Background Image
Previous Page  25 / 68 Next Page
Information
Show Menu
Previous Page 25 / 68 Next Page
Page Background

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,