Costs Must be Contained in Health Care Reform
Monday, August 31, 2009 | 0
By Eugene F. Keefe
Synopsis: Thoughts from the trenches of the Illinois workers' compensation system for our Commander-in-Chief on the tough health care decisions that face our country.
Editor's comment: The American health care expectation is:
- Unlimited,
- 100%-paid-for,
- On-demand medical care.
If/when you offer medical health care coverage, the richest and poorest of our citizens don't just expect such treatment; they are fully prepared to openly and regularly demand it. We feel American citizens of all strata are geared up to make the clarion call of "off with their heads" to any politician, editorial writer, health care insurer, physician, attorney or miscreant who doesn't wholly and intrinsically support that level of coverage whenever any kind of health care is offered to a U.S. citizen.
If you don't know it, this precise business/health care model is codified in the Illinois Workers' Compensation Act.
The Illinois Workers' Compensation Act has no defined limitation on the amount, nature or duration of medical care recommended by a treater to which the injured worker is willing to consent. None. Please don't mumble anything about the hilarious "two-doctor" rule in Section 8(a-3); that rule is only a potential limitation on rookies or the non-initiated. Any Illinois physician, hospital or health care provider worth their salt knows you need referrals to keep the "two-chains" running to the end of any selected path of care. If you have referrals in the medical charts, you have unlimited, 100%-paid-for, on-demand medical care codified for Illinois' injured workers.
If you aren't sure about the infinite provision of health care in this state at the sole cost of Illinois business, your editor handled a claim where a physician provided about $50,000 in relatively worthless injections to a claimant's neck, shoulder and wrist. The patient admitted the "benefit," if any, of the wildly expensive injections, lasted for a few scant minutes. When we deposed the doctor, he admitted he needed to stop the injections and the patient had undergone more than enough of such care. Following his deposition, in direct contradiction to his own opinions, the physician then provided another $50,000 in additional injections!! Our commission and reviewing courts sanctioned all of it to the chagrin of your editor and his client. If you need a copy of the ruling, send a reply.
We want our president to understand unlimited, 100%-paid for, on-demand medical care would work, if we lived in paradise. On this grubby, dusty, imperfect planet, it is certain to bankrupt our society. If they don't plan ahead, that "bankruptcy-thing" is coming sooner, rather than later.
We are petrified, truly scared-to-death to see the U.S. Government think they can "control" this monster. The special interests are spending billions as you read this to carve out their own little piece of what may be a giant federally-run pie. Within five years, we expect to see total chaos and skyrocketing costs — some folks peg the annual cost to be two trillion dollars per year. That is $2,000,000,000,000. Each year.
The current federal debt is a staggering $11.5 trillion — equivalent to more than $37,000 for each and every American and one short guy from Croatia. And it's expanding by over $1 trillion a year. The new health care initiative could triple that debt load.
We also point out every time our federal government tries to take over a business operation; they butcher it to the point of high comedy. We think the only thing the government does even reasonably well is to collect taxes. They do that solely to survive. They don't have to "survive" in doing anything else.
Therefore, in our view, every other federal business operation could be run better by a sixth-grade class. Consider the creaky rail system, the inefficient postal service, the rapidly-becoming-bankrupt Social Security Administration. Consider the fact the U.S. Government still has elevator operators where all elevators have been running automatically by pushing one of those easy-to-read buttons for about four decades. If you don't believe us, take a look on the web at: http://www.usajobs.org/listjobs/jobs/80497127/Elevator%20Operator.htm.
When someone starts talking about great presidents who were Republicans or Democrats, we point out Jack Kennedy, Lyndon Johnson, Dick Nixon, Gerry Ford, Jimmy Carter, Ronald Reagan, Bill Clinton, George Bush (H.W. and W.) and Barack Obama all ran or run governments that had elevator operators long after such work was completely automated. It is not possible to claim to run an efficient government when you have to admit you are using taxpayer money to pay people to push buttons and ride up and down all day like morons in new-fangled elevators. Only the shadow knows how many other ways the federal government is blowing money.
Trying to understand what a mess unlimited, 100% paid for, on-demand medical care means:
We have one claimant who has literally been treating for her entire adult life.
- She is in her mid-50s.
- She has had more than 20 surgeries, many of them major.
- Some of them are arguably "related" to work, some of them are not.
- She is always getting ready for surgery, recovering from surgery or trying to find another area that needs surgery.
- Medical care for her is well into the millions — the cost has been split between various health care insurers and workers' comp policies.
- She injured her low back in the earlier 1990's.
- Medical care is well into the millions and is still cooking with a "pain physician" recommending lots more.
- The most recent MSA value is well over $500,000.
- We inherited the file about six months ago; the case is almost two decades old and still pending.
These sorts of folks have to be reined in with some meaningful objective guidelines. If the feds aren't prepared to slow them down and sign up for all of it, the taxpayers better start expecting giant tax increases.
Looking at these folks from the perspective of Illinois WC, it is our assertion that, if a nutty claimant had the "right" claimant lawyer in front of the "right" arbitrator, they could legally "force" an Illinois employer or insurance carrier to pay for such unlimited medical care. The only limitation would be on the interest level of the claimant lawyer who would eventually grow tired of the game and tell the claimant to settle so they would be paid for their patience and efforts.
Most Illinois employers don't like the basic IWCC model that controlling otherwise unlimited medical costs is left up to non-medical professionals who may become friends with or at least cordial to the many attorneys who appear before them. We don't care if it is Republicans, Democrats or Independents; we are going to need some clearly defined way to control skyrocketing medical costs. We need it in Illinois workers' compensation and we are going to need it in the federal health care system.
We think the best possible concept is utilization review (UR). We learned about it from a claimant attorney who brought it to our state. We are certain UR is controversial, like the so-called "death panels" that were recently ballyhooed in the press. But you have to draw a line somehow and somewhere. Medical care has to be limited in a fair and impartial fashion. If you have a concept better, faster and/or cheaper than UR, please send a reply and we will share it with our readers.
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Eugene F. Keefe is a partner in the Chicago law firm of Keefe, Campbell & Associates.
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