Doctor Offers Health Care Outside Insurance System

Dr. John Muney should be applauded for his courageous stand against Big Insurance in his effort to offer a creative and affordable way for people to have basic medical care.

It is also good to know that someone is willing to take a stand against the "established norms of the U.S. health system".

People do need to recognize that insurers have a stranglehold on medical care and is the major reason for high cost and controlled access to care.

I'm just hoping to see more follow Dr. Muney's lead.

Obviously the "experts" being relied on to come up with reform in the new administration haven't moved off of a square called 'no-sum-change' since leaving the White House discussion weeks ago.

Maybe we shouldn't be relying on these "experts".

"The more things change, the more they stay the same."

NB: I recently chose to refrain from using the term 'health care' because what we really have is 'medical care'. It is a system of illness and disease management for the most part today.

Health Care inherently includes freedom of access to care of choice, regardless the provider. It is focused on healing and cure. Any person seeking care is the person in charge, after all, they are paying in one way or another.

N.Y. doctor offers flat-rate care for uninsuredBy Claudia Parsons

NEW YORK (Reuters) – A New York doctor is offering flat-rate health care for the uninsured for $79 a month, but he has run afoul of state insurance regulations in a case that challenges the established norms of the U.S. health system.

U.S. President Barack Obama has pledged a major overhaul of the $2.5 trillion U.S. healthcare industry, which operates on a system of private health insurance and state-funded Medicare and Medicaid programs for the elderly and poor.

The United States spends more on healthcare than any other country, but at least 46 million people have no insurance.

Dr. John Muney, president of AMG Medical Group, said he started the program in September after noticing that many of his patients were losing their jobs, and therefore, their health insurance coverage.

About 500 people have registered for Muney's $79-a-month plan, accounting for 15 percent of patients at the practice, which has offices in each of New York's five boroughs.

The monthly $79 fee -- roughly equivalent to the price of a Starbucks coffee a day -- covers unlimited preventive visits and onsite medical services such as minor surgery, physical therapy, lab work and gynecological care.

Ilana Clay, a 28-year-old who works in marketing for a jewelry firm, said she signed up in March because she could not afford her employer's health insurance, which would have cost around $300 a month.

"I hadn't been to a doctor in a couple of years at that point," she told Reuters. She had a scar removed in a quick onsite procedure that was covered by the plan.

Muney said another patient came in with a tumor on her finger: "Somebody else asked $3,000 to remove it. The first visit, we were able to remove it, 15 minutes it took us."

BILL TO CHANGE STATE LAW

So far the program has not turned a profit, but Muney said he estimates that it could be profitable with 4,000 patients. In the meantime, he said, his motive is to give something back and provide a model of how healthcare can be more efficient.

"Our healthcare system lends itself to abuse, fraud and waste," he said, adding that bypassing insurers saved on administrative costs, which he said were about 25 percent of the price of care. "With this model, we're bypassing all that."

Muney said he received initial complaints from state insurance authorities in November. "The law says you can do preventive checkups unlimited, but if they come for sick visits you have to charge your overhead costs," he told Reuters.

In February he received a letter instructing him that he must charge that minimum cost, which he calculates at $33 a visit -- a price he says will deter people from signing up.

Troy Oechsner, deputy superintendent of the state insurance department, said the rules were designed to protect consumers.

"Our concern is ... making sure that consumers can rely on any promises made to them and that they will get the services they paid for when they need them," he said.

New York State Assemblyman Adam Clayton Powell said on Thursday he would present a bill to exempt primary health care providers from the insurance regulations in question.

"This is something he's doing to give back, as a service to the community in tough times," Powell said of Muney. "I think any common person would say this is a good thing, however, we know the health insurance companies are going to fight it."

Copyright © 2009 Reuters Limited. All rights reserved

Scattershot method for determining best medicine

This article points to a 50% effectiveness for comparison shopping. Other studies have established that 80% of what is standard in health care doesn't work, and many providers just do not know why.

If this is where things are today, then it is going to be as slow as molasses in January to get a fire under change in health care.

I raised questions about ability to diagnose what ails you. I've also questions drug issues. It just seem as if no one really knows what is going on. And to top it off, doctor groups don't want people to be allowed to comment about them on line.

Is there a problem with free speech in medicine these days as well?

All I know is that for me this does not bode well, and I suppose I'd better get started on that book everyone wants me to write. The one with patient stories, the ones I hear every day from very frustrated people who are only trying to maneuver their way through the current system. They are just seeking preventive tools or better care from a provider who will at least talk with them - face to face.

