Technology versus Politics

Technology is marvelous. It tends to make things better, cheaper, more available. It tends to make people happy.

Politics, on the contrary, is the opposite of all the above.  The most exciting, promising technology turns divisive, corrupt, costly and deadly once politicians get their mitts on it.

We should never have let them monkey with our healthcare.  I’ve said so many times in the past (see links below), and I’ll keep saying so until we snap out of our stupor …or it comes crashing down around us (at which point I will say I Told You So).

So, let me offer just one, seemingly minor, even merely clerical reason, why your healthcare sucks.

It’s called ICD-10.

First of all, in my business of healthcare information/image technology, compliance with ICD-10 has been an enormous (i.e. expen$ive) undertaking. There are seven squillion, nine hundred and ninety three fillion codes (give or take) to correlate to software hooks and data. It has made the inherently complex business of making products for patient care even more complex.

The mass of codes and interrelations is certainly a hassle for the engineers making stuff to sell to doctors – presumably to make healthcare providers’ jobs easier (at increa$ed co$t, of cour$e).

But what does ICD-10 mean to doctors, patients and the tangle of insurance companies and taxpayers who ultimately pay for all this complexity?

Well, as of October 1, the wrong code can lead to not only a denied claim and/or months/years of costly hassle, but perhaps significant punishment (on basis of “Medicare Fraud” among other things too legally frightening to mention) for the doctor/institution as well.

Good, you say?

You want fewer mistakes in medicine.

Yes of course.  We all do.

Doctors must do better, certainly.  Prescription drugs, correctly taken, kill more people by far than do “illegal” drugs.  And hospital stays in general (with iatrogenic infections, drugs, mistakes, etc.) kill more Americans than everything but cancer and heart disease.

But what does “do better” mean?  And how do we help make that happen?

And how much arm-twisting, lawsuit-hurling, defrocking, fining and imprisoning force does it take to be helpful??

Let’s see how ICD-10 “helps.”

Let’s say a Farmer Andy comes to the Family Practice clinic with an infected wound that he’s not so sure he can explain. Stuff happens to farmers all the time, and he just can’t remember what this wound was from, initially. He’s always getting bangs and scrapes and cuts, after all.

(And let us be truthful. Andy is a terrible farmer. He’s mostly into quixotic politics)

So, what was the injury initiating this visit?

It’s legally critical we get this right!

Was it ICD-10 code W55.21, “Bitten by a cow,” or W61.33, “Pecked by a chicken?”

Was it when he became a V00.01 “Pedestrian on foot injured in a collision with roller skater?”
Come to think of it, he had been visiting his nephew in prison when that happened, which could add a Y92.147,“Courtyard of prison as the place of occurrence of the external cause.”

Does that qualify as a Z63.1, “Problems in relationship with in-laws?”

Anyway, the doctor knows it wasn’t Y92.253, “Hurt at the Opera,” since Farmer Andy hasn’t gone there since the last episode…(we mustn’t discuss it here.  That would be a violation of HIPAA rules which could lead to a revoked license and even prison).

Farmer Andy did mention (under his breath, seemingly ashamed) that it could have been an “Accident while knitting or crocheting,” which would be a Y93.D1.

The doctor hated to ask, but since he knew Andy and his family had been to Sea World, could Andy have been “Struck by Orca, initial encounter,” which would be a W56.22?

No, said Andy.  It certainly wouldn’t have been a Killer Whale, nor was it a strike.

There was perhaps that bite from a Sea Lion, Andy recalled.  Though it wasn’t the first time, or even the second time that had happened.

So that would be a W56.11XS “Sequela…Bitten by Sea Lion.”

Hmmm, the doctor thought. That would have a very specific look to it.  No; it must be something else.

The wound wouldn’t look like this if it were a V91.07 “Burn due to water-skis on fire,” certainly.  He’d seen plenty of those before.

And the doctor could tell just by looking at him that Farmer Andy hadn’t been “Sucked into jet engine,” or X52.

Or was he getting the codes wrong?

Damn!

Wait…X52 is actually “Prolonged stay in weightless environment.”

Was it V95.40? No…that one is the rather vague, “Unspecified spacecraft accident injuring occupant.”

