“Culling the Herd”
Good evening. I am Dr. Chris Casscells, a practicing orthopaedic surgeon in Wilmington. My father, Dr. Ward Casscells founded the practice here in 1949, and his mentor, my Godfather, Dr. Alfred R. Shands founded the AI DuPont Institute for Children. Health care is my life and my calling, and that calling is coming to an end. We doctors are the victims of our own success. We have kept too many of you alive too long, and you are costing the government too much to live.
The driving force behind “reform” is escalating Medicare costs and to a lesser extent, for profit insurance rates. Private Health Insurance, introduced during the FDR wage freeze during World War 2, and Medicare, introduced in the sixties, created an inflationary decoupling of cost and benefit, and eliminated the free market and our system of charity hospitals, where young doctors trained. Health care costs are now concentrated to the last few months of life. Since too many people have lived too long, and are expected to cost a lot before passing, they are the low-hanging fruit to fix the bankrupt Medicare system. They need to die sooner. Current legislation as passed is front loaded to eliminate care for seniors which will shorten life span.
In the first two years, there are 2 major Medicare cutbacks to large hospitals, one major cutback to home health care services, cutbacks to extended care and rehab facilities and nursing homes, and one cutback to psychiatric hospitals. As of March 31st, unless Congress acts immediately, there is a 21% cut in Medicare fees to doctors. If you spend less money on seniors, their life span will shorten. If you pay hospitals less, they will spend less on your care, fewer nurses, cheaper medicines, and earlier discharges. You get the picture. As we speak, the Wall Street Journal projected this week a shortage of 150,000 doctors in the country within the next few years. This does not account for the approximately 1/3 of doctors now practicing who are planning to retire because of this legislation according to the New England Journal of Medicine last month. Most doctors I know are going to immediately restrict access to their practice. Personally, we have cut employees and expenses. There will be limited access to care. It’s called rationing by inaccessibility. Fewer services, more patients, get in line for a long wait. If you don’t like your insurance company denying coverage for services, know that Medicare denies more care than anyone. This is only the beginning.
This outcome is profitable for the government. It is called “Culling the Herd”. Make no mistake; this legislation does not fix health care. It intends to fix the insolvent government’s bankrupt insurance products, Medicare and Medicaid, but probably won’t do that either. It does raise taxes on everyone who pays taxes, currently 53% of the citizen population. It will not increase access to actual health care for anyone. It will ration delivery of health care, first to Medicare and Medicaid recipients, then in 8 years to everyone. It needs to be repealed and fixed incrementally by people who actually know what they are doing and actually care about people. So, who do you trust your health to – your Congress? Your IRS agent? Your lawyer? The “healthcare provider” who works for the government clinic? Or your doctor? It’s up to you.
Tax Day Tea Party 2010, Health Care Reform Comments by Dr. Chris Casscells
April 19, 2010 by charliecopeland
Dr. Casscells did an excellent job repairing my ACL a few years ago and I hope he stays in business long into this “new era”.
Unfortunately, based on his and others’ evaluations, I fear that skilled medical professionals like him may become a rare commodity if Obamacare metastasizes in its entirety throughout the fabric of our society.
This will only be exacerbated in the coming years due to the fact that many of the best and brightest in my generation, instead of becoming doctors, have flown the pre-Med coop for the less rigorous, but more rewarding (financially, in the near term) banking professions on Wall Street.
It does raise taxes on everyone who pays taxes, currently 53% of the citizen population.
I wouldn’t want to go much over 53%
Medicare is of course funded by wage taxes which are paid by everybody who gets a paycheck.
Almost half of Medicaid is paid by states, and in Delaware you pay state taxes if you earn as little as $2000.
And the new health care law does not raise taxes.
The so-called Medicare “cuts” are cuts to private insurance providers in the Medicare Advantage program. Benefits in traditional Medicare are actually increased – not exactly a recipe for rationing of care and early death.
This does not account for the approximately 1/3 of doctors now practicing who are planning to retire because of this legislation according to the New England Journal of Medicine last month. Most doctors I know are going to immediately restrict access to their practice.
