A Health Care Offer We Can't Refuse

There are reports that some hospital associations and the AMA have come to an agreement with President Obama on health care reform. Here's some advice for these hospital administrators:  Run, don't walk, to your neighborhood video store and rent Martin Scorcese's masterpiece Goodfellas. 

Goodfellas is based on Wiseguy, a 1990 novel by Nicholas Pileggi. The movie, based on a true story, traces the rise and fall of three gangsters. One particular scene is a good analogy of Obama's modus operandi for passing health care reform.

In the scene, a restaurant owner has difficulties with Tommy, one of the gangsters. The owner visits Paulie, the crime boss, to plead for help. Paulie demurs, asking, "What can I do?" Henry (another gangster) suggests Paulie become a partner in the restaurant. The owner agrees, and then quickly discovers that Paulie is not the "partner" he had in mind.

As Henry
narrates:

Now the guy's got Paulie as a partner. Any problems, he goes to Paulie. Trouble with the bill? He can go to Paulie. Trouble with the cops, deliveries, Tommy, he can call Paulie. But now the guy's gotta come up with Paulie's money every week no matter what. Business bad? **** you, pay me. Oh, you had a fire? **** you, pay me. Place got hit by lightning huh? **** you, pay me."

The mob uses the restaurant as a front for stealing and other criminal activity. In the end, Tommy and Henry torch the restaurant for the insurance.

So now the hospitals, AMA and insurance companies are visiting President Obama. The President likes to refer to the government's role in health care as a
public option. But just like the restaurant owner, they will soon discover that Obama and the federal government will not be a "partner" and his health care plan will never be merely an option. Very soon the American health care system could be controlled 100% by Obama and his friends. Some examples:

Acorn 

As I wrote previously, ACORN and the community organization brigades have already plundered a hospital of resources. When Michelle Obama was promoted to Vice President of the University of Chicago Medical Center she ran something called Community and External Relations. So a Senator's wife, with no medical background or health administration experience becomes a vice-president of a major American hospital.  Why does a hospital do this? Obviously, the hospital needed Senator Obama's help, maybe with legislation, maybe with reimbursements, maybe with the unions. So Mrs. Obama becomes a Vice President, her salary is tripled to over $300,000, and suddenly the hospital is sponsoring ridiculous community enterprises like Principal for a Day and Real Men Cook celebrations. Luckily for the Medical Center, Senator Obama became President Obama and Mrs. Obama's position as Community and External Relations Director was quietly found to be no longer necessary.

SEIU

Like the UAW and GM, SEIU has big plans for health care.  According to this article, in 2008 SEIU represented 17% of hospital workers in the United States. They achieved this amazing result by "pursuing organizing efforts in sectors that are growing with taxpayer money," most notably, health care.  As Steven Malanga writes:

This lucrative business for SEIU has turned traditional notions of union organizing on its head. Since government pays nearly half of all medical bills in this country, SEIU has scored many of its biggest victories working as a powerful lobbyist, often in collusion with employers rather than in confrontation with them. In New York State, for instance, the union's local, 1199SEIU, struck up an unprecedented partnership with an employer group, the Greater New York Healthcare Association, and together campaigned relentlessly (and mostly successfully) to protect and expand the state's Medicaid program -- the most expensive such program in the country. Hyperbolic ads produced by the alliance condemned former Gov. George Pataki in 1999 when he tried to reform and trim the state's Medicaid program, and again in 2007 when newly elected Gov. Eliot Spitzer targeted the bloated program for cost savings. In both cases politicians backed off as their popularity ratings sank from the advertising onslaught.

Eighty-three per cent of the hospital workforce is yet to be unionized. Going state by state, hospital by hospital, or politician by politician is time-consuming and expensive. It's easier to call on your partner, President Obama, to pass health care reform. Once the federal government is paying all the bills, one of the new reforms could easily be that all health care workers will now be represented by a service employees union.

The Trial Lawyers

This group's role in Obama's health care reform is more difficult to ascertain, since the status quo seems to work extremely well for them. All a plaintiff's lawyer has to do today is find a patient, call the physician or hospital's malpractice carrier and threaten to sue. The insurance company compares the cost of defending the doctor versus settling for a few thousand dollars and decides to settle. Call it a legal "shakedown."  The lawyer earns 40% for a few phone calls and a letter or two. The insurance company promptly raises the doctor's premium. The doctor raises his fees to patients with private insurance (since he is precluded from raising his Medicare and Medicaid fees) and continues to order multiple tests to verify every decision he makes on the off chance that one of those cases just might go to trial. Yes sir, the trial lawyers have one sweet setup.

