The Homa Files

WSJ: Health Co-Ops Aren’t the Answer, Sept. 28, 2009

Private health insurers perform many complex and hard-to-replicate functions.

They issue policies and accept financial risks associated with the costs of providing care.

They perform actuarial analyses to track costs and price policies.

They design different benefit structures to meet varying needs.

They select, contract with, and monitor the quality of thousands of hospitals and doctors and other professionals who provide the services covered by their policies.

They assess evidence for which technologies and treatments provide value, and provide information to assist millions of individuals and employers with a range of health-care and health coverage issues

Most plans, especially the best ones, assist with coordination of care and management of chronic conditions, and help consumers save money and time by guiding them to better health decisions.

Typically, all of this is facilitated by highly sophisticated and expensive information systems, and many trained nurses and physicians.

“It took decades and billions of investment dollars, with some of the most sophisticated business minds, to build today’s major health insurance companies”.

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If we want greater competition for today’s health plans to drive down costs,  revise the ground rules and create a competitive landscape across the nation for existing companies.

Start by allowing health plans to compete across state lines. Because of restricted competition, in a large number of states only one or two plans dominate the market.

Reduce the number of mandated benefits states impose on plans. They drive costs 20%-30% higher than they might be.

Encourage health plans to negotiate more aggressively than they do now with hospital monopolies that exist in many local areas.

Promote benefit designs that offer more affordable coverage, such as policies with higher deductibles and health savings accounts that foster greater consumer engagement and healthy behaviors.

A “public option” by any other name—including health-care co-op—just won’t fly. The real competitive force will come from putting more dollars into individuals’ hands and fewer into insurers’ hands, and by fostering true competition among existing insurers.

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Full article:
http://online.wsj.com/article/SB10001424052970204488304574429481529233414.html?mod=djemEditorialPage

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Ken’s Take: The IRS says it will fine or jail you for not paying Obama’s mandate levy.

So, we let thugs free because of jail overcrowding and budget constraints but incarcerate folks who refuse to buy health insurance? 

You just can’t make this stuff up …

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WSJ:  Rhetorical Tax Evasion, Sept. 29, 2009 

The Baucus bill includes the so-called individual mandate, along with what he calls a $1,900 “excise tax” if you don’t buy health insurance.

It had been as much as $3,800 but Dems reduced the amount last week to minimize the political sticker shock.

And, lo, it turns out that if you don’t pay that tax, the IRS could punish you with a $25,000 fine or up to a year in jail, or both.

Under questioning last week, Tom Barthold, the chief of staff of the Joint Committee on Taxation, admitted that the individual mandate would become a part of the Internal Revenue Code and that failing to comply would be a “criminal” act. The willful failure to file would be a simple misdemeanor, punishable by the $25,000 fine or jail time under Section 7203 — statute covering tax evasion.

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In the 1994 health-care debate, the CBO called the individual mandate “an unprecedented form of federal action.”

“The government has never before required people to buy any good or service as a condition of lawful residence in the United States.”

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Full article:
http://online.wsj.com/article/SB10001424052748704471504574439243760133458.html?mod=djemEditorialPage

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Ken’s Take: By the law of averages, most HomaFiles readers are younger than Homa.  So, if these guys are right, maybe the proposed health care “reforms” make sense.

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Excerpted from WSJ: ‘Reform’ Is Income Redistribution, Sept.  27, 2009

Congress is contemplating changes … that would create a massively unfair form of income redistribution and create incentives for many not to buy health insurance at all.

Let’s start with basics: Insurance protects against the risk of something bad happening.

When your house is on fire you no longer need protection against risk. You need a fireman and cash to rebuild your home. But suppose the government requires insurers to sell you fire “insurance” while your house is on fire and says you can pay the same premium as people whose houses are not on fire. The result would be that few homeowners would buy insurance until their houses were on fire.

The same could happen under health insurance reform.

Here’s how: President Obama proposes to require insurers to sell policies to everyone no matter what their health status. By itself this requirement, called “guaranteed issue,” would just mean that insurers would charge predictably sick people the extremely high insurance premiums that reflect their future expected costs. But if Congress adds another requirement, called “community rating,” insurers’ ability to charge higher premiums for higher risks will be sharply limited.

