Saturday, October 24, 2009


Movie premiere? Nope, just people in Los Angeles who are without health insurance lining up for a medical clinic.

I couldn't help noticing that it's taking a while for a coherent health care reform bill to make it to a vote in Congress. Possibly the problem is the sheer complexity of the thing. Perhaps it would be better for the national legislature to focus on and highlight the essentials of a health care bill, pass it, then let Federal cabinets and agencies fill the spaces in between with any regulations which become necessary. Here is my proposal for a relatively simple and effective piece of legislation to reform the current system of providing coverage:

1. Create a publicly financed National Health insurance to cover all annual expenses for catastrophic illnesses (anything totaling more than $3,600 per family per year, which comes to $300 a month).

2. Use a single payer plan for all other medical expenses, including prescribed medicine, with everything up to $3,600 paid for with a "health care" type credit card.

3. The consumer can repay the monthly credit card bill out of his own pocket, with a private insurance plan, or over time like any other credit card- but with a 5% cap on annual interest.

4. Prohibit all health insurance companies from discriminating on any basis- if they insure one, they must insure all, regardless of pre-existing conditions or prior claims. (Lifetime caps will no longer be an issue because #1 will take care of catastrophic expenses; likewise, #1 will reduce exposure of companies who have to take people with pre-existing conditions). Prohibit any denials of coverage based on type of treatment, proven effectiveness of the treatment, or who the provider is. Require prompt payment of all claims (within 30 days) with severe penalties for delays.

5. Fund the government portion of the program with a relatively low (no more than 1 or 2 percent) national sales tax on all goods and services- so every one who consumes anything will be paying for his or her catastrophic insurance.

This proposal will eliminate all unnecessary administrative costs.

This proposal will eliminate the need for a "public option" or cooperatives or triggers.

This proposal will save medical providers and employers billions in administrative overhead costs, in collections, and in indigent write-offs.

This proposal will reduce stress on employees and their families who have already lost or are afraid of losing their medical coverage. It would also free up Americans to take any jobs they want without fear of losing coverage.

This proposal will put American companies on an equal competitive footing with foreign companies which do not have health care as a portion of their overhead.

And to recap my suggestions for cutting costs while improving services:

1. Eliminate all medical malpractice insurance premiums for doctors, hospitals, drug companies, and all other medical related fields. Substitute a no-fault system based on State Worker's Compensation programs. Fund it with a sales tax of no more than 2% on all medical services and products. Use a panel to pay out awards, with one representative from consumers, one from the medical profession, and a professional administrative judge, to determine whether the injury or illness was caused (without regard to negligence, hence the "no-fault" label) by a medical procedure or product, and, if so, what the extent of the harm was. Awards will be paid out in the same manner as in most Worker's Comp cases, without the need for defense or plaintiff's attorneys or jury trials, and with set amounts paid for set degrees of injury.

2. Identify bad doctors and hospitals by publicly posting on the internet all awards from the no-fault system, with all patient identifiers removed to protect confidentiality, listing only the type of injury or illness (i.e. staph infection), the amount recovered, and the year of the incident.

3. Require all physicians, hospitals, and other medical providers to post all costs, services, and fees on a prominent place at their front entrance, and also on the internet. If the foregoing proposal for paying for medical care is instituted, which will make patients responsible for the first $3,600 spent annually on their medical care, they will do enough price shopping and comparisons to cause providers to compete- and lower costs.

4. Require all physicians, technicians, nurses, and patients to certify each test administered and each procedure performed on each patient. This proposal is intended to reduce the fraud occurring in the current system.

Monday, October 19, 2009


"I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant.... I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them."

From the Greek Hippocratic Oath, circa 4th century B.C.E.

On October 13th I had the pleasure of attending the Albany premiere of the documentary movie, Do No Harm, the story of Dr. John Bagnato and Charles Rehberg and their excellent adventures in health care reform. For those who are new to Albany or who have been living in a cave the last six years, those gentlemen were the (then) anonymous authors of the famous Phoebe Factoids faxes back in 2003 The documentary recounted, much of it in the words of Bagnato and Rehberg, how they initially discovered that Phoebe Putney Memorial Hospital's tax returns and other financial filings could be found at an internet website, . During their investigation they found that Phoebe's finances were nothing short of astonishing, as it had managed to amass over two hundred million dollars in cash in offshore banks in the Cayman Islands. In a series of anonymous faxes they sent information embarrassing to Phoebe's bigwigs to numerous local notables, including Congressman Sanford Bishop, and to fax machines in Phoebe itself. [I've never understood why they felt the need to be anonymous, but that's the least of this story.]