This is awesome – physician ranks are badly in need of fresh blood. These older politically conservative physicians will no doubt be replaced by younger, equally skilled doctors with a better head for economic reality.
“I’m not an economics expert, I just play one at tea party rallies”
To the Readers of Resolute Determination:
You have a simple choice.
Do you believe the comments of a distinguished physician whose background is available for all to critique? Whose familial love of medicine has improved the lives of thousands of Delawareans and children?
Or do you believe the railings of an anonymous blogger who doesn’t have the strength of his/her convictions to publicly state his/her name so that we might evaluate the source of the comment?
I leave it to you to judge.
I thought you guys had moved past this “deather” junk after being embarrassed by it last summer.
Readers, please do feel free to fact-check my claims against the good doctor’s.
I know Charlie would like to shift the ground to social status, where he feels more comfortable. But I prefer to deal in facts.
anon-I do deal in facts, and in real person. The good doctor is correct, but you probably won’t find out until it’s too late. By then, you will have to navigate thru layers of Walmart providers, yet to be determined in title as a mid level provider–BEFORE–you get to a real person–er I mean doctor.
Here’s an analogy for you–business thought phone trees were great–and yes for many things they are–but for those tricky lil’ questions that don’t meet any of the phone tree criteria–we all know, you can be looped forever, put in a queu, disconnected, or be told you are calling during the wrong time–my mortgage statement is one thing–my health care is another. Sure a business model can be applied for the administrative care–but I’d like a real, live operator–when it’s a real life I’m dealing with. I will never know why people think healthcare can be great without much expense. They will spend 10k on a family week at Disney, and 40k on a wedding, but meeting a yearly deductible to keep or restore someone to good health, receive an organ, undergo chemo, or have a life saved is OUTRAGEOUS. Healthcare costs. I know it’s the flat tire in everyone’s budget–but if you want the kind of healthcare from pre-cradle to almost beyond grave that everyone expects, and many feel is a right–then you better be prepared to pony up for the privilege. And if you truly are needy, or infirmed then by all means the government should be looking out for you. But until then, I’m willing to pay for my great healthcare, because once the government gets involved, it will become just healthcare–as standard issue as sea rations–sustainable yet objectionable.
But until then, I’m willing to pay for my great healthcare,
You will always have the right to pay more for your healthcare if you want to. Nobody is taking that away from you.
Joanne – your agreement that Obama is killing grannies, is noted. Please keep promoting the deather talk all the way to November. We are counting on the otherwise sane Republicans like yourself to lend your calm quiet approval to the crazy talk.
Now back to the facts:
1. The new health care law does not raise taxes.
2. Medicare benefits are increased (by trimming fat from payments to private providers in Medicare Advantage).
These are checkable facts, not poll questions. It doesn’t matter how many upstanding Republicans write in and say that a lie is the truth.
The thing about physicians needing fresh blood? Well OK that was just my opinion. A pretty good one I think.
How arrogant to assume that you have a lock on the market. If you are not serving patients, they will go elsewhere, especially once they have an insurance card in their hands.
Whatever happened to the conservative faith in good ol’ supply and demand? If the price goes up, more providers will enter the market. Drill here, drill now!
OK, I fact-checked myself – the law actually does raise taxes, on incomes over $250k and tanning beds.
1. The new health care law does not “raise taxes on everyone who pays taxes, currently 53% of the citizen population”
There, fixed. All ready for fact-checking again.
A simple question to my anonymous friend who thinks that he gains credibility by touting Reuters…
Why are friends of the Administration beginning to float a VAT (a sales tax on 100% of people and highly regressive) and why has the CBO stated, only after the healthcare bills passage, that the current government expense forecast is unsustainable?
I think you know the answer, buy cognitive dissonance won’t let you admit it.
Trying to change the subject again?
OK we can have that debate if you want, but first let’s deal with the obvious mis-statements of fact in the doctor’s speech about taxes and granny-killing.
