For those who are serious about giving away vast amounts of money but are clueless how to go...
Today, every Innus is a Canadian citizen who is heir to every disease that a Caucasian Canadian gets. The only change for diseases in Innus is the introduction of monetary economy where greed rules the roost
The creator, if there was one, or for the consumption of Darwinians, evolutionary process would not have left any stone unturned to see that the creation needs no outside help for survival. This is simple logic which science lacks. Science like, many others, is only an enterprise, which seems to have outlived its usefulness. It is this half-baked science, which, according to Nobel Laureate chemist, John von Newman, “is making models, mostly mathematical constructs, which, with verbal jargon, is supposed to work,” really hurts. John was talking of the hard sciences of physics and chemistry, but not our great medical science, which according to another great scientist, Rustum Roy, is only a statistical science where we use surrogate end points statistically to claim our successes. Even hard sciences had to eat the humble pie when they saw liquid helium refusing to obey the rules of physics by flowing against gravity and passing through intact containers! Did liquid helium throw thermodynamics upside down along with Newton’s laws of gravity?
To give an example in medical science, the infamous Multiple Risk Factor Interventional Trial (MRFIT), which spent millions of dollars of American taxpayers’ money, turned out to be a boondoggle, showing that, while the so called risk factors for premature death, such as high blood pressure, blood sugar, and cholesterol could all be controlled with our interventions, the final outcome measure of precocious death does not get altered! Many a time our interventions could alter the final death certificate label (due to adverse drug reactions) but cannot change the date. Statistically, we claim that our interventions are the ‘be all and end all’ of human existence. Some fanatics go to the extent of catching these so called risk factors “young” in the asymptomatic stage of one’s life to the further detriment of health. The ultimate truth is that change of mode of living (as close to nature as is possible) is much more powerful in avoiding premature death.
I still remember what the famous hypertension specialist, Sir George Pickering, wrote about high blood pressure, which I feel, is 100% true. He said “more people in this world make a living OFF hypertension than die OF it.” This naked truth speaks for most of our interventions. About cardiac interventions, which have become the biggest till movers for hospitals, Harlan Krumholz, the chief of cardiology at Yale, had this to say in his editorial comment in the New England Journal of Medicine 1997; 336: 1523 on cardiac procedures, outcomes and accountability: “cardiac procedures are done in the USA mainly because they net billions of dollars in cash for doctors and hospitals, status symbol and visibility… and not for the benefit of patients.” The scenario has not changed in 2013 either.
The 1997 study was a comparison between Ontario and New York. Another study has shown similar findings in the words of DT Ko and colleagues in the JAMA, which is echoed by Krumholz also (JAMA 2013; 310: 151-52) thus: “….higher prevalence of interventionists, and cardiac invasive capabilities- as well as market oriented financing-in New York seems likely to account for much, if not all, of the disparity between New York and Ontario; if so there is an opportunity for reducing health care costs in New York.” This applies to India as we ape the New York style in India.
A scientific study in early 1960s published in the Canadian Medical Association Journal entitled “The failure of scientific medicine, the Innu community study” showed that the Innus, an aboriginal tribe living in the Innu land, a colony off the coast of Saskatchewan, had no illnesses whatsoever until 1892 when the first business, Williams Company, came to start their barter trade there. Till then Innus lived a simple natural life style of an egalitarian hunter gatherer communes sharing and caring. They lived to ripe old age and the causes of death were just old age and predation. They were not aware of money and greed till the Williams Company taught them to sell their hide for biscuits etc. in their possession. Then, came money into their lives and today every Innus is a Canadian citizen who is heir to every disease that a Caucasian Canadian gets. The only change for diseases in Innus is the introduction of monetary economy where greed rules the roost.
Virgin nature has all that we need for good health. Sunshine is your best health tonic which, unfortunately, has been demonised by the drug and cosmetic industry. Monetary economy has destroyed the bounties of nature in every field and made our environment detrimental to human and other species’ health. That is why our all-powerful immune system cannot manage some illnesses fully. Our food is poisoned, drinking water is not potable, air in polluted, work environment is stressful, and our future, uncertain. Man’s greed and proclivity for comfort has been responsible for this raping of nature. That is why, in some instances, we might need help from healers. The father of modern medicine, Hippocrates, probably knew all this when he propounded his hypothesis where he said: “cure rarely, comfort mostly, but console always.” That is true even today, despite all that we claim as advances in technology which have become counter-productive. Latest studies have shown that it is only the human immune system that cures (Bingel et al. Placebo effect. Science Translational Medicine 2010 Feb issue) even with outside interventions. That is called the Placebo effect. A good healer should, therefore, be a good human being, her/his qualifications notwithstanding.