Thus a healthy 25-year-old and a 55-year-old with cancer would pay nearly the same premium for a health policy.  But the 25-year-old … would pay significantly more than needed to cover his expected costs.

Like the homeowner who waits until his house is on fire to buy insurance, younger, poorer, healthier workers will rationally choose to avoid paying high premiums now to subsidize insurance for someone else. After all, they can always get a policy if they get sick.

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To avoid this outcome, most congressional Democrats and some Republicans would combine guaranteed issue and community rating with the requirement that all workers buy health insurance—that is, an “individual mandate.”

But the combination of a guaranteed issue, community rating and an individual mandate means that younger, healthier, lower-income earners would be forced to subsidize older, sicker, higher-income earners.

And because these subsidies are buried within health-insurance premiums, the massive income redistribution is hidden from public view and not debated.

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There are wiser and more equitable ways to ensure that every American has access to affordable health insurance, including high risk pools and taxpayer-funded vouchers subsidized for those who are both poor and sick.

Medicaid, charity care, and uncompensated care provided by hospitals cover some of these costs today. These solutions are imperfect, but so are the reforms being proposed in Congress.

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Full article:
http://online.wsj.com/article/SB10001424052970204488304574434933462691154.html

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Ken’s Take: Apparently, when it comes to healthcare reform,  squeezing corporate profits is more important than saving money …

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From WSJ, A preview of coming political health-care attractions, Sept 22, 2009

The Baucus Bill slashes $123 billion over the next decade from Dems-hated Medicare Advantage program – meaning that many (all?) seniors may lose this coverage.

Why do the Dems hate it?

Because profiteering insurers are “overpaid.”

Seniors like it is because private insurers focus on quality and preventive care and try to manage benefits, as opposed to simply paying bills.

In fact, one-fourth of beneficiaries have chosen it over traditional fee-for-service Medicare.

A new study finds that seniors on Advantage … spent 30% fewer days in hospitals over fee-for-service patients.

http://online.wsj.com/article/SB10001424052970204488304574427200839672342.html#mod=article-outset-box

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From Hugh Hewitt of the Washington Examiner …

Here are five questions every sponsor of any version of Obamacare ought to be obliged to answer — in detail:

1. Can you specify, at least to the level of tens of millions, exactly where will the $300 billion in cuts to Medicare proposed by president come from?

2. The president and his allies agree that the cost of Medicare Advantage programs will have to increase for seniors. By how much will Medicare Advantage premiums increase?

3. The president and his allies agree that some Medicare services will have to be cut. Which Medicare services will have to be cut?

4. Forty-five percent of doctors responding to a recent Investors Business Daily/TIPP poll responded that if Obamacare passed, they would consider quitting or retiring. Even if the number of disgruntled doctors is overstated — by a factor of 2 or or 5 —  wouldn’t the number of doctors who do retire early or quit out of disgust  make the delivery of health care much more difficult than it already is?

5. If the U.S. health system is so bad, how do you explain why the five-year survival rate of women with breast cancer in the United States is higher than that of women in Great Britain and the five-year survival rate for American men with any form of cancer is much higher than the same survival rate among all European men.

Hmmm.

Washington Examiner, “Obamacare is to Medicare what ACORN is to Children’s Protective Services”, September 21, 2009
http://www.washingtonexaminer.com/opinion/columns/Obamacare-is-to-Medicare-what-ACORN-is-to-Children_s-Protective-Services-8268673-59983347.html

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Ken’s Take: I’ve been asking how the folks who choose voluntarily to self-insure and buy big screens instead of health insurance will be caught in the act.  Here’s the answer .  More “take” below”.

Heritage Foundation, The Policy Is The Problem. September 21, 2009

Individual Mandates:

Starting in 2013, almost everyone who does not have coverage would be required to purchase health insurance at a minimum level to be specified in the bill.

Any individual who fails to buy health insurance will be forced to pay a tax by the Internal Revenue Service. Depending on your income and family status the new tax would be as low as $750 per person and as high as $3,800 per family.