HEALTHBEAT: What's the best medicine -- really?
By LAURAN NEERGAARD, AP Medical, Mar 9, 2009

WASHINGTON – Think your doctor knows which drug — or surgery or even diagnostic test — works best? Think again. Half the time, there's little if any good evidence comparing one to another. And one of medicine's little secrets is that brand-new drugs don't have to work any better than cheap old ones to be approved for sale.

Now the government has a $1.1 billion down payment to start unraveling that problem, money provided in the economic stimulus package to better determine which test or treatment works best, when and for whom so that patients don't waste time and money on poor choices.

But which ailments go to the top of a very long wish list? And perhaps most important, how to make sure the results get into doctors' and patients' hands but not overly limit what therapies people can choose?

"There's a lot of clamor ... that this is going to deprive people of the choice to basically have every treatment they want. That's based on a false premise," Dr. Harold Sox, past president of the American College of Physicians, told The Associated Press. Last week, Sox was chosen to lead a panel of the prestigious Institute of Medicine to help guide what comparisons the government makes.

"If people had a good explanation of why a test that they wanted was more likely to hurt them than to help them, they might of their free choice say, 'You know, I was clearly wrong. I shouldn't want that test and now I don't."

At issue is what's called "comparative effectiveness." Should you have open-heart bypass surgery or far less invasive stents to open severely clogged heart arteries? Which of two hot treatments best prevents stroke from a clogged neck artery, surgically rooting out the clog or pushing it aside with a stent?

Does arthroscopic surgery work any better than painkillers for knee arthritis? Of all the competing pills, which is best to start with in treating Type 2 diabetes or high blood pressure? Is there really any difference between Prevacid and Prilosec for heartburn, or between Fosamax and hormone treatments for bone-weakening osteoporosis?

Those winners-and-losers questions drive fierce opposition to comparison effectiveness research from drug makers and others who have a financial stake in the outcome and fear that insurers will use the results to make coverage decisions. Back surgeons once lobbied to kill the federal Agency for Healthcare Research and Quality after it found "insufficient evidence" supporting certain spine operations — not that they didn't work, just that more evidence was needed.

The result: The nation has a scattershot method for determining best medicine. The little-known AHRQ spends about $30 million a year reviewing evidence of select tests and treatments. The National Institutes of Health occasionally compares contested therapies in expensive, years-long studies involving thousands of patients, like the stroke trial now under way.

So an extra $1.1 billion for the government to start spending on such comparisons this year marks a huge jump. By June's end, the Institute of Medicine panel will provide a priority list of up to 50 vexing medical questions to help the feds determine where to start.

Don't expect easy answers. Federal scientists are acutely aware that many of today's studies don't account for wide variations in responses to treatments by minorities or other subgroups.

"We have not yet seen a report or an assessment that says, 'Option A thumbs up, Option B forget it,'" says AHRQ Director Dr. Carolyn Clancy. The goal is "to figure out what's the right choice for me."

"Medical decision-making is rarely black-and-white," adds the NIH's heart chief Dr. Elizabeth Nabel. "We see certainly helping to provide additional evidence that really guides physicians and individuals in sorting through the shades of gray."

The bypass-versus-stent question for severe heart disease is a good example. Last week's New England Journal of Medicine published a comparison suggesting bypass recipients fare slightly better. But Nabel notes that in fact the study found tradeoffs that mean people may legitimately choose the easier recovery of a stent.

A bigger question is how to ensure that patients get the opportunity to consider such findings. AHRQ has begun translating its jargon-filled comparisons into easy-to-understand consumer brochures.

But the most-used comparative effectiveness research may come from a unique program in Oregon called the "Drug Effectiveness Review Project" that evaluates the evidence behind competing drugs.

One example: Two years before the painkiller Vioxx was pulled off the market because of heart side effects, the project declared it riskier than its equally effective cousins, says project director Mark Gibson at Oregon Health and Science University.

The reports don't weigh drug costs but they are used primarily by the Medicaid directors of 14 states in coverage decisions. A wider audience sees them thanks to the influential Consumers Union, which does add price to evaluations done by both the Oregon project and AHRQ to create its free Web-based "Best Buy Drugs" guides.
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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On the Net:
AHRQ: http://effectivehealthcare.ahrq.gov
Oregon project: http://www.ohsu.edu/drugeffectiveness/

Copyright © 2009 The Associated Press.