Monthly Archives: December 2008

Women get better care in the United States than in Canada or England

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The Obama-Biden transition team has specifically used the failure to reach all women with mammography screening as a reason for greater government control of medicine.

It states that only 71.8% of women age 50 to 64 and 63.8% of women age 65 or older received screening mammograms in 2005, despite expert recommendations for annual screening after age 50.

In Canada, however, where “everyone is insured,” the screening rate is only 51.8%, according to Statistics Canada.

Despite universal coverage, the disparities in screening for women of lower socioeconomic status are the same in Canada as in the United States (Katz SJ, et al. Am J Public Health 2000;90(May):799-803).

The transition team implies that the goal should 100% screening, without consideration of potential problems, such as overdiagnosis and overtreatment. Overdiagnosis was shown to be 30% in randomized trials, and reached 40% to 60% in large epidemiologic studies (BMJ 2006;332:538-541).

If seeking anecdotes about difficulties in finding care, the team should look to the British National Health Service. An expectant mother of twins was informed that she needed a Caesarian section because one of the twins was undernourished and not developing properly. Before delivery, she underwent a 5-day ordeal of being ferried 250 miles between four hospitals in search of adequate facilities. Five minutes after birth, one of the twins was taken to another hospital because all the incubators had become full.

The babies became more undernourished as the mother had to starve herself repeatedly in anticipation of surgery that was postponed. And after delivery she had to face a two-hour round-trip daily drive to deliver breast milk (Mail on Line 12/16/08).

The costs endured by women and babies and others whose care is delayed are not counted in the costs of the purportedly efficient single payer.

On “Health Care—of the People, by the People,” you can “Tell us your story, why health care is important to you, or what you’d like to see an Obama-Biden administration do and where you’d like the country to go” at:
http://change.gov/page/s/healthcare.

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Doctors at “house party” deplore destructive “reform” ideas

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The Obama team has allowed a mere two weeks, over the busy holiday season, for collecting all the “input” they need for rapidly forcing a radical “health system reform” plan through Congress. House parties are explicitly designed to elicit tearjerkers showing the “need” for precisely the changes that the Obama/Kennedy/Daschle/Baucus/”stakeholders” forces intend to implement.

On very short notice, AAPS organized a virtual house party, with input from a number of specialties around the country. The doctors warned that the monopolistic stranglehold of big insurers would be tightened, as the insurance industry traded its support for a mandate forcing some 45 million new customers to buy its product.

Universal “coverage” would be a “currency without a marketplace,” like in Massachusetts, without the personnel and facilities to cope with burgeoning demand from healthy, newly entitled consumers. Careful diagnosis and personalized treatment would be further diminished, to be replaced by 11-minute shotgun visits with minimally trained, protocol-wielding physician extenders.

The Hippocratic Oath is already a joke, stated one pathologist, because it is impossible in many cases to comply. Resistance to the destruction of medicine gets one branded as a “disruptive physician.”

Information technology, the panacea for all problems, is a hugely expensive debacle as currently being implemented, physicians say. Physicians are turned into data entry clerks, yet the relevant data may be impossible to find.

Patients may not care that their primary-care physician is only earning $30,000/yr while working harder than ever, but may soon find that what they consider a $10 office visit is not available at any price.

Myths about superior care under socialized medicine, administrative cost savings, the vast potential of the “medical home,” the benefits of “evidence-based medicine,” and other widely believed fantasies need to be debunked by physicians, stated Dr. Jane Orient, AAPS executive director, who moderated the conference.

Powerful special interests are lined up behind the proposed program, and few are left to speak against it. It is vital that Americans hear from their doctors.

Please add your comments below to the edited transcript of the meeting.

Kennedy plan called a bailout for merciless industry

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Insurance industry support for “health care reform” apparently has a big price tag: forcing 46 million Americans to become potential customers. An individual mandate to purchase insurance could help to offset looming cuts to Medicare Advantage plans, writes Melissa Davis.

Companies like Cigna, which have lost some big accounts as cash-strapped employers dropped expensive health plans, also stand to gain, she notes (TheStreet.com 11/24/08).

The Kennedy plan is likely to be the Massachusetts plan for all. He’d prefer Medicare for all, but Republicans are expected to reject a totally government-run program, compromising on a public/private partnership instead.

Single-payer supporter Rose Ann DeMoro, who directs the California Nurses Association, says that an individual mandate would be a “massive bail-out for one of the most merciless industries in America”—one that, she complains is “already rolling in cash.” The 18 biggest insurers reportedly made $16 billion in profit last year (Philadelphia Inquirer 12/8/08).

Massachusetts supposedly assures that mandatory insurance will be “affordable.” Checking premiums for a husband and wife in their mid forties, an AAPS member got premium quotes of $612.22/mon in Massachusetts for a policy comparable to one that cost only $186.90 in Illinois.

Reformers demand that insurers accept all comers regardless of health status or previous illness, and charge everybody the same premium (guaranteed issue/community rating). They also demand all kinds of coverage mandates. America’s Health Insurance Plans, the industry trade group, has recently said it would accept this—but only if the government forces everyone to buy the product (Wall St J 12/9/08). Otherwise, low-risk persons will opt out, driving exorbitant premiums still higher.