In order to enforce these provisions, the Baucus bill would require individuals, health insurers, employers, and government health agencies to report detailed health insurance information on all Americans to the IRS, adding significant administrative costs and reducing privacy protections.

Full article:
http://blog.heritage.org/2009/09/21/morning-bell-the-policy-is-the-problem/

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More Ken’s Take: So, companies submit confirmations that a person (i.e. social security number) is insured.  The confirmations are matched against the IRS files (social security numbers with income) and exceptions are reported out to the health reform fine collectors who go knocking on doors to collect fines and / or repo the big screens.

Might work … yeah, right.

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Excerpted from NY Post, ObamaCare: Losing everyone, Sept 21, 2009

The latest data from Scott Rasmussen’s poll of those who lack health insurance indicates that they’re starting to turn skeptical about the Obama plan. It’s supposed to help them, yet they back ObamaCare by only 58 percent to 35 percent — and only 30 percent support it strongly.

More to the point, only 35 percent feel it will improve the quality of their health care — and, by 41-26, they feel the cost of their care will go up, not down, under the plan.

Having the uninsured — the stated object of Obama’s compassion — turn against his reform would be the most lethal cut of all.

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Requiring everyone to buy insurance will impose a massive tax on all who now are uninsured. The Congressional Budget Office projects that it would force the middle-income uninsured to pay on average more than 15 percent of their income.

CBO estimates that … an individual earning $32,400 a year would have to pay $4,100 in premiums before getting any subsidy.

With deductibles and co-payments, he’d have to shell out $5,600 a year, or 17.3 percent of his income.

A family of four, making $80,000 a year, would have to pay about $10,500 in premiums alone — with deductibles and co-payments, up to $15,000 or just under 20 percent of income.

And if they don’t buy insurance, they’ll face federal fines that begin to approach these same premium levels. They won’t be able to buy what they truly need — catastrophic-only coverage at a lower premium — that won’t satisfy ObamaCare’s “minimum insurance” mandate.

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Full article:
http://www.nypost.com/p/news/opinion/opedcolumnists/obamacare_losing_everyone_GMoSJylS0ZJLsQAtWEVKyN

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Ken’s Take: I’ve asked before (1) How will mandate evaders get caught?  and (2) What will the Feds do if the evaders have already spent their incomes and are deep in hock? How will the fines be collected? By repo’ing uber-sized big screen TVs?

These guys ask if such mandates are even constitutional.

Talk about shoddy staff work …

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Excerpted from WSJ: Mandatory Insurance Is Unconstitutional, Sept. 18, 2009

Under Sen. Max Baucus’s most recent plan, people who do not maintain health insurance for themselves and their families would be forced to pay an “excise tax” —roughly comparable to the cost of insurance coverage under the new plan.

Beginning in 2013, individuals would be required to have health insurance. Individuals and families who do not have insurance for more than three months in a given year would be subject to an annual excise tax of $750 and $1,500, respectively, if their income is below 300% of the federal poverty line (or $66,150 for a family of four). Tax penalties for individuals and families with incomes above that would be $950 and $3,800. The excise tax would be waived for Native Americans and individuals and families whose health-insurance costs would be more than 10% of their annual income.

The majority of those impacted are young people who forgo insurance precisely because they do not expect to need much medical care. When they do, these uninsured pay full freight, often at premium rates, thereby actually subsidizing insured Americans.

Without the mandate, the entire thrust of the new regulatory scheme—requiring insurance companies to cover pre-existing conditions and to accept standardized premiums—would produce dysfunctional consequences. It would make little sense for anyone, young or old, to buy insurance before he actually got sick.

The mandate’s real justifications are even more cynical and political. Making healthy young adults pay billions of dollars in premiums into the national health-care market is the only way to fund universal coverage without raising substantial new taxes.

In effect, this mandate would be one more giant, cross-generational subsidy—imposed on generations who are already stuck with the bill for the federal government’s prior spending sprees.

But a “tax” that falls exclusively on anyone who is uninsured is a penalty beyond Congress’s authority. If the rule were otherwise, Congress could evade all constitutional limits by “taxing” anyone who doesn’t follow an order of any kind—whether to obtain health-care insurance, or to join a health club, or exercise regularly, or even eat your vegetables.