And if you want to talk about “friends of the Administration, ” just be aware “friends of the opposition” are fair game too.
thinks that he gains credibility by touting Reuters…
I think everybody here will thank me for linking to a mainstream news synopsis rather than posting vast swaths of the health care law.
Actually anon, I’m arguing that keeping granny going is REALLY going to cost–as it is now–but going forward, and no financial vested interest by family etc…, all of a sudden, people have a renewed sense of “go ahead, start that chemo on my debilitated, nursing home based great grandmother for the last 11 years, that a “spot” was just found–because “we” want everything done…AND she has insurance for it all….and “we” have to do “everything”, because a beating heart is more important than human suffering, dignity, and guilt of choosing a comfortable, compassionate option. Oh,and by the way–I live in Sioux City, have a business, family, and responsibilities–but tell her ( when she’s alert, or not delusional) I’ll be in for a visit on Groundhog’s Day—if there isn’t a snowstorm.” No anon, our lives now are the very product of excellent healthcare, underwritten by insurances, but expected to be the same cost as some 1962 figure by consumers. Healthcare ain’t Ma Bell.
While I agree, there is some VERY needed, and transformational aspects to this bill, I am thrilled to see come along–I just think aspects of this bill should have been served seperately–or in time–the whole program will tank, leaving folks angry at all HCR, and many pieces to pick up. No, I’m not one asking for repeal–I move forward–but I do think I quick giddy-up is in order, for some of this DEVASTATING impact, in short order it will have on people “who think” they will have coverage–and the reality of no provider who can stay in business to provide coverage at the automatic reduction in benefit occurring in Congress every year for that government sheckle. And your supply/demand theory really can’t kick in as quick as this HCR does. Great doctors are about 8-12 years in the making–and even after all this time,we still haven’t been able to speed that process up. But I guess there is always room for that great kid at the county fair, who has a way w/ animals–didn’t want to go to vet school (BTW is more competitive)–but I bet we could set him up to be delivering babies and call him something. You wait–the lesser, and mid-level provider will become the bottle neck–of this stinky situation, then American will again complain they don’t have healthcare–but have been stuck w/ healthcareless. Again, as I argued before–consider HMOs, a lil’ window of what’s to come. It looks great on paper, makes complete sense, but the actualized model is NOT what Americans want, and quickly opt out if there is a chance. HCR will be the HMO USA–and it will be forever to undo it. Meanwhile, providers will close, restrict, or retool–because they’ll have to. Two of those three options aren’t real encouraging. Of three providers in my immediate family–each one has chosen an option to be executed this coming year–and the “retooler” isn’t real sure it will be a good fit, to stay in the field. We’ll see. So your “drill here, drill now” can’t happen, unless you prefer a tattoo artist to do your surgery, instead of one of the incubated, educated, disciplined, time committed, providers that happen to provide knowledgeable, competent, premier care, but needs a very expensive education to get there. Can’t imagine many underwriting that dream, when the student loan debt has yet to be addressed (in specialties) to any clearly defined measure.
Of three providers in my immediate family–each one has chosen an option to be executed this coming year
Isn’t that a little drastic?
I respect Dr. Casscells opinion as that of an industry insider. It’s no surprise he fears reform.
Medicare is not “bankrupt” or “insolvent”. That’s just anti-government propaganda. Kaiser Foundation says in 2017 we will have solvency problems. Reform is aimed at preventing insolvency. This is not brain surgery. What is there not to understand?
How Dr. Casscells can claim financial hardship for doctors is hard to figure. According to Forbes, medical professionals dominate all the top paying jobs in America. 9 of the 10 top paying jobs were medical in 2008. Surgeons #1. Anesthesia #2. General practitioners #6. Corporate CEO’s are a sad #10.
It’s hard to imagine medical professionals finding any greener pasture than the super lucrative business they’re already in.
