Michael Moore recently pontificated that under Obamacare Americans would have to wait for certain non life-threatening procedures such as a knee replacement. In his mind a “patriotic American” would be happy to do so. If one takes a critical look at socialized healthcare it would be obvious that it doesn’t work. In the UK, the healthcare system is so strapped for money that it is considering outsourcing the management of it to a German company. It is criminal that we would alter our medical system to emulate one that is obviously broken. Despite the pronouncements of healthcare equality we are rapidly moving towards a two tier system that is separate and unequal – those who have the means to do so will simply opt-out.

It is the insertion of Government into the healthcare system that has put us in the position we are in. Cronyism has given corporate interests such as big Pharma, medical insurance companies and hospitals the power to systematically remove competition, control prices and lead to the too big to fail phenomenon that has left doctors and patients on the outside looking in while those who know ‘what is best for us’ continue to gut what was once the best medical system in the world.  The medical insurance industry is an example of a supporter that helped lobby for the passage of Obamacare that has been a big winner.

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After months of denial that healthcare reform would involve rationing of healthcare for those who are the most vulnerable, the senior citizens who depend on Medicare, the President has come up with a proposal to decrease healthcare costs and guess what….it’s rationing.

Under Obamacare, a 15 member panel known as the Medicare Independent Payment Advisory Board (IPAB) was created to ‘oversee healthcare costs’. This panel consists of individuals appointed by the President and confirmed by Congress – two ingredients that make it highly unlikely that they would be truly independent. In addition, there is no requirement that members be practicing physicians which is a recipe for cuts that are highly likely to affect the delivery of quality individualized patient care.

Under his deficit reduction plan, the President proposes to expand the power of this unelected entity to increase the GDP growth per capita cut from the current 1% to 5%. In addition, under his proposal Medicaid payments to states would also be tightly controlled and access to drugs would be limited through spending on prescription drugs.

There are two things that make this proposal doomed to fail if the goal is to decrease health costs while providing quality care:

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I had high hopes after the fall elections that things would change. I expected once the Republicans took power that they would make a concerted effort to reverse the downslide of our health care system into the hole that is created by Obamacare. Apparently, it is just business as usual on Capitol Hill… big surprise.

The House rules committee voted against the amendment by Rep. Steve King that would defund Obamacare thus clearing the way for the mandatory self-funding provisions initially written into the bill by Pelosi et al to take effect.

Either the Republicans are playing politics by allowing this fiasco to drag on into the election season so that they can use it as ammunition against Obama and the Democrats, or they actually like the bill and only pretended to oppose it to increase their chance of getting elected. Whichever scenario is true the outcome is still the same. The further down the road to implementation Obamacare gets, the harder it will be to reverse.

While the Republicans dither there are a few truths that are becoming quite clear.

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Since the healthcare reform legislation passed, the discussion has centered on the fear of a government takeover of healthcare, but maybe this should not be the focus. Perhaps we should be worried about a corporate takeover of healthcare.

HIPPA (Health Information Portable Accountability Act) was signed into law in 1996 ostensibly to protect a patient’s privacy. It involved “covered entities” such as physicians, administrators who administer health plans for employers, and anyone who is involved in transactions including business associates. Over time it has evolved into a legal club that consists of fines and or jail time that can be used to punish those who have been deemed to violate the rule. The Recovery and Reinvestment Act of 2009 gives the Secretary of the Department of Health and Human Services the power to determine the amount of fines and whether civil penalties will be applied to those who violate HIPPA.  As with many other tenants of Obamacare, this was not present within the healthcare reform bill. It is simply another example of a legislative sleight of hand that makes it easier to slide in questionable pieces of legislation that may not be popular by distracting with one hand while the other is doing the dirty work.

If the over 700 waivers to the healthcare mandate granted by Secretary Sebelius to big corporations such as Waffle House and Foot Locker, and supporters of  Obamacare such as Aetna, Cigna and the SEIU are any indication, those who oppose the administration need to watch their backs. Dr Milton Wolf wrote an article for The Washington Times (The Tawdry Details of Obamacare) that provides an excellent synopsis of the privileged treatment bestowed upon friends of the administration. Clearly, this highlights what the president said about rewarding friends. Those who are not lucky enough to receive these waivers will have the thankless task of being under the mandate yolk and therefore picking up the tab. In the age where the government constantly talks about ‘fairness’ how fair is that?  It is yet another example of rules that are applied unequally.

Now that the cozy relationship between Google and the government has been brought to light it leads one to wonder what other favors will Google be granted?

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If Obamacare is completely implemented, doctors will no longer be practicing medicine. They will instead become the drones tasked with deciding who gets the meager healthcare crumbs doled out by the bureaucrats who have the ultimate power over patient life and death. Those who are deemed to have illnesses that require treatments which are not cost effective can expect a one way ticket to a hospice.

