Healthcare Journal of new orleans
I
NOV / DEC 2017
25
level and then you have all the federal agen-
cies, they are very far from the American
people and yet they are making all sorts of
decisions concerning the people’s doctors
and the patients themselves.
Our organization is focused on building
escape hatches back into freedom. You can
see this with Medicare with the $43 trillion
underfunded liability and what the Afford-
able Care Act did. It took half a billion dol-
lars fromMedicare. It put in this innovation
center whose whole purpose is to figure out
ways to cut down access to care and there-
fore cut down costs. And then we have the
IPAB, the Independent Payment Advisory
Board, which is not yet in place, but is sup-
posed to be in place tomake decisions about
whether a treatment will ever get funding.
As soon as Medicare gets to a certain point
of financial difficulty, IPAB is supposed to
take over these decisions and completely
bypass the President and Congress. That’s
why people said that it’s all unconstitu-
tional, but that’s particularly unconstitu-
tional because it is an unelected entity all
unto itself.
With the whole purpose of reducing costs
in Medicare, the only way you can reduce
costs in a program that’s already $43 trillion
in unfunded liability with 10,000 patients
coming in every day is to ration the care.
The other thing that the Affordable Care
Act has in it are theAccountable Care Orga-
nizations, theACO’s, which have been called
HMO’s on steroids. People in Medicare are
being assigned to anACO if they are in origi-
nal Medicare. Not all of them. To date, the
last number I sawwas 9 million. You have a
choice as a senior inMedicare, of traditional
or original Medicare, which means you can
go anywhere you want. Anywhere in the
country. Any doctor. Any hospital. Or you
can go into MedicareAdvantage, which is a
health plan with a network, so your options
are limited. But the ACO is a managed care
entity, an HMO entity. And so, at least 9 mil-
lion people who have chosen original Medi-
care, where they can go anywhere, are being
assigned to the ACO. Without their knowl-
edge. And they freely admit that you might
not know.
And then the doctors that they get...a lot
of people don’t know that their doctor is in
an ACO. But those doctors are graded and
the ACO gets more or less money accord-
ing to how well they keep their Medicare
patients within the ACO.
So here are patients who think they can
go anywhere. They have paid more, prob-
ably, to be able to go anywhere. And yet their
doctor is kind of working a little bit against
them to make sure they stay within theACO
network, and the patient doesn’t even know.
These kinds of rationing strategies are hap-
pening. This is one of the reasons why we
are building the escape hatches.
One of the escape hatches could be that
people, when they turn 65, would not be
automatically enrolled in Medicare Part
A. Right now, they’re not automatically
enrolled, but if they don’t enroll they lose
their Social Security benefits. That’s not a
law. It’s not a rule. It’s something the Clin-
tons put in the procedural manual in 1993
and we are trying to strike that out of that
manual. All it would take would be President
Trump doing so, because it’s not a law, it’s
not a rule, it can just be struck.
And there’s now a lawsuit about it, but the
Supreme Court chose not to hear it. That
was unfortunate.
The whole idea is that once you’re in
Medicare, Medicare becomes your pri-
mary coverage. So even though you had
better private insurance and even though
you still have private insurance, that pri-
vate insurance can’t be your primary cov-
erage. You are limited to all of these ration-
ing restrictions withMedicare and you have
to go through that entire process before you
can move into your secondary coverage.
And for some people that might be too late.
Right? And they’re vulnerable. They could
be dying. They could be dealing with can-
cer, and they just can’t figure out they are
limited by Medicare.
So that’s one of our escape hatches: to
strike that from that procedural manual.
Another one is the Wedge of Health Free-
dom, which is our initiative to drive patients
to doctors who are in the free trade zone. We
call that free trade zone theWedge of Health
Freedom because we needed Americans to
have something to grab onto as a place to go
for affordable, confidential, patient-centered
care. These doctors have no contracts with
insurance, no contracts with the govern-
ment, but they will welcome any patient. So,