Full article:
http://online.wsj.com/article/SB10001424052970204518504574416623109362480.html?mod=djemEditorialPage

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Ken’s Take: I don’t have a stake in this issue, but it’s fun to watch it reveal itself.  Gotta admit that Obama-logic makes me dizzy sometimes.  Maybe he’s just way smarter than I am … oe maybe he’s just making this stuff up as he goes.

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Excerpted from WSJ, Obama’s Nontax Tax, Sept. 21, 2009

On his round of five Sunday talk shows President Obama revealed a great deal about his philosophy of government and how he defines a tax increase.

Under Max Baucus’s Senate bill that Mr. Obama supports, everyone would be required to buy health insurance or else pay a penalty as high as $3,800 a year. George Stephanopoulos posed the obvious question about this kind of coercion when “the government is forcing people to spend money, fining you if you don’t [buy insurance]. . . . How is that not a tax?”

“Well, hold on a second, George,” Mr. Obama replied. “Here’s what’s happening. You and I are both paying $900, on average—our families—in higher premiums because of uncompensated care. Now what I’ve said is that if you can’t afford health insurance, you certainly shouldn’t be punished for that. That’s just piling on. If, on the other hand, we’re giving tax credits, we’ve set up an exchange, you are now part of a big pool, we’ve driven down the costs, we’ve done everything we can and you actually can afford health insurance, but you’ve just decided, you know what, I want to take my chances.  And then you get hit by a bus and you and I have to pay for the emergency room care, that’s . . .”

“That may be,” Mr. Stephanopoulos responded, “but it’s still a tax increase.”

Mr. Obama: “No, but—but, George, you—you can’t just make up that language and decide that that’s called a tax increase.”

“I don’t think I’m making it up,” Mr. Stephanopoulos said. He then had the temerity to challenge the Philologist in Chief, with an assist from Merriam-Webster. He cited that dictionary’s definition of “tax”—”a charge, usually of money, imposed by authority on persons or property for public purposes.”

Mr. Obama: “George, the fact that you looked up Merriam’s Dictionary, the definition of tax increase, indicates to me that you’re stretching a little bit right now.”

The CBO estimates that the Senate’s individual mandate will result in new revenues of some $20 billion over 10 years because some people will choose to opt out of ObamaCare. If that $20 billion doesn’t count as tax revenue, then what is it?

Under Mr. Obama’s definition, all taxes can be justified in the name of providing some type of service, however wasteful. It turns out the President thinks a health-care tax is not a tax if he thinks the tax is for your own good. His problem is that the individual mandate really is a tax, but the President doesn’t want voters to think of it that way, because taxes are unpopular

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[Fact: uncompensated care accounts for about only 2.2% of national health spending today.]

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Full article:
http://online.wsj.com/article/SB10001424052970204488304574425294029138738.html?mod=djemEditorialPage

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Ken’s Take: If you think it’s hard to get in to see a doctor now, just wait …

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IBD, 45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul, September 15, 2009

Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found.

The poll contradicts the White House claims that the medical profession is behind the proposed overhaul.

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Major findings included:

• Two-thirds, or 65%, of doctors say they oppose the proposed government expansion plan. This contradicts the administration’s claims that doctors are part of an “unprecedented coalition” supporting a medical overhaul.

• 45%, said they “would consider leaving their practice or taking an early retirement” if Congress passes the plan the Democratic majority and White House have in mind.

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More than 800,000 doctors were practicing in 2006, the government says. Projecting the poll’s finding onto that population, 360,000 doctors would consider quitting. The number of doctors is already lagging population growth. From 2003 to 2006, the number of active physicians in the U.S. grew by just 0.8% a year, adding a total of 25,700 doctors.

The U.S. today has just 2.4 physicians per 1,000 population — below the median of 3.1 for members of the Organization for Economic Cooperation and Development, the official club of wealthy nations.

A recent study from the Association of American Medical Colleges found steadily declining enrollment in medical schools since 1980. The study found that, just with current patient demand, the U.S. will have 159,000 fewer doctors than it needs by 2025.