So why the silence from the legal community as Obama and the Democrats, (to whose campaign coffers they have contributed mightily) try to reform away their livelihood? The trial lawyers have a very big seat at the table, since Kansas Governor Kathleen Sebelius, who used to work as the
chief lobbyist for her state's trial lawyers association, is now Secretary of Health and Human Services.

Actually, the thank-you gift to the trial lawyers is included in the House's health care reform bill, as reported in the Wall Street Journal.  Should the Democrats' health care plan actually make it through Congress, I suggest we all keep a close eye on  ERISA, the Employee Retirement Income Security Act of 1974:

ERISA establishes minimum standards for retirement, health, and other welfare benefit plans (including life insurance, disability insurance, and apprenticeship plans).ERISA is administered by the Employee Benefits Security Administration (EBSA), a division of the U.S. Department of Labor (DOL).

In other words, ERISA, through the Department of Labor, sets the standards for our managed care plans. But there is one huge provision in ERISA law that has stuck in the craw of every trial lawyer since its inception:

The most important thing to understand about what ERISA does not cover is a legal remedy for damages resulting from injury, suffering, or death, under a managed-care plan. You may be able to sue an ERISA-governed plan to get coverage, a certain test or procedure, but you cannot sue for damages that occur if there was a delay in getting care - even if this results in injury, economic loss, or death.

Do you understand this, average American patient? As the law stands now, trial lawyers are prevented from suing your managed care company for punitive damages! Imagine being a lawyer and seeing all those gorgeous jury awards for pain and suffering just waiting to be plucked and being told, "Sorry -- I'm protected by ERISA." There's only so much blood you can get out of a single doctor or hospital. But the managed care plans are gigantic turnips! So once the behemoth health care bill is finally dumped on your legislator's desk, I will be willing to wager that somewhere in its depths will be obscure language concerning ERISA. Because if there is one thing I know about lawyers, they don't stay quiet without a very good reason.

So buy some popcorn, rent the film, and take some notes. As for the health care movie we find ourselves in -- the credits haven't rolled yet. There's still time for a plot twist and maybe, just maybe, an alternate ending.

Carol Peracchio is a registered nurse.
There are reports that some hospital associations and the AMA have come to an agreement with President Obama on health care reform. Here's some advice for these hospital administrators:  Run, don't walk, to your neighborhood video store and rent Martin Scorcese's masterpiece Goodfellas. 

Goodfellas is based on Wiseguy, a 1990 novel by Nicholas Pileggi. The movie, based on a true story, traces the rise and fall of three gangsters. One particular scene is a good analogy of Obama's modus operandi for passing health care reform.

In the scene, a restaurant owner has difficulties with Tommy, one of the gangsters. The owner visits Paulie, the crime boss, to plead for help. Paulie demurs, asking, "What can I do?" Henry (another gangster) suggests Paulie become a partner in the restaurant. The owner agrees, and then quickly discovers that Paulie is not the "partner" he had in mind.

As Henry
narrates:

Now the guy's got Paulie as a partner. Any problems, he goes to Paulie. Trouble with the bill? He can go to Paulie. Trouble with the cops, deliveries, Tommy, he can call Paulie. But now the guy's gotta come up with Paulie's money every week no matter what. Business bad? **** you, pay me. Oh, you had a fire? **** you, pay me. Place got hit by lightning huh? **** you, pay me."

The mob uses the restaurant as a front for stealing and other criminal activity. In the end, Tommy and Henry torch the restaurant for the insurance.

So now the hospitals, AMA and insurance companies are visiting President Obama. The President likes to refer to the government's role in health care as a
public option. But just like the restaurant owner, they will soon discover that Obama and the federal government will not be a "partner" and his health care plan will never be merely an option. Very soon the American health care system could be controlled 100% by Obama and his friends. Some examples:

Acorn 

As I wrote previously, ACORN and the community organization brigades have already plundered a hospital of resources. When Michelle Obama was promoted to Vice President of the University of Chicago Medical Center she ran something called Community and External Relations. So a Senator's wife, with no medical background or health administration experience becomes a vice-president of a major American hospital.  Why does a hospital do this? Obviously, the hospital needed Senator Obama's help, maybe with legislation, maybe with reimbursements, maybe with the unions. So Mrs. Obama becomes a Vice President, her salary is tripled to over $300,000, and suddenly the hospital is sponsoring ridiculous community enterprises like Principal for a Day and Real Men Cook celebrations. Luckily for the Medical Center, Senator Obama became President Obama and Mrs. Obama's position as Community and External Relations Director was quietly found to be no longer necessary.

