Health Care Bill!

Yesterday I had the privilege to be a part of the Million Med March that took place all across the US at noon in 23+ cities. Doctors, nurses, allied health professionals and our patients came together to protest the takeover of 17% of our gross national product under the guise of improving health care in the United States. We already have the best health care in the world and a total takeover in the name of a fix is not what we need. As one speaker pointed out, if the kitchen sink was dripping you would fix it and not remodel the entire kitchen! So should it be with health care in the USA.

There are certainly places to fix in what we currently have, but these do not require an entire gutting of the system. If there is fraud and waste in the Medicare and Medicaid system, FIX IT NOW. If there needs to be tort reform, FIX IT NOW. If Health Savings Accounts will allow young people to buy catastrophic insurance and self insure for mundane medical events, KEEP THIS OPTION! There is no precedent for the federal government forcing anyone to have insurance for anything! Yes, the federal government has a flood insurance program, but it is voluntary. If you don't have it and you sustain a loss in a flood, you are holding the bag for restoration or a new place to live. STATES require minimal automobile insurance coverage to protect the owner from the liability of damage that they cause to another. The idea of fines and jail sentences for not having health insurance is unprecedented and could be deemed unconstitutional.

And for the final affront to you and me, costs of these programs that are being forced on us by the federal government will be pushed off to the individual states to fund. The states will be responsible for the increased numbers of people who will be pushed onto Medicaid and other public programs for their health care. Guess where the states will get their money for this?? You betcha...you and I will be paying more for both our state and federal taxes and you can bet your bottom dollar (and we are getting right down to that) that we will be getting a lot less for our money. Sure you can keep your doctor if you like them......as long as they stay in practice. Sure you can keep your health plan if you like it......as long as NOTHING is changed in your plan or as long as your employer decides to provide it rather than pay a fine that might actually save them some money. After all, you aren't left in the lurch......Now there is a public option for you!

A highlight of the afternoon was the appearance of Health Care Bill who exemplified all that is wrong with the legislation that proposes to fix our health care.

Health Care Reform--What You Don't Know but Should!

After hearing the POTUS with the TOTUS blather on in broad generalities about health care reform last night..."we need change , we need it now, the stars are aligned, the system is broken, I and the Congress have the best healthcare on the planet, oh, did I mention that I have the best healthcare on the planet...and I have a doctor that follows me around all of the time and, oh, by the way, you can take the cheap pill.", I received this from Smart Girl Politics about the things that are REALLY in the bill and you can make your own informed decisions. I know that it will take time to read all of this---that is why our legislators don't.... but it is worth it to arm ourselves with facts from the actual bill to combat the misinformation that we are being fed by the axis of evil...er... I meant the administration.

All 1017 pages of HR3200 can be accessed for your bathroom reading enjoyment.


Peter Fleckstein (aka Fleckman) is reading it and has been posting his findings on Twitter. Robert Wenzel from www.economicpolicyjournal.com has summarized Fleckstein's findings in his July 20, 2009 post. (Note: All comments are Fleckman's and remember that they are written for 140 character Tweets).

Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL EMPLOYERS that self insure!!
Pg 30 Sec 123 of HC bill - THERE WILL BE A GOVT COMMITTEE that decides what treatments/benes u get
Pg 29 lines 4-16 in the HC bill - YOUR HEALTHCARE IS RATIONED!!!
Pg 42 of HC Bill - The Health Choices Commissioner will choose UR HC Benefits 4 you. U have no choice!
PG 50 Section 152 in HC bill - HC will be provided 2 ALL non US citizens, illegal or otherwise
Pg 58HC Bill - Govt will have real-time access 2 individs finances & a National ID Healthcard will b issued!
Pg 59 HC Bill lines 21-24 Govt will have direct access 2 ur banks accts 4 elect. funds transfer
PG 65 Sec 164 is a payoff subsidized plan 4 retirees and their families in Unions & community orgs (ACORN).
Pg 72 Lines 8-14 Govt is creating an HC Exchange 2 bring priv HC plans under Govt control.
PG 84 Sec 203 HC bill - Govt mandates ALL benefit pkgs 4 priv. HC plans in the Exchange
PG 85 Line 7 HC Bill - Specs for of Benefit Levels for Plans = The Govt will ration ur Healthcare!PG 91 Lines 4-7 HC Bill - Govt mandates linguistic approp svcs. Example - Translation 4 illegal aliens
Pg 95 HC Bill Lines 8-18 The Govt will use groups i.e., ACORN & Americorps 2 sign up indiv. for Govt HC plan
PG 85 Line 7 HC Bill - Specs of Ben Levels 4 Plans. #AARP members - U Health care WILL b rationed-
PG 102 Lines 12-18 HC Bill - Medicaid Eligible Indiv. will b automat.enrolled in Medicaid. No choice
PG 124 lines 24-25 HC No company can sue GOVT on price fixing. No "judicial review" against Govt Monop
PG 127 Lines 1-16 HC Bill - Doctors/ #AMA - The Govt will tell YOU what u can make.
PG 145 Line 15-17 An Employer MUST auto enroll employees into pub opt plan. NO CHOICE
PG 126 Lines 22-25 Employers MUST pay 4 HC 4 part time employees AND their families.
Pg 149 Lines 16-24 ANY Emplyr w payroll 400k & above who does not prov. pub opt. pays 8% tax on all payroll
pg 150 Lines 9-13 Biz w payroll btw 251k & 400k who doesnt prov. pub. opt pays 2-6% tax on all payroll
Pg 167 Lines 18-23 ANY individual who doesnt have acceptable HC accrdng 2 Govt will be taxed 2.5% of inc
Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from indiv. taxes. (Americans will pay)
Pg 195 HC Bill -officers & employees of HC Admin (GOVT) will have access 2 ALL Americans finan/pers recs
PG 203 Line 14-15 HC - "The tax imposed under this section shall not be treated as tax" Yes, it says that
Pg 239 Line 14-24 HC Bill Govt will reduce physician svcs 4 Medicaid. Seniors, low income, poor affected
Pg 241 Line 6-8 HC Bill - Doctors, doesnt matter what specialty u have, you'll all be paid the same
PG 253 Line 10-18 Govt sets value of Dr's time, prof judg, etc. Literally value of humans.
PG 265 Sec 1131 Govt mandates & controls productivity for private HC industries
PG 268 Sec 1141 Fed Govt regulates rental & purchase of power driven wheelchairs
PG 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!
Page 280 Sec 1151 The Govt will penalize hospitals 4 what Govt deems preventable readmissions. (MY NOTE: THEY ALREADY DO THIS!!)
Pg 298 Lines 9-11 Drs, treat a patient during initial admiss that results in a readmiss-Govt will penalize u.
Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Govt tells Drs. what/how much they can own.
Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion- Govt is mandating hospitals cannot expand
Pg 321 2-13 Hospitals have oppt to apply for exception BUT community input required. Can u say ACORN?!!
Pg335 L 16-25 Pg 336-339 - Govt mandates estab. of outcome based measures. HC the way they want. Rationing
Pg 341 Lines 3-9 Govt has authority 2 disqual Medicare Adv Plans, HMOs, etc. Forcing peeps in2 Govt plan
Pg 354 Sec 1177 - Govt will RESTRICT enrollment of Special needs ppl! WTF. My sis has down syndrome!!
Pg 379 Sec 1191 Govt creates more bureaucracy - Telehealth Advisory Cmtte. Can u say HC by phone?
PG 425 Lines 4-12 Govt mandates Advance Care Planning Consult. Think Senior Citizens end of life
Pg 425 Lines 17-19 Govt will instruct & consult regarding living wills, durable powers of atty. Mandatory! (MY NOTE: THIS WILL PLEASE THE ATTORNEYS!)
PG 425 Lines 22-25, 426 Lines 1-3 Govt provides apprvd list of end of life resources, guiding u in death
PG 427 Lines 15-24 Govt mandates program 4 orders 4 end of life. The Govt has a say in how ur life ends
Pg 429 Lines 1-9 An "adv. care planning consult" will b used frequently as patients health deteriorates
PG 429 Lines 10-12 "adv. care consultation" may incl an ORDER 4 end of life plans. AN ORDER from GOV
Pg 429 Lines 13-25 - The govt will specify which Doctors can write an end of life order.
PG 430 Lines 11-15 The Govt will decide what level of treatment u will have at end of life
Pg 469 - Community Based Home Medical Services=Non profit orgs. Hello, ACORN Medical Svcs here!!?
Page 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. 1 monthly payment 2 a community-based org. Like ACORN?
PG 489 Sec 1308 The Govt will cover Marriage & Family therapy. Which means they will insert Govt in2 ur marriage
Pg 494-498 Govt will cover Mental Health Svcs including defining, creating, rationing those svcs

These comments get us less than half way into the 1017 page bill...but this is what the Administration does not want we, the commoners, the unwashed masses to find out, which is why there is such a hurry to get this through. SLOW DOWN AND READ THE FINE PRINT.