Full article:
http://www.ibdeditorials.com/IBDArticles.aspx?id=337909690110379

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According to Rasmussen …

One week after President Obama’s speech to Congress, opposition to his health care reform plan has reached a new high of 55%.

The latest Rasmussen Reports daily tracking poll shows that just 42% now support the plan, matching the low first reached in August.

A week ago, 44% supported the proposal and 53% were opposed.

Following the President’s speech —  intended to relaunch the health care initiative —  support for the president’s effort bounced as high as 51% .

But the new numbers suggest that the bounce was short-lived.

http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/september_2009/health_care_reform

Ken’s Take: Simple arithmetic – if you can’t lay off 2/3s of your insurance bill to an employer (or anybody else), it appears that you’re paying 3 times as much — even though the underlying cost of the insurance didn’t change. 

Are these guys grossly disingenuous or just plain dumb re: basic economics?

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Excerpted from WSJ, Obama and the cost of individual insurance, SEPTEMBER 16, 2009

President Obama likes to take a swipe at “the marketplace” by asserting that “buying insurance on your own costs you three times as much as the coverage you get from your employer.”

This is simply false. The CBO expects premiums for employer-sponsored coverage to cost about $5,000 for singles and $13,000 for families this year on average.

According to the CBO: “Premiums for policies purchased in the individual market are much lower — about one-third lower for single coverage and half that level for family policies.”

One reason that individual policies are cheaper is that they generally require more cost-sharing by consumers.

The reason that employment-based plans seem cheaper is that on average workers only pay 17% of the premiums directly if they’re single (about $850), and 27% for family policies (about $3,500). Businesses pick up the rest by paying lower wages, thus hiding the real costs.

Meanwhile, in the individual market, consumers pay with after-tax dollars.  

This tax differential is the core of “our inefficient and inequitable system of tax-advantaged, employer-based health insurance.”

“While the federal tax code promotes overspending by making the majority unaware of the true cost of their insurance and care … the code is grossly unfair to the self-employed, small businesses, workers who stick with a bad job because they need the coverage, and workers who lose their jobs after getting sick. . . . How this developed and persisted despite its unfairness and maladaptive consequences is a powerful illustration of the law of unintended consequences and the fact that government can take six decades or more to fix its obvious mistakes.”

Full article:
http://online.wsj.com/article/SB10001424052970203917304574412813119441566.html?mod=djemEditorialPage

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Excerpted from Fast Company, Infographic of the Day: Flow Chart of Obama’s Health-Care Plan, Sep 14, 2009

Charts and infographics have unequaled power to convince and explain. So why aren’t they playing a bigger role in the health-care debate?

President Obama  … uses 21st century technologies in an unprecedented ways … but he remains as musty as John Adams, in at least one respect: His insistence to use speeches alone, unaided by charts or graphs, to get his point across …  It’s not a terribly efficient way to communicate. Not, at least, compared with graphs.

There’s a business-world fetish with that one powerpoint slide that totally encapsulates a problem. Our culture is quickly growing to accept the idea of a definitive infographic, because infographics are better able to model an issue, in its sweep and complexity, than a mountain of words possibly can. No one, outside of CEO’s at investor meetings and politicians, still communicates with huge groups using speeches alone.

Why shouldn’t last week’s address to Congress have been accompanied by a couple charts? 

A summary chart (below) could have be flashed on screen endlessly afterward—more powerful than any meandering quote.

http://www.fastcompany.com/blog/cliff-kuang/design-innovation/infographic-day-flow-chart-obamas-healthcare-plan

Pres Obama raised some eyebrows when he implied in his press conference that doctors will sometimes opt to perform surgery on patients because the reimbursements are higher.  The example was silly since surgeons – not GPs – generally rip out tonsils. 

But, there is a broader issue: how & why might a doctor perform unnecessary or marginally required procedures.

Here are a couple of interesting factoids.

Excerpted from WSJ: Obama and the Practice of Medicine, Aug 14, 2009 

Medicare data shows that for the most part, major surgeries aren’t the source of waste in health care. These kinds of procedures are typically guided by clear clinical criteria and are closely scrutinized by doctors and patients alike. Rather it is in routine procedures and treatments that economic incentives factor heavily into doctors’ decisions.

