's the way the government likes to do things.

"I don't see where all these people are going to get their primary care," Buck said. "There aren't enough of us in the pipeline. Everyone won't have a chance to be able to look at a doctor in the face."

Free health care for everyone does not guarantee access to health care.

Shriner's Change

For years the Shriner's association has supported crippled children and never charged a dime nor billed insurance for treatment.

That is about to change.

The Shriners say they will keep a presence in all 22 cities where they provide care for children, but some of the facilities may be downgraded to outpatient surgical centers.

Shriners Hospitals for Children also will begin accepting insurance.

Even not for profit organizations cannot operate forever on donations. I wonder if other organizations, like St. Jude in Memphis will make changes as well.

Traditionally, the fraternal group has provided care free of charge and without billing insurance companies, but the new hospital CEO, Douglas Maxwell, says the nonprofit needs to change the way it does business.

The rising cost of medicine and a shrinking endowment forced the Shriners this week to look at revamping its hospital system to remain solvent.

I see this as a good thing. It is much better to scale back and increase their revenue sources rather than shuttering.

This is a change you can believe in.

Yes you can.