The Massachusetts plan is being showcased as a great success, having decreased the uninsured rate for adults with incomes below 300% of poverty by 11%, and the rate for those with incomes below 100% of poverty by two-thirds. However, the cost of premiums continues to rise at twice the rate of general inflation; there is a 4% surcharge on the cost of each policy to cover the cost of running the Commonwealth Connector; and the cost of the program, expected to reach $1.35 billion by 2011, greatly exceeds original estimates (Neurology Today 11/20/08).

The level of public support for an individual mandate is said to have increased to 57% in 2007 and 58% in 2008. However, the people most supportive of the mandate are the most affluent, and the least affected by it. Of those who make more than $75,000 a year, 69% are supportive, but only 49% of those making between $25,000 and $50,000 are. Only 37% of those directly affected support the mandate, compared to 62% of those not affected. Only 22% of those affected say the law is helping them, while 60% say it is hurting (Greg Scandlen, Consumer Power Report #154, 11/19/08, quoting Robert Blendon in Health Affairs).

A public backlash against the plan is likely—probably resulting in a single payer system. In 10 Massachusetts districts, 72% of voters on Nov 4 supported a ballot question instructing their representatives to support legislation creating “a cost-effective single payer health insurance system that is available to all residents, and oppose laws penalizing those who fail to obtain health insurance” (Neurology Today, op. cit.).

Thus the insurance company bailout could be an example of saving the village in order to wreck it—except, of course, for the carriers chosen to administer the public program.

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Massachusetts resorts to group visits with the doctor

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Massachusetts, the proud model for likely Obama-Kennedy reform, is trying a new answer for the problem of a severe doctor shortage: group appointments.

Deluged with demand from newly insured patients, doctors have no room on their appointment schedules for all the new patients. At Holyoke Medical Center, it takes 4 months to get an appointment. A patient with chronic Lyme disease can’t find a single primary physician in three towns who will accept a new patient, so she goes to the emergency room, recounting her history to a different intake nurse, for all medical needs, including her regular prescriptions.

The Massachusetts universal coverage law required 440,000 more people to buy insurance or sign up with expanded Medicaid, and every one of them has to have a primary doctor in order to get into the system. Yet in the past year, 18 primary physicians have left the Amherst area (All Things Considered). , NPR 11/20/08

Harvard Vanguard Medical Associates now features “shared medical appointments.” Dr. Gene Lindsey, reputedly HVMA’s best cardiologist, sees all his patients in groups. HGMA plans to offer group appointments with 50 physicians and nurse practitioners (Liz Kowalcyzk, “The Doctor Will See All of You Now,” Boston Globe 11/30/08).

One group appointment, featured in a Boston Globe video showed nine patients seated in folding chairs around a table with snacks. Dr. Erickson shook hands with each of them and examined them one by one, discussing their medical details aloud. The video showed him listening to and percussing chests through clothing.

The appointment lasted 90 minutes. This is said to reduce doctor and patient dissatisfaction about feeling rushed during a 15 to 20 minute visit. Patients are said to be pleased that they are spending much more time in the room with the doctor. Nearly 80% said they would schedule future group appointments.

Patients are said to benefit from hearing others describe their symptoms and ask questions.

“People came to me with similar complaints and I had these canned speeches,” Erickson explained.

Patients have to sign a form promising not to reveal information they learn about other patients.

The doctor can bill for nine individual visits for the time period in which he previously could have seen only four to six individual patients. He can thus increase his productivity without having to work more.

There were 58 comments posted by Dec 1, and not all patients were pleased.

One wrote: “Nice business model if you can achieve it. Convince state lawmakers to require everyone to ‘get’ medical insurance which is really privatized medical taxation. Now convince the check-writing insuracrats that it’s justified to pay you the same for less service. Sorry, sharing the appointment with others is less service. This is little different than a taxi driver charging each of five passengers the same fare to go from location A to destination B. At least the taxi driver doesn’t provide less service.”

Another wrote: “There aren’t enough doctors because doctors are required to practice high-speed cookbook medicine…. So the answer is to speed it up more so patients can listen to canned speeches together?”

Other descriptions: “Third-world standard of care: many people being seen by a doctor at the same time, sharing…germs.” A “commoditization” of human beings. Having to listen to all the other patients is a “tax on people’s time.”

One idealist thinks it’s just what we need: “I think that as a nation we need to move AWAY from rampant individualism toward a system that embracees shared responsibility in a community. You are more likely to follow those pesky lifestyle recommendations if you feel like you’ll not only be letting down yourself and your doctor, but also your community.”

The appointments are “voluntary”—although possibly the only kind available for months. They are focused on health care, not sickness care: “1) education, 2) individual goals, expectations, and treatment plans, 3) self-management strategies, 4) developing a personal action plan.

Obama needs to look no farther than Massachusetts for a model, writes Jeremy Smerd. One small problem: Massachusetts knew it was not addressing the cost issue. Annual state spending could top $1 billion by 2009 (Workforce Management). 11/11/08

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