But, doctors have been accused of excessive prescription of home medical equipment and excessive utilization of radiology scans since —  In the absence of financial incentives to restrain excess use —  relatively safe diagnostic procedures can often be justified—even if their benefits are slim.

For doctors whom Medicare pays per intervention, the problem isn’t the fee-for-service model, but the way that the government program sets the fees. Medicare’s size demands that it keep payment systems simple. Thus it relies on fixed prices for checklists of services tied to discrete billing codes. These uniform payment rules reward low and high quality care the same. Fees are set according to a fixed price schedule with no tie to the physician’s quality, experience level, or the outcome of the service.A more rational system would pay doctors for entire “episodes of care,” rather than individual procedures.

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Full article:
http://online.wsj.com/article/SB10001424052970204409904574350370729883030.html

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Washington Post,10 Things I Hate About Health-Care Reform, September 6, 2009

As a cardiologist and the administrator of a large practice that includes general internists and specialists, I spend much of my time trying to figure out how to provide care for a growing number of uninsured or underinsured patients. I also have to battle billion-dollar private insurance companies that don’t adequately cover patients with preexisting illnesses and often deny coverage for necessary treatments.

Here are 10 major reasons why I — and doctors like me — worry that the legislation on the table will leave us worse off.

1. Private insurance companies escape real regulation.

2. We urgently need tort reform, but it’s nowhere to be seen.

Without fixing these spiraling insurance costs and the legal environment that allows large payments in unjust suits, physicians will continue to practice expensive “defensive” medicine or simply leave states that do not enact tort reform.

3. “Prevention” won’t magically make costs go down.

in general, prevention adds to costs instead of reducing them. That’s because it often means medication for hypertension and elevated cholesterol, and screening and early treatment for cancer. No amount of “prevention” will put a dent in the cost of keeping Americans healthy.

4. Reform efforts don’t address our critical shortage of health-care workers.

Many people believe that the fix for our physician deficit is simple: expand class sizes at existing medical schools and create new ones. Sorry, it’s not that easy. There is a cap on the number of federally funded training positions for newly minted M.D.s. It hasn’t changed since 1996. If the number of graduates of U.S. medical schools increases but the number of post-graduate training positions remains the same, we won’t have fixed the problem — we’ll have created a different one.

5. We need more primary-care physicians — but we also need specialists.

Everyone is worried about the dwindling ranks of primary-care physicians. But we need more specialists, too. There are impending shortages in fields such as oncology, cardiology, general surgery and gastroenterology.  Few Americans will tolerate not having access to a specialist in an emergency or having care rationed because of a limited number of skilled physicians.

6. We have to streamline drug development and shake up the Food and Drug Administration.

Creating and producing new drug therapies in the United States is a nightmare. Regulatory hurdles, disorganization and a lack of leadership at the FDA, as well as burdensome conflict-of-interest policies, have made the drug-approval process grindingly slow. At the same time, development costs are close to $1 billion per drug.

7. We can’t fund health-care reform by cutting payments to doctors.

The Centers for Medicare and Medicaid Services has proposed increasing payments to primary-care physicians by approximately 6 percent while lowering payments for many specialists, including cardiologists and oncologists, by as much as 20 to 40 percent. The American College of Cardiology estimates that 40 percent of the cardiology practices in Florida will go bankrupt.

8. We can’t forget about research.

Every modern treatment for human disease is related in some way to research at U.S. academic medical centers. However, decreased federal funding for research over the past six years has threatened to decimate a generation of young scientists and the cures they could discover.

9. Cutting reimbursements could shut some hospitals down.

It is unlikely that the homeless, the mentally ill, the substance abusers or the illegal immigrants who now receive their care in “safety net” hospitals will carry any form of health insurance.

10. We need to improve the quality of care.

The Institute of Medicine has pointed out, poor quality of care can be divided into three types: underuse of care, misuse of care and overuse of care. While eliminating misuse and overuse will decrease the cost of care, correcting problems from underuse will actually increase costs.

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I want my patients to have insurance that will pay for their care, and I want to be able to offer new medications and the most sophisticated treatment. I want to be able to give preventive care as well as to monitor patients effectively if they develop diseases. I want to be able care for my patients in their homes, and I want to offer palliative care if it becomes necessary. I want them to be able to afford all this.