For their trouble they were targeted by then District Attorney Ken Hodges, a descendent of the hospital's founders and the recipient of thousands of dollars in campaign donations by top executives at the hospital. Hodges used bogus grand jury subpoenas (there was no grand jury meeting) served on BellSouth to discover who sent the faxes- then he accepted thousands of dollars from Phoebe and turned the faxes over to Phoebe's lawyers. Later the intrepid duo were arrested and booked on false charges (readers should watch the documentary, available on DVD, to get the full story on the prosecution) and each retained renowned criminal defense attorneys featured in the documentary- Bobby Lee Cook of Summerville, Georgia and J. Converse Bright of Valdosta.

At one time Dr. Bagnato was the chief of surgery at Phoebe and Rehberg, a certified public accountant, was the manager of Bagnato's medical practice. Why these two gentlemen, both family men with solid roots in the community, decided to take on the local medical behemoth, is explained succinctly by Rehberg and Bagnato in the film- they refused to stand by and do nothing while those who were supposed to be served by the local (formerly) public hospital were ripped off and shut out at every turn. Georgia Watch's Hospital Accountability Project, which also sponsored the movie premiere, reported that Phoebe was overcharging its patients by hundreds of millions and marking up prices over 200 percent. In 2007 Phoebe charged patients over $700 million ($752,273,508) while their actual costs of services totaled less than half that amount- $357,452,957.

Rehberg and Bagnato discovered that Phoebe's actions were the opposite of its slogan, "The Hospital with a Heart," as it repeatedly sued patients whose illnesses cost them their jobs and their assets they needed to pay for medical care. They also uncovered some unseemly practices, such as business expenses for liquor and cigars from one London trip by its top executives and hundreds of thousands of dollars for corporate jet rentals (Johnny Cochran's jet!) to fly top honchos to the Cayman Islands, presumably to visit the $200 million they had stashed in Cayman banks to make sure their money didn't get lonely. Not to mention hundreds of thousands to hire ex-FBI agents out of Phoenix to harass and intimidate Rehberg, Bagnato, and their wives and children.

As for the absurd criminal prosecutions, after some long and agonizing legal proceedings, in July of 2007 visiting Superior Court Judge Harry Jay Altman dismissed all of the criminal charges prior to trial. Here's an excerpt from an Albany Journal column I wrote in December of 2005:

* The Special Prosecutor, Houston Judicial Circuit District Attorney Kelley R. Burke, responded to Maverick Attorney Ralph Scoccimaro s passionate defense of his client with some inflammatory speech of his own- comparing the Phoebe Factoids to:

"... go[ing] onto someone else s property and burning a cross under the guise of free speech which is tantamount to what these defendants are claiming."

Well, no. Burning a cross on someone s lawn isn t remotely comparable to faxing a document to a Congressman which reveals the sleazy machinations of a public hospital that has managed to stash away over $200 million in cash, much of it from government funded Medicaid and Medicare payments.

* Finally, District Attorney Ken Hodges has some splaining to do, as Ricky used to say to Lucy. Why did he use a 2003 grand jury to subpoena BellSouth's phone records to unearth Bagnato and Rehberg as the source of the faxes? Why did he turn Bagnato and Rehberg s phone records over to Phoebe s lawyer, but not present a criminal case to that grand jury or any of the half dozen grand juries that met after that? Why did he wait over a year and a half to request a special prosecutor? Was his decision to request a special prosecutor affected by the avalanche of bad publicity from the May 9, 2005, Atlanta Journal-Constitution front page expose of his giving grand jury documents to campaign contributors at Phoebe?

After the October 2009 movie premier the director, Rebecca Shanberg, and Dr. Bagnato appeared at a panel discussion. Although this case may now seem almost like ancient history, it is still topical, as Rehberg has a federal lawsuit pending against Ken Hodges, and Hodges, who left Phoebe, excuse me, the DA's office to join the Baudino Law Group (which collects millions annually in legal fees from.... wait for it..... Phoebe Putney!) is running for Attorney General of Georgia.

Thursday, October 08, 2009

Taking the Highway

The current state of affairs in American health care

Imagine for a moment that once a month you needed to drive 100 miles to the City to take your 3 year old daughter to see a medical specialist. There's an excellent interstate connecting your town to the City. It's six lanes wide, limited access, with smooth pavement. Government funds built it with your road taxes. But you're not allowed to use it. Instead, every time you make the trip, you have to take an old dirt road, filled with ruts, sometimes impassable after it rains so that you can't get there at all. Why can't you use it? Because the government decrees that once you are 65 years old, you can use the interstate; until then, you have to find your own way. You can't even pay a toll to use the road you desperately need to take.

Crazy, huh? Well, no crazier than our current debate over providing affordable health care to those under 65. Once Americans reach that magic number, they can ride the smooth road of Medicare, paid for by payroll taxes on wage earners, most of whom are under 65. But until they reach that age, they've got to find their own way- or perhaps not be able to make the trip at all if they are too poor to pay a doctor or to afford decent insurance.

The obvious solution is to allow everyone under 65 to buy into Medicare- to pay a toll to use the service. Congress: are you listening?