Like so many bills passed by Congress, there was a hidden provision in the Stimulus bill passed in 2009. It spends 1.1 billion dollars to create an important piece of the framework for the healthcare bill called the Coordinating Council on Comparative Effectiveness Research. It is based on the false premise that doctors in consultation with their patients don’t have the ability to make the right healthcare choices (see executive summary). The council consists of 15 people appointed by the President.

They all have one thing in common–they are all isolated from day to day patient care; and therefore, are insulated from the real practice of the art of medicine. It makes it easy to see patients as a cost center to be controlled. With views of members like Dr Emanuel, who champions the complete-lives system, it is hard to ignore the probability that senior citizens, those with chronic illness, and the very young will be on the outside looking in. This council is another example of the people of this country being told by the government that it knows what is best for us.

The framework set up by the stimulus bill merely set the stage for the implementation found in the healthcare reform bill. How can the government get doctors to participate in Obamacare thereby a) willingly destroying the doctor patient relationship, and  b) betraying their Hippocratic Oath to provide treatments that they deem to be effective? Simple – fear and intimidation.

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Does the government have the right to potentially risk the health of men, women and children who travel in the name of national security? Now that the body scanners have been deployed in many US airports, it is time to take a second look. We were told by the government that they were necessary to secure our safety after the attempt by the underwear bomber. Some have theorized that the scans can damage the DNA. Unfortunately, very little is known about the effects on the human body because no long term studies have been done. Therefore, it is hard to say with certainty that the benefits out weigh the risks.

Now that they have been deployed in many airports throughout the country, it is time to ask whether they are safe. Do the facts jibe with what we have been told?

1. The pictures can not be saved.

FACT: That turned out not to be true. The pictures can be saved and there have been instances of abuse.
In the UK where the scans are mandatory, children are not allowed to go through them because of the fear that the saved pictures can be hacked, and will therefore breach child pornography laws.

2. There are no health risks.

FACT: No one knows. Presumably even low dose radiation can have a harmful effect. Conservative estimates state that there will be one additional death for every 200 million people exposed to the body scanners. There will be even more people who develop cancer from the exposure. Although we are exposed to background radiation on a daily basis, it is not the same as placing our bodies in a field of focused radiation.

3. It will make us safer

FACT: The body scanner technology would not have been able to identify the underwear bomber because it cannot see powder, nor can it see anything placed in a body cavity. It can see liquids and ceramics and fine intimate detail of an individual, but it is no better at picking up metal objects than the metal detector.

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The implementation of the healthcare reform bill that was passed in March has now begun. Unfortunately, it is becoming obvious that the promises made such as: a) you can keep your physician and medical plan if you like them; b) your healthcare costs will go down; c) there will be no healthcare rationing; and d) everyone will be covered simply were not true.

We were fed a steady diet of fear, distraction and falsehoods to sell healthcare reform.

• We were told that unless something was done healthcare costs would bankrupt the country

The Congressional Budget Office (CBO) released a report admitting that the actual cost of the healthcare system would be far higher than was initially estimated  - a cost of more than 1 trillion dollars

• We were told that healthcare premiums would decrease for families

The CBO report estimates that the cost of healthcare premiums would go up by $2100 for the average family next year

• We were told that if we liked our health insurance and doctor we could keep them

Thousands of Medicare recipients from Massachusetts to Maine will lose supplemental insurance through Medicare advantage thereby increasing there healthcare costs exponentially.

• There will be no healthcare rationing

The choice of Donald Berwick speaks for itself. He is a champion of the British model of socialized one size fits all medicine. It is a broken system that is based on rationing of care that is collapsing under its own weight.

There have also been examples of nascent rationing here in the US. e.g, in Colorado the cancer drug Avastin is not covered by Medicare although it is covered in other states. In addition, the effectiveness of screening tools such as mammograms are being questioned. It is likely that these studies will eventually be used to argue that mammograms are not effective and therefore will not be covered by insurance.

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Now that elections are around the corner members of Congress who voted for the healthcare reform bill are spending a lot of time back-peddling, avoiding the topic all together or digging themselves in a deeper hole by claiming that Americans will have better healthcare with choice of doctors, and expanded coverage at an affordable price.

Let’s look at the facts:

• The bill was written by and for Big Pharma and the medical insurance industry. Senator Max Baucus a member of the congressional brain trust who brought us the healthcare reform bill admitted he never fully read it and has no idea what is even in it. Now he admits to having no clue what was in the bill he helped shove down our throats…. Unbelievable? Surprising? No just business as usual.

• Those on Medicare were told that they would see no change in their benefits and would be able to keep their physician. In fact, 11 million senior citizens will see premiums go up because of cost cutting including the removal of Medicare advantage. Furthermore, since there has been a decline in the number of physicians who currently are accepting new Medicare patients or who take Medicare at all, it is likely that seniors will not be able to keep their doctor and will pay more for less.