Dr. Casscells manages to twist things to the point where spending $500 billion a year on Medicare dooms seniors to untimely death, “culling the herd? Killing off the low hanging senior fruit. $500 billion for Medicare is a plot to hurt seniors, kill them off early. You really have to be an anti-government zealot to come up with that. AARP likes reform. AARP says talk of encouraging death for seniors is nut talk.
On the matter of who do you trust? Medicare fraud is costing us $60 billion. Government insurance isn’t the problem. Stealing is the problem. Unscrupulous physicians, hospitals, equipment suppliers are robbing insurance companies blind. The FBI says medical fraud is epidemic. Congress just added $200 million to police the industry. The biblical proverb “physician heal thyself” comes to mind.
If those we’re supposed to “trust” were not robbing Medicare, we would not have the problems we have. Without strong aggressive oversight (somebody coming between the patient and the medical industry) fraud would devour the system.
Pharmaceutical giant Pfizer is paying $2.3 billion to resolve criminal and civil fines involving collusion with doctors. CEO of Tenet Healthcare, a leading hospital chain, indicted for fraud. California cardiac surgeons indicted for performing hundreds of unnecessary bypass operations on victims who trusted the doctor. In Miami, FBI busts eight phony clinics set up with phony patients billing Medicare. Just the tip of a corrupt iceberg. Google “doctor indicted”. The results are scary. Ask the Jackson family who they trust.
Doctors are indeed special. God bless them for the work they do, the miracles they perform. But it’s not sainthood. Not some closed society we let do anything anytime for any price. Anytime you mix vulnerable consumers with a high powered for profit industry, the need for strict oversight is obvious.
The primary driver of escalating medical costs is technology, not private insurance, not Medicare, not a decoupling of patient from costs. Medical science is what has changed the cost equation most.
When Medicare started, there was no $3 million MRI suite offering $4000 scans. No $1.5 million dollar DiVinci surgical robots. No human hearts bypassed or flown cross country on ice for implantation. No titanium body parts or $10K a month drug regimens. Doctors tools fit in a black bag. We did not need a lawyer or living will to unhook us from the million dollar apparatus of modern medicine.
You can blame third party insurance for creating these miracles. There’s no market for this technology if patients had to pay. It’s the gift that keeps on costing more and more.
Dr. Casscells needs to understand we are putting limitations in place. Otherwise his industry is going to parlay our desire for eternal life into an all consuming expense that will bankrupt America.
Reform is a step is the right direction. If things go sour we will do mid course corrections. He should be for this reform not against it.
Doctors who leave this most lucrative of all professions will be replaced by others. The threat of quitting medicine, refusing to heal people, has no more public appeal than the Wall Street banker who says he will quit if his bonus is cut. So what? High paying jobs rarely go undesired for long.
Dr. Casscells says “Most doctors I know are going to immediately restrict access to their practice.” Have they squared this with the Hippocratic Oath? Or are they too busy going over their 401k statements?
Great doctors are about 8-12 years in the making
So let’s get started. It takes time to break a cartel.
If prices and shortages go up as much as Dr. Casscells thinks, that will bring ‘em in to medical school.
Also, don’t forget the nurse practitioners and community health centers. Doctors don’t want you to know that at least half of what they do can be done by an NP (at least for certain fields like GP, GYN, peds…)
The Miami bust up of millions in Medicaid/Medicare had nothing to do with a practitioner–it was computer based, in an office by some “entrepeneur” who learned the system.
And why bemoan someone’s “lucrative” profession? Think about it, it may be lucrative as an end result–but those are earned dollars. Short end on the front entry–w/ interest as they went along. Earned by actually having to do the surgery, see the patient, get up at night, work long hours, be on-call, interrupt other plans etc..They’re not just making money, because they are a doctor–they are working continually. CEOs get to a point, where they are a brand name, or figure head–your doctor doesn’t–he does have to see you, touch you, prescribe, evaluate, surgery etc. The business doesn’t run on it’s own–lots of hours doing all the important things. Unless you’re Dr. Oz, there’s no syndication fees being collected. It’s show up, do the job, for your pay.