How about Y37.54?  (Doctor types in code and waits…it’s a big database)

When the doctor worked in the hospital, there was an entire department of people whose only job is to “do coding.”  Here in the clinic, they’ve got a part-time/outside IT department, and sometimes their network bogs down, and…
Oh, here it comes…

Oh heck no!  Y37.54 is “Military operation involving nuclear radiation effects of nuclear weapon.”  SMH, he thought.  He should’ve remembered this one from last week’s incident.

Ah, there it is…V97.33 is the sucked-into-jet-engine code.

Dang it, he has to remember that.  The CMS (Centers for Medicare & Medicaid Services) “ICD-10 Ombudsman” was fairly lenient last time.

He can’t afford to make that mistake again!

OK, I have a question for you.  Does the preceding strike you as the best way to improve healthcare delivery?

No?

Now, codifying data is a great idea.  In the right hands and in the right way, when we’re ready (this is a key part), then having convenient, appropriate labels for all our data makes it easier to store, find, and use in a meaningful way.  And I’m even all in favor of people using ICD-10 exactly as it is…if they choose to.

Let me restate that.

If people trained in the care of patients, in their situation (hospital, clinic, private practice) find that using ICD-10 codes helps them treat patients, then great.  Excellent, even!

But that’s not how our $y$tem work$, is it?  It’s not up to the healthcare professional how things are billed and paid anymore.  It hasn’t been for many years now.  In the most practical $en$e, politicians are more involved in healthcare decisions than doctors are.  Doctors can bill for only what they can get paid for by people other than patients; and that is determined by politicians.  In this case, technology becomes more of a parasite than an aid.

As a true-free-market technology guy, that breaks my heart.

Just imagine you’re trying to sell something; a product you make, your old car, cookies at a bake sale…but bickering politicians, lawyers and lobbyists determined what you could charge for it.  Imagine they demand you buy some things, and don’t let you buy others…and that every political intervention not only directly affects your job…it substantially changes your job.

How would that work out in the real world?

And the way “meaningful use” and other “federal” requirements are being FORCED on healthcare providers is, at this state in our knowledge and technology, madness on top of even more madness (do I even need to mention Obamacare?).

To make matters worse, healthcare has been a union shop/monopoly for over a hundred years.  There can be no serious competition with what politicians and lobbyists call healthcare.

If the rest of our technology worked like this, we’d all be clacking away on Windows 3.1, at best.

There were smart people involved in the development of ICD codes.  Lots of them.  But their seemingly dedicated work was performed in disconnection from monetary, human and practical technology concerns.  It’s another good example, in fact, of such obsessive bureaucratic “paperwork” (albeit mostly without paper), that the recording and processing of all this data can and often does compromise patient care in ways analogous to the Observer Effect.

OK, so I have another question for you.

Should we let doctors, who go to school for many years and spend a lot of time in residency and continuous training, actually do the jobs they were trained to do, or should we continue to vote for ever-more intrusion into that profession by politicians, who don’t need any education or even interest in healthcare at all?

Well, please think on it.

It’s your money, your rights, your life and health at stake here, you know.

https://wedeclare.wordpress.com/2013/10/15/can-politicians-even-define-health-care/

https://wedeclare.wordpress.com/2009/07/28/health-insurance…or-healthcare…choose-one/

https://wedeclare.wordpress.com/2009/09/23/a-short-history-of-health-care-let-doctors-be-doctors/

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Andy’s Annotated US Constitution

With all the disinformation and historical revisionism buzzing like flies on politics (even with the “Tea Party” as much as anywhere else), I just had to present what I believe to be the facts.

So here’s an annotated USA constitution again: https://wedeclare.files.wordpress.com/2016/03/annotated-usa-constitution.pdf

Summer 2010 Indiana Policy Review

Here’s the latest Indiana Policy Review summer 2010 journal – “A Tea Party Primer.”  Please pass it on to everybody you know.  Tell them to pass it on to everybody they know.

Etc.

It’s now or never, my friends…

Here’s one last column before I take down this site:

I have never believed in the Easter Bunny, Santa Claus, or that creepy Tooth Fairy thing. 

