Decisive Reform for Our Dying Health Care System

By E. Stanley Kardatzke

Dr. Stan Kardatzke is a physician
who has practiced and taught clinical
family practice for over 25 years. He
has been a Chairman of two different
managed health care companies.
Formerly he was Chief Executive
Officer of Physician Corporation of
America, a managed care company
which took care of the health of over 300, 000 people across
the nation. He has seen the problems of our health care system
from many view points. He writes this book from his depth
of experience as a physician, businessman, church leader, and
student of health economics. This book is for lawmakers, health
regulators, employers, physicians, and all Americans who want
to solve our nations health care crisis.

• Language: English
• Publisher: Xlibris US
• Release date: Oct 13, 2010
• ISBN: 9781453589700

E. Stanley Kardatzke

Dr. Stan Kardatzke is a physician who has practiced and taught clinical family practice for over 25 years. He has been a Chairman of two different managed health care companies. Formerly he was Chief Executive Officer of Physician Corporation of America, a managed care company which took care of the health of over 300, 000 people across the nation. He has seen the problems of our health care system from many view points. He writes this book from his depth of experience as a physician, businessman, church leader, and student of health economics. This book is for lawmakers, health regulators, employers, physicians, and all Americans who want to solve our nation’s health care crisis.

Book preview

CONTENTS

CHAPTER I—CODE BLUE

CHAPTER II—WHERE IS THE PAIN AND THE PROBLEM IN OUR SYSTEM?

CHAPTER III—FINANCIAL INCENTIVES FOR EXPENSIVE PROCEDURES

CHAPTER IV—DECREASED ACCESS TO PRIMARY CARE

CHAPTER V—CONTRIBUTING FACTORS

CHAPTER VI—SIMPLE SOLUTIONS FOR THE FINANCIAL HEMORRHAGE (Privatizing of the Government Option The Merging of Medicaid and Medicare)

CHAPTER VII—ADDITIONAL PROBLEMS TO BE TREATED

CHAPTER VIII—HOW SHOULD WE PAY THE DOCTOR?

CHAPTER IX—EVALUATING QUALITY

CHAPTER X—INCREASE ACCESS AND PLACE MORE PRIMARY CARE PHYSICIANS

CHAPTER XI—CURRENT POLITICAL PROPOSALS REGARDING A NATIONAL HEALTH CARE POLICY

CHAPTER XII—A UNIFYING PRESCRIPTION FOR OUR NATION

SUMMARY

APPENDIX A

APPENDIX B

APPENDIX C

APPENDIX D

APPENDIX E

APPENDIX F

APPENDIX G

ENDNOTES

I dedicate this book to my wife, Suzonne,

for her loving commitment to my total health—

physically, emotionally, and spiritually.

I am especially grateful for the doctors and

patients that I have worked with over the past

forty-five years who helped me learn about

how to control health care costs by

controlling diseases and illnesses earlier.

Acknowledgment

There are many people who assisted me with the research, compiling, and writing of this book over the past fifteen years. Initially, some of my research involved interviewing prominent business, government, and health care leaders. I am very grateful for the following who gave me personal interviews: Senator Bob Dole of Kansas, Mr. Larry Jones, past President of the Coleman Company; Mr. Terry Hartshorn, past President of Pacificare, Inc.; Mr. Ed Moy, former director for Prepaid Health for Health Care Financing Administration (HCFA); Mr. Paul Oreffice, past Chairman of Dow Chemical; Dr. John Tupper, past president of the American Medical Association; and Dr. Gail Wilensky, the past administrator for HFCA. Peter Kilissanly, Past president of PCA. These leaders graciously shared their insight into the U.S. health care crisis.

I would also like to give special credit to Peter G. Peterson, the author of On Borrowed Time. I am grateful to the authors of the books listed in the bibliography and footnotes and to the artists and photographers for allowing me to use their work.

Finally, I am indebted to my son, Corrigan Kardatzke, and my daughter, Heidi Kardatzke, and family friend Megan Hopwood for their work in assisting in editing and formatting this book.

Introduction

Over the past year, all of us in America have been watching the news about the Health Care Reform debate in Washington. Both Democrats and Republicans do agree that we need significant changes. However, they cannot agree on how to change the system for the better and still be financially responsible to the American people’s future. The current law regarding Health Care Reform is over two thousand pages, and it still misses the most important issues that are causing our Health Care crisis and how to fix them. I have been at the top of our health care system as a CEO of a very large Health care company, and I also have been a family doctor, and now I am again an emergency physician. This book suggests simple methods for solving the current Health Care Reform debate and giving the uninsured health coverage while still saving billions annually.

For over forty-five years, I have watched the marvelous improvements in medical technology, yet I have seen an ever increasing number of patients denied basic health care because of no health insurance. As a former Chairman of several health care companies, I have watched many businesses struggle to stay afloat, much of their problem being the cost of health care for their employees. During the past forty years as CEO of Health Insurance companies and as a Emergency Physician and Family physician, I have studied, experimented with, and implemented various incentives and management tools with hundreds of thousands of patients in many states that were quite successful in improving health outcomes and, at the same time, saving hundreds of millions of dollars. These things that I have observed and learned over forty-five years can be used to correct the crisis in our health care system. Even though sections of this book may offend certain professionals and politicians, I can no longer sit by idly and watch the widening gap between the medically rich and the medically poor and the continuous political debate on Health care Reform.

