The recent political chatter about “Obamacare” before the Supreme Court of the United States got a great deal of media attention. President Obama added fuel to the fire when he declared, “Ultimately, I am confident the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress.”
For someone who was a law professor those words were absurd. Even if a bill passed unanimously in the house and senate, it could still be overturned – if the law was in violation of the Constitution.
Giving up is not “reform.” County Executive Ed Mangano’s proposal to transfer property assessment from the county to the towns might possibly speed up assessment decisions by replacing one large and overwhelmed bureaucracy with several somewhat smaller ones. It will likely recreate problems that were major motivations in creating our highly centralized county government 75 years ago.
The 1938 county charter merged the town Boards of Assessors and the County Board of Equalization, ending three decades of complaints, lawsuits and hard feelings about the lack of specific, uniform levels of property assessments between the towns. In a tax system screaming out for simplification, clarification and a sense of certainty, spinning off assessments to the towns will reintroduce “equalization” as an annual issue. Tens of thousands of residents are still trying to figure out why their assessment went down but their tax bill still went up. The division of taxes heading up the tax food chain in an equitable manner is the most complex subject in local government, and it’s all going to make people very sad, particularly in villages and school districts that are split between townships.
Manhattan District Attorney (D.A.) Robert Morgenthau was facing a spirited Democratic primary challenge from a former judge in 2005, but his opponent had trouble finding anything substantively negative to say about Morgenthau.
The reason I know this: a city-based tabloid newspaper reporter called me weeks before the election, asking whether it was legal to have a Manhattan driver’s license while at the same time registering and insuring a car in Dutchess County, where auto insurance premiums are much lower. The answer: yes, so long as the insured vehicle is primarily garaged in Dutchess County. I was the director of public affairs for the New York State Insurance Department at the time and knew immediately the question pertained to Morgenthau because he met those criteria.
Written by Michael A. Miller, email@example.com Thursday, 05 December 2013 00:00
“It used to be, if you were having a heart attack, you called your doctor and he met you at the hospital,” a respected physician told me recently. “The primary physician determined what was wrong with you and sent you to a specialist to fix it. Today, the primary’s main job is to funnel patients into the system’s network of specialists.”
Some physicians must now make a special effort even to look patients in the face, because they spend so much of the time-limited appointments clicking boxes on a computer screen.
“One doctor I know is employing someone to sit in the corner to take notes for him, so that long-time patients can see that he’s looking and listening and not being rude,” another physician, a specialist, told me. “That’s not going to cut costs.”
When I was a little boy, my father had an operation, and the family physician, whose office was in his home a few blocks away, came by to check on him. I remember house calls. I’m old.
Many Long Island doctors are selling their practices to the mega-hospital groups, and sole practitioners are disappearing, often because of the cost and hassle of dealing with insurance companies and upgrading technology. For a lot of them, life on the assembly line has been a bitter experience. For most, it certainly hasn’t streamlined administration or improved the delivery of actual care to patients. Paperwork and redundancies have skyrocketed.
Are you a new patient, or have you not been here in a while? Please come 15 minutes early for paperwork. If you’ve had to fill out the same patient history questionnaire twice in the same day, in the same building, you know how frustrating it all is. Each time patients fill out the same paperwork, the chance of errors increases substantially. At one of Long Island’s hospital networks, patient data still can’t be shared digitally between offices. Doctors are walking around clicking and tapping at expensive tablet computers, but to send the information to the doctor on the third floor, they print it out and use the fax machine.
Insurance companies demand the paperwork because their systems are designed to weed out procedures.
While the federal health care reforms didn’t cause all this, it won’t fix much and it will probably make a lot of it worse for patients and conscientious health care professionals.
Consider these EMRs. The Affordable Care Act (“Obamacare”) provides incentives to hospitals, labs, clinic and doctors to set up Emergency Medical Record systems, which can share digital medical histories. A boom industry has emerged in setting up the hardware, software, staff training and ongoing administration of EMR systems, which can cost between $15,000 and $70,000 per doctor and hundreds of millions for a hospital system.
Doctors tap away at their screens. Billions of dollars have already been paid to providers demonstrating “meaningful use” of DMR. The gag is that the incentives are based on receiving digital files, but not opening and understanding them. One of my doctor buddies says this: “EMR is a farce.”
Some parts of the private sector are making a mint off health care reform, a lot of it under the radar screen. This is what happens when every point along the line of health care delivery must be monetized and profitable, and when foxes design the chicken coop.
Much of the hysteria over Obamacare has been exaggerated or presented out of context. Some real problems have been lost in the noise. Obamacare is seriously flawed because it is not significant reform. It’s an adjustment, based around maintaining an insurance system that America outgrew
when I was a boy, when doctors carried big bags and rang the doorbell.