But that doesn’t mean that I haven’t nurtured other baseless, nutty beliefs until some painful paroxysm jolted me awake. 

Many years ago, under horrible personal circumstances, I endured the same spiritual upheaval you’re feeling right now.  Just as with you, my religion turned out to be a big lie.  My false god turned against me, just as it’s turning against you now.  So like you, I can no longer believe in the charity, peace and love of …politicians. 

While initially painful, there is relief in this truth that sets you free. 

But there’s another problem.  Nobody alive remembers how liberty works.  We cannot imagine how schools, roads jobs, healthcare, or food ever existed without a political genesis, subsequent bailouts, lawsuits and bipartisan bickering.  Only if you’re over 100 years old did you even exist when there was such a thing as a free market; with all the innovation, competition and rapid advancement that entails.

So as we endure the agony of Change that’s not working, we must thoughtfully prepare a better way forward.  I suggest we first retrieve what we’ve lost from the past.

All federal authority is still clearly written into the Constitution for the United States of America (Article I, Section 8; Article II, Sections 2-4; Article III), which you could read in just a few minutes.  All other powers are still very clearly denied by one short sentence (Amendment 10).  Similarly, all Indiana government powers are spelled out in the Indiana Constitution, while every other conceivable power is still denied by a single sentence (Article I, Section 25).

No state or federal constitution was ever amended, altered or suspended to authorize most of what governments now do to citizens.  Nullification of anything unconstitutional is already law at every level of government in the republic.  So we have the right, the power, and the duty, to tell politicians to back off; all the way back to the constitutions.

Here’s a summary of what that means:

  1. Citizens can do whatever they want to as long as they don’t harm anybody else, or take what’s not theirs.
  2. We’d have no more government than necessary to maintain #1
  3. We invite others around the world to emulate our success, but otherwise leave them the heck alone.
  4. Your major civic duty is to disobey, invalidate and otherwise eliminate all unconstitutional taxes, mandates, organizations and agents.  Yes, civil disobedience is a duty. 

So caveat emptor would replace the FDA, FTC, FDIC, FCC and a zillion other F’agencies.  Common sense, family ties, competition, voluntary associations, charity and free market options galore would replace union/corporate monstrosities, Medicare, Social Security, lobbyists, regulations, litigation and price controls.  And because of the preceding, you get to keep what you earn, buy what you like (smoke it if you’re fool enough – and as long as you don’t blow it in my face), and live however and with whomever you want…as long as you leave others, and their stuff, alone.

No federal tooth fairies, no President coming down the chimney with presents, no more bogus political promises; just a reality proven to work better than anything else ever tried.

That may not be a Square Deal or a New Deal.  But it’s a fair deal, which makes it the best deal in all of human history. 

Can you live with that? 

People used to call that “freedom.”

And they liked it.

What he should’ve said

I’m not breaking my vow to never blog again…I’m just sayin’ that our President’s speech was too long, and all wrong.

Here’s what he (or McConnell) should’ve said:

My fellow human beings, over the past hundred years, American voters have gradually surrendered their property, initiative, freedom and security to politicians, and that was a stupid thing to do.

Now our debts and fear/aggressions, crimes and perversions have grown so big and obvious that, frankly, I’m embarrassed that you still think that you can trust politicians with your life, liberty and pursuit of health insurance.  The whole point of our constitutions was to put a leash on politics, so that real people could live by their own choice, generosity, sweat and ingenuity.  But we rob you blind, tell you we saved you from worse, and you’re still voting for this two-headed, two-faced Demorepublicrat monster.

Dang, people.

It’s by your choice that those who’ve been right all along are called “fringe,” and most accurately, “loser;” while those who’ve been wrong, or worse, deceived you intentionally, are called “expert,” “wonk,” or of course, “The Honorable so and so.”

I cannot apologize for your choices, but I am truly sorry that we politicians did what comes natural to us, and that you still have much to suffer before our mess can be made right.

I’ve already said that I’d rather be a good one-term President than a mediocre two-timer.  So whether voters have learned from our collective mistakes or not, I now intend to do what’s right.

And what’s right is to recognize that, while any fool can wield power, only the great restrain it.

My fellow Americans, I am the President who will wean you off politics.