The United States health care system is critically ill. Many experts tend to blame a particular component in our health system (hospitals, physicians, insurance companies, and attorneys, etc.). However, I believe that the illness is not due to the component members of our system, but due to THE INHERENTLY WRONG INCENTIVES, which are woven into our current system.

I am presenting this book to all Americans, especially those in leadership positions. I have documented the causes of our health care crisis and have suggested a ten-step reconstruction plan, which, if enacted this year, would solve problems of access to health care for all while reducing (not increasing) health care costs by the year 2011.

I hope reading this clarifies the issues and challenges all to action!

Since I am both a Family Physician and an Emergency Physician and also a former Chief Executive Officer of two HMOs. I will introduce my concepts initially as a physician and later close and summarize as a health economist. Frequently, physicians are called upon to treat a critically ill patient who has multiple organ systems involved in the illness. Physicians must order and coordinate complex protocols of the following: (1) intravenous fluids and drugs, (2) complex diagnostic studies, (3) surgical procedures, and (4) intensive care. As the patient stabilizes, the physician might order physical therapy and rehabilitative education to assist the patient with post-illness recovery. These different treatment plans do not all occur simultaneously. Physicians have many different opinions as to what should be done and in what order. In the same way, all those concerned see the U.S. health care system as quite ill. Many components of the health care system are dysfunctional. Many leaders in health care, government, and business have differing opinions as to how and when the various plans of actions should be implemented.

Young physicians are trained with established protocols for the treatment of patients with critical emergencies. These protocols call for systematic evaluation and a treatment plan, which has sequential order. For example,

1. Check and maintain airway and respiratory ventilation.

2. Maintain blood pressure, stop obvious hemorrhaging, and start IVs.

3. Commence specific diagnostic testing of blood, urine, and x-rays, etc.

4. Institute specific IV treatment of whole blood, plasma, antibiotics, cardiovascular drugs, etc.

5. Transfer to surgery or medical intensive care.

6. After patient is stabilized, commence physical therapy, ambulation.

7. Transfer to a regular hospital room and begin process of preparing patient and family for convalescence, more physical therapy, medical education, and disability training.

8. Discharge to the home with home health team and personal-physician supervision.

Physicians are trained to analyze and respond step-by-step to the needs of the critically ill patient. If physicians did not have pre-learned protocols, they might become disorganized with the confusion of the multiple-system involvement of the critically ill seen in the emergency room. Groaning patients, with obvious traumatic injuries and very anxious family members, create situations not conducive to calm decision making. Therefore, predetermined protocols help physicians organize the proper treatment in the best time sequence for the most efficient results for the critically ill patient.

I believe we should address the dysfunctional U.S. health care system in the same way. There are issues that must be addressed immediately. There are other issues that need more study, and finally, there are issues that must be addressed for the long-term improvement of our nation’s health. There are some poorly thought-out opinions from some political groups that may seem to be similar to the attitudes of panicked family members in the emergency room. Therefore, in order to properly attack the issues in correct order, I shall list the major issues and select the order in which I believe the issues need to be addressed.

• We must increase access to primary care and urgent care physicians seven days a week, especially for the uninsured and Medicaid patients.

• We do need a type of National-mandated employer health insurance, with a Government Option for those with lower income paid for by an 8 percent income tax on those who choose the Government-option plan.

• Medicaid reorganization and merger with Medicare into one organization.

• Reduce pressure on Hospital Emergency Departments by high copayments for unnecessary visits to ERs and low payments for Primary and Urgent Care visits.

• Malpractice reform legislation to make it similar to Worker’s Compensation.

• Medicaid/Medicare payment increases for Primary Care specialties to incentivize primary care physicians to take care of their own patients seven days a week, by phone or visit, and encourage more Medical Students to choose Primary Care Residency programs.

• Reduction of the Cost and Bureaucracy of Billing, Coding, and HIPPA through Reformation and Simplification of the Regulations.

We now must select the method of correction and timing of each issue to be addressed.

CHAPTER I

CODE BLUE

Symptoms of a System in Crisis

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The patient is critically ill, the blood pressure is 80/40, temperature 101°, pulse 140, urine output 10 cc/hour. The patient is confused. Lab studies show a severe anemia with a hemoglobin of 7.2 g, the white blood count demonstrates a serious infection process (WBC 22,000 ).

It is obvious this patient is very ill. We don’t have enough history or clinical exams to know the specific diagnosis, but we do know the patient is seriously ill. It does not take a group of intensive care specialists to tell the family that this patient is seriously ill, even the medical receptionist knows.

The U.S. health care system is also seriously ill. Most statistical indicators point toward the rapid deterioration of the health care system. We don’t need more data to tell us the system is sick; employers, patients, insurers, and physicians know it. The following data confirms the system is ill:

1. The number of Americans without Health Insurance has more than doubled in the past thirty years. Now Fifty million Americans do not have health insurance, and most of these do not have a personal physician. They frequently do not get vital and inexpensive preventive care services, allowing minor illnesses to progress to very serious and expensive illnesses, which require emergency room care for which they cannot pay, and frequently, they must take personal bankruptcy, leaving the hospitals with the unpaid bills and the patient with poor credit. This causes approximately $150 billion every year in unpaid medical bills that must be paid by taxpayers and the Insurance Premiums.

2. The Kiaser Foundation reported that from 2001 to 2007, Health Insurance premiums have risen 78 percent while wages