SEIU

Like the UAW and GM, SEIU has big plans for health care.  According to this article, in 2008 SEIU represented 17% of hospital workers in the United States. They achieved this amazing result by "pursuing organizing efforts in sectors that are growing with taxpayer money," most notably, health care.  As Steven Malanga writes:

This lucrative business for SEIU has turned traditional notions of union organizing on its head. Since government pays nearly half of all medical bills in this country, SEIU has scored many of its biggest victories working as a powerful lobbyist, often in collusion with employers rather than in confrontation with them. In New York State, for instance, the union's local, 1199SEIU, struck up an unprecedented partnership with an employer group, the Greater New York Healthcare Association, and together campaigned relentlessly (and mostly successfully) to protect and expand the state's Medicaid program -- the most expensive such program in the country. Hyperbolic ads produced by the alliance condemned former Gov. George Pataki in 1999 when he tried to reform and trim the state's Medicaid program, and again in 2007 when newly elected Gov. Eliot Spitzer targeted the bloated program for cost savings. In both cases politicians backed off as their popularity ratings sank from the advertising onslaught.

Eighty-three per cent of the hospital workforce is yet to be unionized. Going state by state, hospital by hospital, or politician by politician is time-consuming and expensive. It's easier to call on your partner, President Obama, to pass health care reform. Once the federal government is paying all the bills, one of the new reforms could easily be that all health care workers will now be represented by a service employees union.

The Trial Lawyers

This group's role in Obama's health care reform is more difficult to ascertain, since the status quo seems to work extremely well for them. All a plaintiff's lawyer has to do today is find a patient, call the physician or hospital's malpractice carrier and threaten to sue. The insurance company compares the cost of defending the doctor versus settling for a few thousand dollars and decides to settle. Call it a legal "shakedown."  The lawyer earns 40% for a few phone calls and a letter or two. The insurance company promptly raises the doctor's premium. The doctor raises his fees to patients with private insurance (since he is precluded from raising his Medicare and Medicaid fees) and continues to order multiple tests to verify every decision he makes on the off chance that one of those cases just might go to trial. Yes sir, the trial lawyers have one sweet setup.

So why the silence from the legal community as Obama and the Democrats, (to whose campaign coffers they have contributed mightily) try to reform away their livelihood? The trial lawyers have a very big seat at the table, since Kansas Governor Kathleen Sebelius, who used to work as the
chief lobbyist for her state's trial lawyers association, is now Secretary of Health and Human Services.

Actually, the thank-you gift to the trial lawyers is included in the House's health care reform bill, as reported in the Wall Street Journal.  Should the Democrats' health care plan actually make it through Congress, I suggest we all keep a close eye on  ERISA, the Employee Retirement Income Security Act of 1974:

ERISA establishes minimum standards for retirement, health, and other welfare benefit plans (including life insurance, disability insurance, and apprenticeship plans).ERISA is administered by the Employee Benefits Security Administration (EBSA), a division of the U.S. Department of Labor (DOL).

In other words, ERISA, through the Department of Labor, sets the standards for our managed care plans. But there is one huge provision in ERISA law that has stuck in the craw of every trial lawyer since its inception:

The most important thing to understand about what ERISA does not cover is a legal remedy for damages resulting from injury, suffering, or death, under a managed-care plan. You may be able to sue an ERISA-governed plan to get coverage, a certain test or procedure, but you cannot sue for damages that occur if there was a delay in getting care - even if this results in injury, economic loss, or death.

Do you understand this, average American patient? As the law stands now, trial lawyers are prevented from suing your managed care company for punitive damages! Imagine being a lawyer and seeing all those gorgeous jury awards for pain and suffering just waiting to be plucked and being told, "Sorry -- I'm protected by ERISA." There's only so much blood you can get out of a single doctor or hospital. But the managed care plans are gigantic turnips! So once the behemoth health care bill is finally dumped on your legislator's desk, I will be willing to wager that somewhere in its depths will be obscure language concerning ERISA. Because if there is one thing I know about lawyers, they don't stay quiet without a very good reason.

So buy some popcorn, rent the film, and take some notes. As for the health care movie we find ourselves in -- the credits haven't rolled yet. There's still time for a plot twist and maybe, just maybe, an alternate ending.

Carol Peracchio is a registered nurse.