You want somebody to care for you?  Make some friends, join a church or voluntary service association, and raise a good family.  If you can’t get people to care for you voluntarily, I’m sure not going to sqeeze taxpayers for you.

As for a financial stimulus?  I will suggest that Congress gets double-pay to just stay home and leave you the heck alone.

About terrorism…we never should’ve gone weak-kneed over zealots with exploding underpants.

I’m telling all you red-blooded game hunters out there, that as of right now, it’s open season on terrorists.  Have at ’em, but of course try not to make too many mistakes.  You plug ’em, we’ll plant ’em.

Does that scare you?  If so, then you have no idea how much suffering currently takes place, even in the homes of our soldiers; and you have no idea how much our endless wars cost you in money, social disorder, freedom, security and opportunities lost forever.

Overnight, ordinary rednecks could end, and forever scare away terrorism, at a tiny fraction of the current cost in dollars, corruption and human life; and allow us to bring our troops home.  Not just from Afghanistan and Iraq, but from all over the world.  We’d no longer flex our muscles or play nanny on foreign soil, because the world would know that we are impenetrable here at home.

As far as job creation goes?

I know economics was supposed to be two-thirds of my speech.  But government is violence, not business.  Government is more about oppression, slavery, genocide and war than anything else it may pretend to be.  It never creates.  It cannot give without first taking.  You should never have let us rob Peter to pay Paul.  Not only is it morally wrong in its essence, but you should have known that you are not Paul.

To wrap this up, let me say that I have read the Constitution that I swore to uphold against all enemies, foreign and domestic; and I now aim to do just that, as written in both black, and white.  People have fought and died for this precious contract, and I will never again let anyone in my administration treat it with anything other than respect.

Then again, it’s up to you, American voters, to hold me to that.

Thank you, and may God bless us all.

A Short History of Health Care: Let Doctors Be Doctors

I just ran across this on another website.  It’s a column I wrote for Indiana Policy Review a couple of years ago that seems more appropriate than ever now.

A Short History of Health Care: Let Doctors Be Doctors
By Andrew Horning

Healthcare is an odd business in that it has always been both expensive and unpleasant. Until the 1920s, the average doctor couldn’t even help with the average ailment. While medicine then included a range of arts like phrenology, acupuncture, homeopathy and allopathy it really was a coin-toss whether you’d be saved or killed by a doctor’s work.

Then the 20’s brought insulin, sulfa, other “miracle” drugs and sterile fields that meant, for the first time, that healthcare actually worked more often than not. From there, doctors, scientists and medical engineers really took off; rapid advancements increased life expectancies and decreased suffering. And because of increasing effectiveness and supply, healthcare was even becoming cheaper in real cost-benefit terms.

However, politicians had nothing at all to do with this, and that was apparently a problem. Teddy Roosevelt proposed a German-style, cradle-to-grave “socialized” healthcare system, but it was assailed as “the Prussian Menace” in those anti-German years before WWI, and Teddy’s scheme died. Even so, politicians wanting to seem compassionate started promoting socialized healthcare. The July 1919 issue of the Insurance Monitor made this prescient assertion: “The opportunities for fraud upset all statistical calculations. . . . Health and sickness are vague terms open to endless construction. Death is clearly defined, but to say what shall constitute such loss of health as will justify insurance compensation is no easy task.”

No matter. Between The Revenue Act of 1939’s health-related tax breaks, and 1943, when the War Labor Board excluded employer-paid health insurance from its wage freeze, American politicians charged into health care on their favorite horse, income tax.

In a nutshell, here’s what happened: Tax breaks for employer-paid health insurance meant that health insurance became a part of employment, and insurance became an integral part of healthcare. This inserted middlemen, which of course made everything more expensive. But who cared? The tax-subsidized, payroll-deducted cost was invisible enough that Americans started using insurance to pay for routine visits, dental checkups, eyeglasses and even plastic surgery. Group insurance offered large corporations better plans than small companies could muster, giving large corporations even greater advantages in hiring and competition than corporate laws already gave them. This also meant that the poor, or worse, the self employed, were even further distanced from the rich and incorporated in a very serious way. Obviously this created problems, but politicians never admit error, do they?