No, not drastic at all those 3 practitioners–realistic to the situation at hand:
Cardiologist at Scripps–could have been retired 8 years ago, LOVES his work, patients, research etc.–but the 136 buck reimbursement–soon to be cut again, on a gravely ill patient necessitating a 2-3 hr. consult/evaluation, has to be stretched a bit far w/ overhead of salaries and office expenses. His practice is not “just sore throats, and red ears”, yet his reimbursement is established as such. But…but…but..they have insurance. Well, the feds aren’t sending enough.
Oncologist in group practice–she travels to a rural satellite once a week, necessitating 8 hours car time. Guess which clinic isn’t going to be re-contracted, because of decreased reimbursement, lost patient time, at an already busy home site–and just the whole disgust of mandated and legislated care? Serving the needy wasn’t her deal breaker–but working harder to be able to serve the needy was.
And lastly– a dentist–seriously looking to phase out a private practice, and just join the Public Health Corp–regular hours, vacation, guaranteed check, pension, and a long line of anonymous lives–just like your local deli.
And yes, doctors do know NPs can do much of the work that is routine–and hire them in full measure–but that care isn’t cheap either–and as one MD told me–I can’t afford them, because they visit and talk too much (a good thing for some patients), and again, the reimbursement is per patient–so it is a consideration.
Anyway it’s a mess–let’s just hope we don’t get too far, in this sweeping legislation, that we don’t go too far in NOT being able to deliver REAL reform.
Just wish Americans could see the “real” fees being collected in their behalf–and quit pointing out the abberancies of billing that happen, but hardly reflect the whole story.
joanne, who’s bemoaning a lucrative profession? I love making as much as I can as long as nobody gets hurt or swindled. As a small business owner I found hard 24/7 work is the only way to do it. No problem with high earners here. I was responding to Dr. Casscells trying to say doctors will fold up and go elsewhere for better money. Like things are tough out there in the medical field – when the fact is it’s the highest paying.
I hope you agree corruption in the health care industry, including doctors, hospitals, equipment providers, in home service providers is a major problem we need to smash. Medicare Fraud Strike forces are starting to set a new tone.
A very good friend of mine made super big money twice in his long careen in medical equipment. Once in the 80′s selling modified Lazy Boy recliners as “life chairs’ and selling $50 dollar TENS electronic pain gadgets to Medicare for $750. He is now experiencing another bonanza as top gun at the Scooter Store. Frankly I am not sure if we can afford to provide our seniors with such a nice set of wheels. It’s a very nice idea. If we try to cut back on that they will squeal as loud as Dr. Casscells.
I am a fiscal conservative. Very much a deficit hawk. Very concerned about health care inflation sucking the air out of our economy. Concerned about the looming financial problems of Medicare. I’m not sure what the argument is here. I’m just saying if Medicare goes from $500 billion to the projected $900 billion in ten years we are screwed unless we act now. I never thought I would see red blooded conservatives so eager for a free lunch. No taxes. No deficit. Plenty of spending on Medicare. What’s with that? What am I missing?
So this fiscal conservative says let’s all sacrifice. Maybe a tweak in the payroll tax ceilings, maybe some fee cuts, maybe tighten up on high dollar treatments and Scooters. it’s what conservative Republicans preach all the time. Belt tightening. Limits to what government can spend. So now we start down that path and what do we get from a super conservative Tea Party doctor? He wants more money from the government program, and says if they put limits and cuts in place, his colleagues will just turn their back on the elderly, stamp their feet refuse to treat them. All the while spouting hot air about government plots to eradicate sickly seniors.
The first political words that resonated with me were the old quaint JFK “ask not what your country can do for you, ask what you can do for your country”. I pondered the meaning of that for a long time. I didn’t quite get it. Now I do.