Good Nurses Make Good Doctors

While surfing the internet for sites with medical flavor, I was pleased to find a great site for nurses. SCRUBS is a refreshing and bright ezine where the needs of today's nurse are addressed. When I was a medical student and later a resident in obstetrics and gynecology, medicine was different th an it is practiced today. There was less technology and lots more hands on interaction with the patients. Some of the most valuable bedside lessons that I learned, however, did not happen at the hands of my professors, but rather from the nurses who spent hours at the patient's bedside. Old school nurses taught me to "read" the patient's body language as it changed in the course of their illness or labor, to talk with them in general conversation to find out more about their attitudes and personalities, and to individualize my care to the patient and try to define ways to make them compliant under hardship.

Today it is a different world in the field of health care and, in certain ways, the change has not been for the better. The role of the physician and the nurse are modified in ways that we could hardly have predicted 30 years ago. The nurse and the physician have new rules to abide by in terms of patient length of stay and appropriate testing. Much more is required of both physicians and nurses in our litiginous society. Technology has enabled both physicians and nurses to be impersonal with telemetry at the nursing station and the EMR, with its cookie cutter phrases and check marked boxes, replacing carefully written notes.

Scrubs provides information for all aspects of the nurse's life. There are health, money, humor and lifestyle features, inspirational stories and even a sassy doctor/nurse point/ counterpoint column in which a doctor and a nurse address a specific topic so that you can get inside the other's head and see where they are coming from! With Showtime's Nurse Jackie being promoted heavily in print and even on billboards, there are also an entertainment area. To check the pulse of the readership, polls are sprinkled over the site. For the nurse who is stretched too thin due to "staffing for census" or fatiqued from 12 hour shifts, this site is an oasis for rejuvenation and a reminder of why we chose the medical field in the first place.



Scrubs

License Bureau, Post Office...Healthcare???

As Barack Obama rolls out his ambitious agenda for the USSA and continues to spend our way to oblivion, some have questioned whether he will have to put some of his projects on the back burner as public sentiment and buyer's remorse starts to set in. Some have said that Cap and Trade may have to go on the back burner for the time being, but that health care may be "fixed" this year.

The issue of health care in the USSA has been a topic of great debate for literally decades. My father passed away in 1989 and years before that, in the early years of my career in medicine, he gave me a bumper sticker that said "If You Like the Post Office You Will Love National Health care." The issue of health care and what is wrong with it is complicated, crosses multiple sectors of the economy and I don't have the solution. What I do have is a caution.

Friday, 4/17/09, Red State's Jeff Emanuel had a post entitled, "Who Should have the Final Say About Your Medical Care: Your Doctor, or Government Bureaucrats?" In the article a young woman in Georgia who was severely disabled from birth and required intensive home care had her benefits cut by 15% over the objections of her physician. These benefits were from federal and state medicaid. The suit has been in the courts for several years and has worked its way to the 11th US Circuit Court of Appeals where the ruling was overturned and the courts ruled that the physician and not the bureaucratic machine should determine the patient's care.

Rhonda Meadows, commissioner of Georgia’s Department of Community Health,
immediately appealed the ruling to the 11th U.S. Circuit Court of Appeals on behalf of the Peach State. Her argument was that state officials, not doctors, should have final say in what treatments and care patients within their purview require. Florida and Alabama, which fall under the 11th Circuit’s jurisdiction and will have to abide by its ruling, filed an amicus brief with the Atlanta-based court.

Is this a glimpse of what government health care would look like? Those who are heavy weight on the system are cut back and left to wither and die?

Many hospitals today are employing ethicists. These ethicists are doctors who are employed to "help" families faced with end-of-life issues work through the emotional mine field of decision making . While at times, these decisions may seem clear, they become muddled when the ethicist is called in on behalf of the hospital to meet with the families because the patient's care has become long and costly...those high ticket patients whose hospitalizations have languished over long times, without an end in sight....these are patients who have become respirator dependent after a catastrophic event like a heart attack or stroke, who have had multiple complications after emergency major surgery or who have multiple comorbid conditions complicating what otherwise would have been a much simpler procedure. Many of these patients have Medicare or Medicaid and the reimbursement for their care is low. Many of these patients are patients for whom the hospital will have to eat large amounts of the bill. The growing use of the ethicist physician is in some ways a disturbing trend that could become more widely used in a government health system where rationing of resources must, by default, be used. What better group to ration but the "big ticket" patient who is burning through resources without an end in sight. The ethicist can be used to gently "help" the family see the folly of continuing the fight for an unworthy life and justify withholding of supportive measures. Where the line is to be drawn is anyone's guess, but it could well be a line that moves depending on the number of people to be served and the amount of resources available. Is a preemie's stay in the NICU justified? How about a 60 year old patient who needs coronary artery surgery? What if that same patient also is obese? What if that patient also has Type II diabetes? Where is the line drawn when a patient has a hip fracture or needs a hip replacement? What about a 300 pound woman who needs knee replacement due to wear and tear from chronic obesity? And where do organ transplants fall in the rationing plan? What about infertility treatments?

