Commentary on Managed Care
(licensed vs non-licensed de facto practice of medicine)



"Managed care is a social experiment involuntarily imposed upon a group of unconsenting subjects... the physician and his patient." Anon.

Monday, 15 November 2010

Commentary by
Roger S Case, MD

(Health Officer, Island County & Commissioner, Whidbey General Hospital)


This is the fifteenth  in a series of commentaries addressing the subject of the funding of (y)our medical care, and what we as wage earners (and businesses) can and must do to regain control of his/her/our healthcare dollar.

Friday, 18 April 1997

  Saturday, 26 April 1997

Saturday, 11 April 1998

Friday, February 15, 2002

Friday, 11 July 2003

Saturday, 7 January 2006

Friday, 10 November 2006

Sunday, 18 March 2007

Wednesday, 13 February 2008

Wednesday, 30 April 2008

Tuesday, 30 December 2008

Monday, 29 June 2009

Sunday, 16 August 2009

Monday, 26 April 2010

Monday, 15 November 2010

  Top of Pg.


I am writing this commentary as a deeply concerned physician, presenting these issues from my viewpoint of having been intimately involved in the practice and administration of health care in a variety of programs with military and civilian staff personnel and patients over a span of 45+ years.

A fundamental transformation is indeed afoot, change you will have to believe in – like it or not. Providers and the public had better prepare for the hidden consequences, only a few of which are presently obvious! 

There are significant issues and changes to contemplate regarding how to best accommodate the health care needs of our communities now and in the out years with the resources available to us. All providers must have a comprehensive understanding of the terms for which all will all be held accountable: “best practices”, “standards of care”  “meaningful use”, “compliance”, “comparative effectiveness” …and so on. Some of this is heavy reading, but you won’t find it dull.

This is my understanding of what the original 1,017 page bill truly projected for the future of the deliverance and funding of health care in America, should it have been passed. Of course this bill has now been superseded by a 2,700+ page bill with even more ominous features – the Patient Protection and Affordable Care Act (ACA), signed into law 23 March 2010.

There is no argument that reform is indeed necessary, but the reformation should be in the funding and accessibility to health care, tort reform, and the leveling of the insurance playing field to remove the excesses now rampant in the siphoning away of the insurance premium dollar (read my early commentaries).  The ACA does not bode well for America... The present administration knows little, if anything, about “the real world” provision of healthcare …ergo the CMS dilemma, a governmental program, mind you.

4 Nov. 2010 – And so it begins: Determination of Essential Health Benefits  
The Patient Protection and Affordable Care Act (ACA), signed into law on 23 March 2010, will “allow” individuals and businesses to purchase health insurance directly in a health insurance exchange. The law stipulates that certain general categories of care be covered; however, the specific package of "essential health benefits" is to be defined by the U.S. Secretary of Health and Human Services. At the request of the Secretary, the IOM will make recommendations on the criteria and methods for determining and updating the “essential benefit package”.   More >>  

Far more ominous — You need to know there are a couple of never mentioned provisions found deep in the "Stimulus Bill". One provision establishes a 15-member board, the "Federal Coordinating Council for Comparative Effectiveness Research" for medical care. Functionally, this is a rationing board. Three days after passage of the Stimulus Bill, President Obama named all 15 members to this board. Also in this same bill, the "National Coordinator for Health Information Technology" was charged to establish the means to "determine treatment at the time and place of care". How scary is that!!! And there are serious consequences for physicians not complying with the care determined by this activity – seriously heavy fines and even imprisonment!!   This ‘meaningful use’ compliance standard is to begin being enforced in 2013.

For more details please watch this: http://www.youtube.com/watch?v=8HnkxIh62dQ   …and more >>

Keep yourself informed, and stay well.

Roger S Case
, MD, FAAFP, retired Family Practitioner

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