In short, I want to see major reforms in health care — I just don’t want what is on the table.

Full article:
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/04/AR2009090402274.html

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Ken’s Take: A very clever juxtaposition that gives the health care debate in a different perspective … 

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WSJ, A Doctor’s Plan for Legal Industry Reform, Sept. 3, 2009

Since committees of lawyers are deciding what doctors should and should not do, perhaps physician committees can decide whether lawyers are necessary in any given situation.  Doctors sholuld take on the important duty of controlling and regulating lawyers.

Since most of what lawyers do is repetitive boilerplate or pushing paper, physicians would have no problem dictating what is appropriate for attorneys.

After all, we physicians know much more about legal practice than lawyers do about medicine.

Following are highlights of a proposed bill authorizing the dismantling of the current framework of law practice, i.e. “reforming” it:

• Contingency fees will be  … eventually outlawed. This will put legal rewards back into the pockets of the deserving—the public and the aggrieved parties. Slick lawyers taking their “cut” smacks of a bookie operation. Attorneys will be permitted to keep up to 3% in contingency cases, the remainder going into a pool for poor people.

•  Each potential legal situation will be assigned a relative value, and charges limited to this amount. Program participation and acceptance of this amount is mandatory, regardless of the number of hours spent on the matter. Government schedules of flat fees for each service, analogous to medicine’s Diagnosis Related Groups (DRGs), will be issued. For example, any divorce will have a set fee of, say, $1,000, regardless of its simplicity or complexity. This will eliminate shady hourly billing. Niggling fees such as $2 per page photocopied or faxed would disappear. Who else nickels-and-dimes you while at the same time charging hundreds of dollars per hour? I’m surprised lawyers don’t tack shipping and handling onto their bills.

• Legal “death panels.“ Over 75? You will not be entitled to legal care for any matter. Why waste money on those who are only going to die soon? We can decrease utilization, save money and unclog the courts simultaneously. Grandma, you’re on your own.

• Ration legal care. One may need to wait months to consult an attorney. Despite a perceived legal need, physician review panels or government bureaucrats may deem advice unnecessary. Possibly one may not get representation before court dates or deadlines. But that’ s tough: What do you want for “free”?

• Physician controlled legal review. This is potentially the most exciting reform, with doctors leading committees for determining the necessity of all legal procedures and the fairness of attorney fees. What a wonderful way for doctors to get even with the sharks attempting to eviscerate the practice of medicine.

• Discourage/eliminate specialization. Legal specialists with extra training and experience charge more money, contributing to increased costs of legal care, making it unaffordable for many. This reform will guarantee a selection of mediocre, unmotivated attorneys but should help slow rising legal costs. Big shot under indictment? Too bad. Under reform you too may have to go to the government legal shop for advice.

• Electronic legal records. We should enter the digital age and computerize and centralize legal records nationwide. All files must be in a standard, preferably inconvenient, format and must be available to government agencies. A single database of judgments, court records, client files, etc. will decrease legal expenses. Anyone with Internet access will be able to search the database, eliminating unjustifiable fees charged by law firms for supposedly proprietary information, while fostering transparency. It will enable consumers to dump their clunker attorneys and transfer records easily.

• Ban legal advertisements. Catchy phone numbers such as 1-800-LAWYERS would be seized by the government and repurposed for reporting unscrupulous attorneys.

• New government oversight. Government overhead to manage the legal system will include a cabinet secretary, commissioners, ombudsmen, auditors, assistants, czars and departments.

• Collect data about the supply of and demand for attorneys.Create a commission to study the diversity and geographic distribution of attorneys, with power to stipulate and enforce corrective actions to right imbalances. The more bureaucracy the better. One can never have too many eyes watching these sleazy sneaks.

• Lawyer Reduction Act. A self-explanatory bill that not only decreases the number of law students, but also arbitrarily removes 3,200 attorneys from practice each year. Textbook addition by subtraction.

Enthusiastically embracing the above legal changes can serve as a “teachable moment” and will go a long way toward giving the lawyers who run Congress a taste of their own medicine.