We have the best health care system in the world and we serve people from many countries who come here to have their medical care because they can't get it in a timely manner in their own countries. This has to say volumes about the present state of health care in America. Fixing it, like we have just "fixed" Chrysler and GM, will put government bureaucrats in charge of what you can get, where you can get it and when you will be able to get care. What will government single payer health care do to the access to drugs? Will we be regimented to a strict formulary where one medication fits all? As a resident, I trained in the City and County Hospitals where there was a government formulary and the number of medications available for our patients was severely limited. For example, there was one hormonal replacement medication. There was one brand of birth control pills available to patients. There were charcoal pills for post-op gas relief. If they worked, it was fine, but if not, too bad.

I hardly think that this kind of regimentation will be acceptable to the vast majority of American consumers who are accustomed to individualized treatment for most conditions and are accustomed to rapid access to expensive technology and diagnostic tests, but unless we wake up and smell the coffee, this could be your lot in life in the not too distant future.

See a Need, Meet a Need

Two years ago I heard the words "you have breast cancer." The reaction to these words is, at best, like being punched in the gut. Thoughts swirl uncontrollably in your head and most of the next words the doctor says are just "blah, blah, blah, blah blah." So far, my tale has been mostly a good one but, for others the tale is much less happy and the road is full of bumps.

Being a physician as well as a cancer survivor, I feel that whatever I can do to help others in this situation should be my personal mission. One of the things that I did during my treatment was agree to participate in a study on women with breast cancer in collaboration with two universities in my state. This was not a medical study, but rather an attitudinal and sociologic study and I found the questions intriguing. Many of the questions dealt with how the cancer patient was able to function during diagnosis and treatment...days lost to jobs, availability of transportation to treatments, access to supportive family and friends, ability to just talk to someone....By the end of my interview, I was in tears, knowing how lucky I was to have all of the things I needed to get through this personal ordeal.

Last week, while stopped in traffic waiting to make a right hand turn, I was rear-ended by a woman. When we pulled into a nearby parking lot to exchange information, I could see that she was shaken and upset far out of proportion to the relatively minor accident we had. She confided to me that she was on her way to the first of her 5-hour chemotherapy sessions for advanced breast cancer. The only papers that she had in her car to write down her exchange of information were pages of her medical records and information from the oncology center. She told me that she had been so upset by the news of her diagnosis and the prospect of her impending chemotherapy that she had been vomiting all evening. Clearly this woman was a danger to those on the road in her distracted state. Then I recalled the fact that the day I was given confirmation of my own diagnosis I had nearly run a red light on the way home. I was so deep in my own thoughts and all of the "What if's" that I had put the familiar drive home on autopilot.

I know that there are transportation programs for the elderly and the indigent, but are there programs for the ordinary cancer patient who is otherwise able to provide their own transportation and doesn't want to be a burden on others??? I pondered this on the way home from the auto body shop today after getting estimates of the damage to my car. We put so much emphasis on prevention, but providing transportation for the distraught or sick patient is really another kind of prevention program. We need to not just treat the cancer--we need to be aware of the emotional effects that the diagnosis of cancer places on the patient. We also need to realize that some people deal with this diagnosis in isolation.

The American Cancer Society's Road to Recovery program provides free transportation to those who need transportation for ANY reason, however, when I tried to find this in my local area, I found nothing. Apparently this program relies entirely on volunteers who make their time available to take patients to their treatments. If you are looking to give back in a tangible way to the community, this would be a program well worth investigating in your own neighborhood. If you find yourself with time on your hands and a need to fill that time, this may be the right volunteer or service opportunity for you. You would be helping the community, helping a patient in need, and providing a companion to talk to during a time when there may be a need for a sympathetic ear.

For all of the faults and criticisms of our health care system, we have one of the best systems on the planet. We can effect cures for all manner of disease states and improve the quality of life for many but I fear that we look the other way, or perhaps have no idea of the fragility and vulnerability that we as health care providers produce when we give out bad news to a patient and then send them off to "deal with it."