Let us go back to nature and try to set things right to prevent destruction of nature. Just see the difference in your wellbeing when you change from walking with footwear to walking barefoot. The bio-positive electrons, plenty on the earth’s surface, are the most powerful anti-oxidants. Hopefully nature will recoup for the good of the human race. Let our politicians be warned that nature is not there for everyone to loot. If you treat nature as your mother she will feed and heal you; if, on the contrary, you treat nature as your mistress she will kick you in the teeth. A word of advice for our profession is in order. Be human and humane and treat every patient as your own-self in distress and do unto them as you would want done unto you. Let not greed take over like it has done in New York in the above cited studies compared to Ontario where social medicine does not give any incentive for over diagnosis and overtreatment. Please remember that it is nature that heals. Even the best cardiac surgeon cannot make a heart transplant heal in a dead body. It needs human immune system for healing. The surgeon is only a catalyst or facilitator. Be humble and care for your patients-other name for patient care.
A High Court directive puts additional responsibility on IRDA to issue guidelines for insurance companies to come up with package rates for 42 ailments based on policyholder’s sum insured and type of hospital. It will ensure that TPA’s role in recommending claim payment is marginalised
The Bombay High Court has directed Insurance Regulatory and Development Authority (IRDA) to issue guidelines for insurance companies to come up with package rates for 42 standard ailments in the policy document. The package rates can be based on policyholder’s sum insured and type of hospital combination. It is no surprise that insurance regulator did not want to get involved in this task-IRDA’s advocate argued that this was not within its realm. Bombay HC Chief Justice Mohit Shah said, “You have the power. You don't exercise it.” He gave the example of former election commissioner TN Seshan reforming the election system despite limitations.
A division bench of Chief Justice Shah and Justice MS Sanklecha heard a public interest litigation (PIL) by activist Gaurang Damani on issues facing mediclaim policyholders. According to Mr Damani, “The good old cashless mediclaim days are no longer available with government insurers, who realised it was more expensive than reimbursement claims. There is no financial incentive to restart cashless facility. Information on package rates for 42 standard procedures will help policyholders know what they are entitled to. Today, there is lack of transparency and third party administrators (TPAs) have huge discretionary powers. Bills for same procedure undergone in the same hospital are settled with different amounts.”
Recently, Moneylife had written about a policyholder from United India Insurance, who was handed over a bill of Rs65,368 by Chennai-based New Hope Indian Speciality hospital, for appendicitis surgery done at the insurance company’s preferred provider network (PPN). The TPA, Vipul MedCorp approved only Rs25,000 for the surgery. The TPA and hospital agreement for package rates seems to be a farce. Had the policyholder known that the policy would only pay Rs25,000 for the surgery, she could have looked for another hospital instead of having to foot the difference in the hospital bill.
United India Insurance makes a mockery of PPN package rates
Packaged rate for standard procedures specified in the policy will force the insurance companies and TPAs to become more transparent about what they are willing to pay, avoiding nasty surprises for the policyholder later. Today, going to PPN does not ensure complete coverage for hospital bill, even if there is no sub-limit for the said procedure and even when the policyholder has availed room facility within its room-rent limit.
Moneylife had written about health insurance guidelines issued by IRDA that initially barred TPAs from claim settlement and were later revised to allowing the TPAs to recommend a claim amount. Please read Do IRDA health insurance guidelines really disallow claims settlement by TPAs?
During the High Court hearing last Friday, Mr Damani pointed this loophole-it gives enough discretionary power to the TPA, to the extent of recommending zero claim payment. Will this mean the claim is rejected? In 2011-12 , about 6 lakh claims out of 37 lakh worth Rs1,200 crore were pending. TPAs are known for keeping float; delaying the payment to policyholder even after getting it from the insurance company. The judges, in their order, also directed that insurers will frame guidelines for TPAs to recommend the claim amount.
According to Mr Damani, “The TPAs will not be able to settle claims. The insurance company and not the TPAs will have to give reasons for claims rejection or partial payment. Moreover, if 42 procedures have packaged rates mentioned in the policy, the TPAs cannot execute an arbitrary settlement amount. The packaged rates will be transparent and policyholder will be aware of what cost will he receive. Competition will take care of market forces to offer appropriate package rates for the 42 procedures in the mediclaim policy.”