Full article:
http://online.wsj.com/article/SB10001424052970204731804574387021307651050.html?mod=djemEditorialPage

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Ken’s Take: A very clever juxtaposition that gives the health care debate in a different perspective … 

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WSJ, A Doctor’s Plan for Legal Industry Reform, Sept. 3, 2009

Since committees of lawyers are deciding what doctors should and should not do, perhaps physician committees can decide whether lawyers are necessary in any given situation.  Doctors sholuld take on the important duty of controlling and regulating lawyers.

Since most of what lawyers do is repetitive boilerplate or pushing paper, physicians would have no problem dictating what is appropriate for attorneys.

After all, we physicians know much more about legal practice than lawyers do about medicine.

Following are highlights of a proposed bill authorizing the dismantling of the current framework of law practice, i.e. “reforming” it:

• Contingency fees will be  … eventually outlawed. This will put legal rewards back into the pockets of the deserving—the public and the aggrieved parties. Slick lawyers taking their “cut” smacks of a bookie operation. Attorneys will be permitted to keep up to 3% in contingency cases, the remainder going into a pool for poor people.

•  Each potential legal situation will be assigned a relative value, and charges limited to this amount. Program participation and acceptance of this amount is mandatory, regardless of the number of hours spent on the matter. Government schedules of flat fees for each service, analogous to medicine’s Diagnosis Related Groups (DRGs), will be issued. For example, any divorce will have a set fee of, say, $1,000, regardless of its simplicity or complexity. This will eliminate shady hourly billing. Niggling fees such as $2 per page photocopied or faxed would disappear. Who else nickels-and-dimes you while at the same time charging hundreds of dollars per hour? I’m surprised lawyers don’t tack shipping and handling onto their bills.

• Legal “death panels.“ Over 75? You will not be entitled to legal care for any matter. Why waste money on those who are only going to die soon? We can decrease utilization, save money and unclog the courts simultaneously. Grandma, you’re on your own.

• Ration legal care. One may need to wait months to consult an attorney. Despite a perceived legal need, physician review panels or government bureaucrats may deem advice unnecessary. Possibly one may not get representation before court dates or deadlines. But that’ s tough: What do you want for “free”?

• Physician controlled legal review. This is potentially the most exciting reform, with doctors leading committees for determining the necessity of all legal procedures and the fairness of attorney fees. What a wonderful way for doctors to get even with the sharks attempting to eviscerate the practice of medicine.

• Discourage/eliminate specialization. Legal specialists with extra training and experience charge more money, contributing to increased costs of legal care, making it unaffordable for many. This reform will guarantee a selection of mediocre, unmotivated attorneys but should help slow rising legal costs. Big shot under indictment? Too bad. Under reform you too may have to go to the government legal shop for advice.

• Electronic legal records. We should enter the digital age and computerize and centralize legal records nationwide. All files must be in a standard, preferably inconvenient, format and must be available to government agencies. A single database of judgments, court records, client files, etc. will decrease legal expenses. Anyone with Internet access will be able to search the database, eliminating unjustifiable fees charged by law firms for supposedly proprietary information, while fostering transparency. It will enable consumers to dump their clunker attorneys and transfer records easily.

• Ban legal advertisements. Catchy phone numbers such as 1-800-LAWYERS would be seized by the government and repurposed for reporting unscrupulous attorneys.

• New government oversight. Government overhead to manage the legal system will include a cabinet secretary, commissioners, ombudsmen, auditors, assistants, czars and departments.

• Collect data about the supply of and demand for attorneys.Create a commission to study the diversity and geographic distribution of attorneys, with power to stipulate and enforce corrective actions to right imbalances. The more bureaucracy the better. One can never have too many eyes watching these sleazy sneaks.

• Lawyer Reduction Act. A self-explanatory bill that not only decreases the number of law students, but also arbitrarily removes 3,200 attorneys from practice each year. Textbook addition by subtraction.

Enthusiastically embracing the above legal changes can serve as a “teachable moment” and will go a long way toward giving the lawyers who run Congress a taste of their own medicine.

Full article:
http://online.wsj.com/article/SB10001424052970204731804574387021307651050.html?mod=djemEditorialPage

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