Four days before Tax Day, 1953, President Dwight Eisenhower established the U.S. Department of Health, Education and Welfare, giving government even more direct control over some of humanity’s most precious commodities. More political money and power meant more reasons for businesses to make campaign contributions and lobby. Of course, politicians at every level of government have used healthcare policy to reward their friends and punish their enemies. That’s their stock in trade.

Now tax money and policy is sifted and sorted through political appointees, immortal bureaucracies and defense-contract-style arrangements to feed a dwindling number of profit-starved insurance companies who then deny your claim. Doctors hire legions of workers to manage the regulatory, litigative, and insurance paperwork hassles; or leave private practice to become an employee within a clerically staffed healthcare corporation. So healthcare is still both expensive and unpleasant. But now it’s only because politicians, not doctors, are practicing medicine. Our healthcare injustices and vital statistics have decayed into an embarrassment at just the time when technology should make healthcare cheap, effective and available to all.

It is hard to imagine what politicians could have done to make our healthcare situation any worse. Yet, according to a July 2006 Harris Poll, Americans rate the issue of healthcare well-behind Iraq, the economy, immigration and even gas prices. Even more strangely, most people now think we must, to some degree and by some unspecified method, “socialize” healthcare just as Europe, Canada and other nations are now scrambling back toward free market reforms. What are we thinking?

Let politicians have their way with Iraq, the Colts and toll roads. Let them run lotteries and practice voodoo. But please, let doctors do healthcare at last; they’ve earned the right.

RELATED POSTS:
https://wedeclare.wordpress.com/2013/10/15/can-politicians-even-define-health-care/
https://wedeclare.wordpress.com/2009/07/28/health-insurance%E2%80%A6or-healthcare%E2%80%A6choose-one/

Health Insurance…or Healthcare…Choose One

At least as far back as the funeral societies of ancient Greece, humans have formed co-ops or investment groups to manage the kind of losses that happen to people rarely, without warning, or as in the case of a funeral, only once.  Early insurance organizations, like modern ones, averaged and distributed the losses to make them less painful.

These were not comprehensive relief plans.  Maybe a best friend would compensate you for the loss of a favorite hat, but the early societies and later insurance policies were intended to minimize only the loss of a ship, a precious heirloom, or a loved one.  Such insurance was rarely compulsory because the benefits were clear, and forced participation would change the mathematics of sustainable cost versus periodic benefit.

Imagine what would happen, for example, if lawmakers decided that legal minimum auto insurance wasn’t enough.  What if they decreed that insurance companies must pay every driver for regular auto maintenance, new shocks, batteries, and even the cost of gas?  Imagine tax money and tax benefits stirred into the mix.  The mathematics would go so out of whack that it would no longer be anything like insurance.  We’d have only a usuriously inefficient pre-payment scheme for everyday occurrences.  The rare collisions and breakdowns for which you’d really want insurance would become insignificant to the total costs involved.

So to stay in business in such a regulatory/fiscal swamp, auto insurance companies would start jacking up premiums and denying claims.  Outraged by rising costs and worsening service, drivers would beg lawmakers to enact cost caps and more regulations against the now-vilified mechanics and insurance companies.  But the pricing rules, bizarre service regulations, and now-necessary political lobbying would drive some mechanics and insurance companies out of business, while others would learn the game and rake in the dough.  On the other hand, even the cleverest shops would have to hire legions of front-office staff to handle the increasingly tricky paperwork and guidelines.  Grumbling about long waits, co-payments, changing service providers, and extra charges for high octane fuel, motorists would forgo routine oil changes or new tires, and cross their fingers against the catastrophic breakdown.  Some motorists would seek “alternative” car care services from chanting transmission savants who’d burn incense to heal a dying clutch.

Ultimately, the bloated world of automobile services would collapse, leaving only a niche market catering to the elite.

So far, this is only a dream scenario for public transportation advocates.

Now here’s the real question:

Which would you rather have -universal health insurance, or health care?   You can’t have both.   The numbers don’t work, and we’re already witnessing the result.

In a free market, prices drop and availability improves with every technological advance.  That’s not what’s happening in healthcare, is it?   Increased demand should lead to increased supply unless somebody uses force to change the rules.