The following “friends” are US Senators who voted against a John McCain sponsored Senate Resolution to disavow the use of a VAT:
Republican George Voinovich of Ohio, and a dozen Democrats: Daniel Akaka (Hawaii), Jeff Bingaman (N.M.), Sherrod Brown (Ohio), Robert Byrd (W.Va.), Ben Cardin (Md.), Byron Dorgan (N.D.), Ted Kaufman (Del.), Carl Levin (Mich.), Jack Reed (R.I.), Tom Udall (N.M.), James Webb (Va.) and Sheldon Whitehouse (R.I.). That vote will look especially inviting to challengers on Jim Webb’s 2012 re-election resume.
As I asked previously, why are friends of the Administration beginning to float a VAT (a sales tax on 100% of people and highly regressive) and why has the CBO stated, only after the healthcare bills passage, that the current government expense forecast is unsustainable?
Simply because the healthcare reform bill will require taxes to go up on everyone, and the left is preparing to propose the most regressive form of taxation… a sales tax (aka VAT).
Hey, I remember another guy who kept demanding anti-tax pledges, and railing against non-existent sales tax proposals… How’d that work out?
Actually anon–it probably worked out pretty good. Put Delawareans on “high alert” that a sales tax was in the atmosphere, clearing the way for a pre-emptive warning to their respective legislator–”Don’t even try it–not even at the 11th hour of those budget meetings…” So far so good.
Put Delawareans on “high alert” that a sales tax was in the atmosphere
It also successfully headed off the invasion of the Venusian army, so I guess you are right.
Charlie, by regressive tax I guess you mean a tax that hits low income earners harder than high income earners. The “left” is not really known for regressive. I doubt they are going to be pushing regressive taxes. Can progressives be regressive too.
This post started out with the Tea Party death panel “culling the herd” conspiracy theory. Now it’s health reform means progressives imposing regressive taxes for everybody. Can we move on to who really demolished the Twin Towers?
a poster here writes of the plight of the cardiac doctor who had to do a 2-3 hour consultation for the low low Medicare fee of $135. No mention of the 5-10 minute consultations done for the same fee.
When my 85 year old aunt died after being hospitalized for 2 weeks, I noticed on her invoices that 6 doctors visited her room the day before she passed. 5 visited the day she died of what was described as natural causes. They all billed Medicare for dropping by the room. I figure if they were there for five minutes that around $1000 an hour. Cool. It was obvious to me this is a scam. I can just see the pager message: Medicare opportunity in room 606 . .
President Obama is certainly not ruling out a VAT – the most regressive type of tax available.
I guess what I’m saying is I would be totally surprised if the American version of VAT was repressive. We pride ourselves on progressive taxes. If Obama is the guy that changes that, well he comes right off Mount Rushmore in my mind.
I hope you are getting your Financial Obligation Act idea circulated. The idea of constructing a new kind of money connection between corporate behavior and executive wealth is timely to say the least. Just what modern day Capitalism needs. A bit of a kick in the ass.
Before we get to a VAT first we should try the FAT. The Financial Activity Tax would tax financial institution profits and executive pay.
There is no reason to increase taxes on our declining wage base. The US economy has shifted away from a wage-based, manufacturing income toward an income based on manipulating finances. So those transactions are the new economy, and taxation needs to follow the money where it is being made.
Bankers and the wealthy will object, but once the tax burden is lightened on wage-earners (i.e., their customers), they may be pleasantly surprised at the results.
I don’t think the US economy has shifted from honest work to financial manipulation. Some greedy white collar sociopaths for sure, but that can be fixed.
Somebody needs to crunch those “lost” manufacturing jobs numbers in a way the puts it in context with all the new post industrial jobs. People who used to sew socks and sweaters, assemble brooms and shoes are now writing HTML or running eBay stores. Companies that used to have big smokestacks now have brain training rooms. Apple Microsoft Sun Adobe Intel Cisco they must be manufacturing something, because the world sure buys a lot of it. If you live in South Korea you buy the world’s finest graphic editing software directly from Adobe in California for $500. It’s delivered directly to your computer in Korea where it runs on an Intel chip also from California.
It is a little scary living on brain industries rather than brawn industries, but times change. We can fix Wall Street if the GOP plays ball.