Thoughts upon terminating government insurance:
The Breakdown of American Healthcare
The breakdown of America’s health care system began in the 60’s with the rise of Republicans led by Governor Ronald Reagan who presided over the emptying of California mental hospitals under the guise of community psychiatry. The promised shift of funds never happened. Result: the mentally ill homeless Reagan-Bush-Clinton people and prisoners in the prison industrial complex. Mentally ill and hurting but less incapacitated have no actual coverage under their attenuated and rationed nominal insurance plans. The deceptive practices permitted under corporate medicine have allowed false and misleading information to appear legitimate. The scope and seriousness which is only now coming to awareness is seen only in cartoons because of the effectiveness of the corporatocracy in managing information.
The poisonous dogma of deregulation and privatization allowed corruption and altering government policy to suit special interest groups that crafted self-serving regulatory policy. The public, fed on managed information, is victimized by the actual harm that is caused by the omissions, semantics, and euphemisms of mercantilia that has produced the debased attenuated health care.
Dependency on government and third party payers has conferred power on the corporate entities to objectify and transfer the locus of power from usual professional societies to the corporate entities. Say good bye to collegiality. The focus is on cost- and not quality as claimed.
The contemporary manifestation of the tutelary hegemony management policy is the agitprop maneuver of scapegoating and harassing health care providers- especially those in the mental health area. Under the guise of cost containment and quality assurance a recent “audit” by the National Heritage Insurance Company, private contractor to Medicare alleges that there was an overpayment to me for 1997 of $79,371.54.
Alameda County Behavioral Health Care Services, a contracting “private entity” has attempted to implement a complex reporting system with mandatory cookbook protocol. The MediCal payments due prior to their contract with Alameda County remain impounded for failure to retrospectively submit for review of all prior claims.
The following are my responses to both entities.
Letter of withdrawal from Alameda County (California) Behavioral Health Plan
Tod H. Mikuriya, M.D.
Marye L. Thomas, M.D., Director
Alameda County Behavioral Health Plan
2000 Embarcadero Cove Suite 400
Oakland, CA 94606
Notice of Termination
July 19, 1999
Via Certified Mail
Dear Dr. Thomas,
Per section 13, Termination Provisions you are hereby notified that the Specialty Mental Health Services Agreement is terminated as of June 30, 1999.
After participation in the MediCal system for more than thirty years I can no longer be part of what I have come to realize is a large scale abusive fraud perpetrated upon patients and providers by health policy bureaucrats.
The current rationing of health care defrauds patients by deceiving them that they actually have health care coverage and will be optimally treated. They aren’t. They won’t be. Treatment is denied, reduced, and debased through harmful and intrusive policies.
Visits are functionally and actually limited by cookbook formulae with mandated pro forma comprehensive reviews. Seven pages of rationing tools: Request for Prior Consultation, ACBHCS RES, and RCR.
Pharmacological “formularies” and “treatment authorization requests” protocol adds expensive and “penny wise- pound foolish” frustration that harm patients with obligatory less expensive drugs with more side effects and less efficacy- especially for the management of chronic conditions. A seriously depressed resident of a chronic care facility with multiple medical problems required an expensive acute hospitalization because of constipation from tricyclics after a request for an SSRI was turned down. These pharmacist decisions preempt and supersede physician judgement with harmful formulaic medicine. The compliance problems with inferior medicines add to costs that will never appear on spreadsheets because these data are not kept. While this policy has changed, the process has not.
Over the years I have endured de facto rationing of mental heath care and marginalization of psychiatric medicine with discounted rates from other medical specialties and semantic demotion from physician to “provider”.
Extraordinary popular delusions and madness of crowds: In collective magical thinking decision-makers believed that more privatized regulation was a good idea. Under the banner of quality control and cost containment these additional entities were created. The fundamental flawed premise is that spending it on rationing will somehow save money. (guidelines, limits, and obligatory justifications) Privatized management is not for free. Attenuation and downgrading quality and amount of health services results from this additional administrative overhead.
This latest “reform” was the creation and interposition of another level of “privatized” regulatory bureaucracy. Alameda County Behavioral Health Plan is a product of this institutional delusional behavior. This expression of Parkinson’s’ law and corporate medicine has significantly escalated with the creation of corporate entities to ration health care delivery. A sales campaign promoting the idea that public and private institutions had somehow failed coupled with cut backs in provider fees which is the actual cause of health care delivery problems. Monies are diverted from actual health care to regulatory activities, which both adds to costs and detracts from actual health care delivery. Parkinson’s law in action. Actual health care is attenuated and diminished.
To the direct costs of ACBHP, itself, add the expenses incurred by the providers obliged to produce additional documentation for review. These uncompensated services put additional financial and psychological stresses on the hapless provider. While California law precludes the practice of corporate medicine, these private entities are indeed the embodiment of corporate medicine that intrudes through the use of non-physician reviewers motivated by rationing medical care rather than the patient’s well being. The additional medical reportage mandated in traditional paper and pencil records keeping environments is burdensome to provide. No enabling automation is provided to cope with the escalating documentation and administrative demands. It is assumed that these services will be borne by the physician. Compensation is determined unilaterally and without consultation.
The bundled demands for higher levels of administrative services plus the penurious rates of compensation result in an unacceptable contractual relationship and conditions for further participation.
To facilitate remedial action on health care planning I enclose a copy of PLANNING AND MANAGEMENT SYSTEM and OUTCOME MANAGEMENT OVERVIEW, used by the City of Sunnyvale and similar to the methodology recommended by the Legislative Analyst Office.
If or when you are able to put together a coherent plan that is fair,
technologically competent, and user friendly I will consider rejoining. Until
then count me out.
Very truly yours,
Tod H. Mikuriya, M.D.
July 29, 2004: Dr. Mikuriya sues Health and Human Services Secretary Thompson to prevent collection of over $100,000 in alleged overpayments, penalties, and interest. Read the complaint (large pdf).