That force has been building against healthcare since the late 1800’s, when Germany’s Chancellor Bismarck made socialized health insurance the latest thing from Europe.  Wage and price controls during WWII, along with a tax exemption for employer-provided health insurance sealed a devil’s bargain at a time when technology was revolutionizing healthcare.  Costs should have come down, but they were climbing, just as house calls and bartered care were getting pushed away.

And healthcare became tied to employment, because healthcare became one and the same as health insurance.   Health insurance was a perk of work with the real costs tax-subsidized into invisibility.  This caused a moral hazard, by which people began to use healthcare services differently than if they knew the actual costs.  This started the upward climb in real costs.   So without a job to hide those costs, healthcare spiraled out of reach.

Then President Johnson signed Medicare into law in 1965.  The doctors, businessmen and insurance companies who’d previously opposed socialized medicine hardly dared to speak against this keystone in the arch of the “Great Society.”  Almost at once, market logic was replaced by all that’s worst about politics.

Not so long ago, congress started using Medicare money to pay politically savvy teaching hospitals to reduce the number of doctors they trained.  As with paying farmers to ignore farming, our congress decided that healthcare needed price supports.  Yet Medicare payments for real services have been cut again and again across the board, with the most dramatic cuts yet just ahead.

As you should expect with politics, however, these cuts don’t lower costs…just the opposite, in fact, is happening.  Proposed “utilization rate” and “self-referral” rules intended to cut costs and abuse already, for example, force doctors to order more expensive tests using ionizing-radiation instead of cheaper, safer, and sometimes even more-effective ultrasound tests.  I’ve personally witnessed this, and a good friend of mine (a medical professional himself) has suffered a far more personal medical imaging horror story in which taxpayers got charged ten times the necessary cost, and my friend suffered serious medical complications.

But there’s more to say about where we’re headed.

It’s been said that blood is thicker than water …and that money is thicker than blood.  Your mother is not writing the rules that determine when you get care, and when you die.

We’ve long ago moved past the ideal of patient-centered care, and into cost-accounting for the Common Good. That’s dangerous enough.  But we’re so collectivized in risk (while “privatized” in profit) that everyone has a financial hook in you.  We all want you healthy enough to work and pay your share of the burden.  But just as a transmission can’t tolerate a broken gear, the collective We The People (and the bureaucrats who do our dirtiest deeds) will cast you aside when you’re too weak to work.

Proper pain management is expensive, and doesn’t add to the machine’s bottom line.  Prolonging the life of non-productive cogs doesn’t make sense to the Common Good, does it?

And despite what Obama the Chicago politician promises, doctor-assisted-suicide/euthanasia is already in discussion.  Seriously.

If you’re up for reading 1018 pages, you can read it for yourself.  (I’ll make it easy…read the context before and after page 428 here http://energycommerce.house.gov/Press_111/20090714/aahca.pdf)

And the long run economics are not sane.

For the past hundred years or so, almost every nation on earth has operated on a debt-currency, central banking model that’s, well …a Ponzi Scheme that makes Bernie Madoff look like a petty pickpocket. The true costs of each generation’s debt is deferred into monetary inflation and social re-engineering as a bubble to beat all bubbles.

True, I’d rather go broke on healthcare than on war; and maybe that’s a choice to make. But going broke, in case you haven’t noticed, is a global phenomenon already; and, once again, despite what you’ve been told by the class of people with a 100-year, 100% record of error, we’re just getting started.

The third-party-payer, tax-policy-created healthcare mess we have now must go.  But what I see people debating is whether to put out this fire with dry wood, or gasoline.

As every chapter of human history amply demonstrates, politics isn’t the solution, it’s the problem.

We could fall back into funeral societies if we had to.  Without cars, we could still get around just fine.  I thank God that our politicians haven’t yet proposed food insurance, or a “universal food supply.”

But if we keep letting politicians sell insurance and practice medicine, we’ll see what it’s like to live without health.

RELATED POSTS:
https://wedeclare.wordpress.com/2013/10/15/can-politicians-even-define-health-care/
https://wedeclare.wordpress.com/2009/09/23/a-short-history-of-health-care-let-doctors-be-doctors/