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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Can politicians even define “health care?”

I’ve worked in healthcare since 1978 in public health, research, clinical, education and industry roles.  And I can’t tell you what healthcare is.

Ascelpius-V-PoliticsTo my wife, it’s massage and things that smell nice.  To others, it’s Reiki, or heterodox nutrition.  Some debate that vaccines are bad medicine, but marijuana is great healthcare.  And they have convincing arguments.

Is gender-reassignment, or voodoo healthcare too?  I don’t know.

I think cardiovascular science and technology is really cool stuff, it’s my specialty, and I think it should qualify as healthcare.  But as for everything else?  I can’t even give you a clean definition of “health.”  And I’ve been in the business my whole life.

Politicians sure think they know all about it.  And by the Election Day polling numbers, well-over 90% of us believe and trust that politicians should control …everything.

But after the more than 100 years the unionized AMA has wielded political monopoly power, the 80 years of taxpayer subsidized health insurance, 60 years of socialized health, education and welfare, and the almost 50 years of even more directly socialized healthcare in the form of our rapidly swelling Medicare system, I’m appalled that we think we want more politics in healthcare.  I’m disgusted that we’ve been lead to believe that health insurance is what we want when that is often antithetical to healthcare.  And I’m embarrassed that We The People haven’t seen a better way to live that’s always been right before us.

In every field of science, technology and plain old merchandise that isn’t so political, costs decrease while quality, efficacy and availability increases with every new advance.  Luxuries of yesterday like cellphones and personal computers are now ubiquitous and powerful necessities.

The in-your-face availability and range of price/quality in shoes, coffee, kitchen gadgets and even things like used magazines and historical wristwatch reproductions has become amazing in a relative freedom from political control.

There’ve been innumerable healthcare advances in the last century that would’ve made healthcare cheap, effective, and easily available to all…if not for all the politics that’s been creeping in since Teddy Roosevelt’s time.
Politicians have already made everything related to medicine unfair, complicated, ever-changing, severely limited, and ghastly expensive.

And they’re not done yet.

However, none of the preceding is any part of my main objection to more politics in healthcare.
I’ll let others quibble over whether politicians will finally be able to keep a promise, or make something work at all as advertised.

The real problem, whenever we rub that genie’s lamp of politics, is corruption, and calamity.

Everything government does, it does by force.  Politics can’t do anything without at least the threat of fines, taxes, courts, guns and prisons.

It’s easy to dream that this kind of force can be used for good.  But the usual reality, as evidenced by all of human history, is a scale and degree of injustice and death that only politics can achieve.
Power is of course a seduction for those who’d wield it.  But it’s just as attractive to those who can simply buy the portion of such power as suits their purposes.

And make no mistake.  All power is for sale.

Whenever politicians are allowed to steal a new power, there’s a new industry in lobbying for the use of that power.  We can see how that lobby has worked for the military industrialists and bankers, and we should see what it has done to our health, education and welfare as well.

Adding more power to government, with more snooping into things that are more personal than ever before possible, only makes the resulting corruption more dangerous.

Hitler’s infamous “T4” eugenics/euthanasia program under Germany’s socialized healthcare system certainly demonstrated one hazard in giving politicians so much power over life.  But think about what we already know of our own government; what they’ve admitted to from the past (testing plutonium on school kids, syphilis experiments on black men, experiments on soldiers), and what they’ve been forced to admit recently about their spying, militarization and deceit.   Think hard about how much more secretive, powerful and deceitful we know our government to be now than ever before; and just what such a government is capable of doing with the actual coding in our cells.

And changing the role of healthcare workers from healers to government agents who’ll give to politicians everything from your DNA to your intimate personal and family details, will, over time, change the sort of people who’d seek out such a career.
You really shouldn’t want that to happen.

We The People have exactly and only what we have freely and repetitiously chosen not just every every day we sigh, and yield to what we know is wrong and isn’t working; but also every Election Day.

Elections were meant to be a means of peaceful revolution.  We’d better finally use them for that purpose, because the power over our bodies we’re granting to politicians now will have no good end, unless that end is determined by our change of heart and mind.

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

Huxley Only Imagined…

Well now.  Here’s something interesting

Not only is the Orwellian title attention-grabbing in its own right (and absurd, since experience hath shewn that governments by their nature do the opposite of “save lives.”), but just read this perversity and see if you don’t get cold chills.  Just think about the ramifications – our corrupt, foolish and selfish politicians collecting and owning all DNA data from everybody born in the USA:

  • Our politicians’ record with data security (from both hacking and plain old screwups) is just awful.  Mistakes will be madeHuge ones.  The United Kingdom, our apparent role model, already screwed up with DNA samples, among other things.
  • You think “pre-existing condition” exclusions are bad now!
  • What little good could come out of such a thing is certainly outweighed by sci-fi mischief and Keystone Cops incompetence.

Oh, but it sounds so well-intended and helpful, doesn’t it?  What’s the history of that as applied to politicians?

Anyway, it’s scheduled for debate in the House of Representatives.  Nearly all reps will vote on this without having read a word of it.  They may tell a 20-something legislative aid to read it for them, but most of those starry-eyed future congresscritters haven’t lived long enough to get through a history book and they’ve never heard about such a thing as constitutional limitation of powers.

It’s up to you to tell your reps what’s what and just who they work for.  Brave New World?  It’s still your choice.

Choose wisely.