• The nomination of Donald Berwick to head CMS means a philosophical shift of our healthcare system to the British model of medicine that puts a premium on cost and not the needs of the individual. An example of this is the decision by the FDA remove Avastin from the medication available to treat advanced cancer because it is deemed that the good of extension of life is outweighed by the cost of the medication. Medicare has already stopped covering the use for Avastin to treat  ovarian cancer in Colorado.

It is clear that the relentless drive to reform the health care system was a cynical political push for a win at all costs. We were told what we wanted to hear and there was no attention paid to the consequences. Every single card was played – from the class card to the race card, and getting us to fight among ourselves achieved the goal of distraction. Now that the smoke has cleared it is pretty obvious that in the name of expanding healthcare to approximately 30 million more people, we have sacrificed what is best about our healthcare system – individualized patient care, the doctor patient relationship, and the drive towards innovation. However, the costs have not changed.

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It has been almost three months since the oil spill in the gulf. However, there has been little attention given to the health effects of exposure to the various components present in the spill or the chemical used to disperse the oil.

The contents of the oils spill contain several components. Each has the potential to cause health risks to those who are exposed to them. These are some facts of some of the most toxic substances:

1.  Benzene

Is a colorless liquid that has a somewhat sweet odor. It evaporates in air quickly and can dissolve into water. Therefore, it can be present in rain water carried distances and can have an effect on the ground a distance from the original source. Reports from the EPA have put the amount of Benzene measured near the Gulf of Mexico at 3,000-4,000 parts per billion (normal 0-4ppb). The EPA has set the minimum benzene exposure in drinking water at 5 ppb and the Occupational Safety and Health Administration (OSHA) has placed safe exposure of benzene at 1part per million parts of workplace air for 8 hour shifts in a 40 hour work week. The EPA considers it a carcinogen at 1,000 ppb. Exposure to benzene vapors can cause a myriad of symptoms from headaches, nausea, dizziness, and drowsiness to rashes, respiratory difficulty. It has also beenlinked to leukemia and lymphoma. More Benzene Facts

2.  Hydrogen Sulfide

This is a colorless flammable gas that is highly toxic that has a characteristic  “rotten egg” odor.It is 20% heavier than air, and therefore will accumulate on the ground and in confined spaces. At concentrations above 100 ppm the olfactory nerve (the nerve that controls the sense of smell) is affected and the person can no longer detect the foul smell. However, if the person has a prolonged exposure to a low concentration the ability to detect the smell will also be lost. Exposure to the gas at low concentrations (0-10 ppm) can cause eye, nose and throat irritation. At moderate concentrations (10-50 ppm) it can cause headache, dizziness, nausea and vomiting and cough. Respiratory difficulty; and at high concentrations (50-200 ppm) it can cause convulsions, coma and death. The EPA has measured the level of hydrogen sulfide gas in the gulf at 1000 ppm (the normal is 5-10 ppb).Most countries put a safe legal limit in the work environment of 10 ppm. In addition, protective equipment such as air respirators is mandated.More Safety Facts

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Health care reform is the latest piece of the puzzle to be put in place. If you add this to what has happened in the financial industry and the banking industry a bigger picture begins to emerge. With the proposed financial regulations, there seems to be a movement towards the consolidation of power in a few institutions, systematically removing free competition, setting up the too big to fail phenomenon, thereby giving people less choice that will ultimately cost everybody more in the long run.

Since the passage of healthcare reform, there has not been a lot of talk about the role that hospitals will play. What no one talks about is the fact that there has been a quiet movement or shift of doctors from private practice to hospital employees. Many smaller community hospitals and doctor owned hospitals have gone out of business because they could not afford to keep their doors open. In addition, there has also been a quiet consolidation of hospitals. For example, in Atlanta, groups of specialists have become hospital employees.  With the movement of various specialists, hospitals have now become specialty centers for specific patient care.

It is not hard to visualize a future where there will only be a certain number of hospitals that are able to provide care for specialized diseases such as cardiac care, or orthopedic surgery.  If that happens, access will be restricted since patients will be limited as to where they will be able to go to receive their care.  If there was only one specialty heart center in the city and only a certain number of doctors on staff, by definition, there will be a limited number of patients that can be treated at any specific time. Unfortunately, these changes will likely lead to the de facto rationing of care.  In addition to the problem of access, costs will likely go up because of the lack of competition.

The demise of Lehman Brothers and the consolidation of other large financial companies have led to very few winners in the financial industry – the biggest of which is Goldman Sachs.  The banking industry has seen a few surviving large institutions such as Chase and Citibank. What the larger banks didn’t acquire in mergers, the FDIC removed by taking over and closing hundreds of smaller and community banks. Makes you wonder if the credit unions will be next on the list.

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Have you wondered how healthcare reform will play out? You only need to look at how healthcare has been laid out by the World Health Organization (WHO). The International Classification of Disease also known as the ICD is the coding system that is used to classify diseases. It is published by the (WHO), and it is also the basis for reimbursement for hospitals and physicians.

There have been several iterations of the ICD. The most recent is ICD-10. Seven countries have adopted it to date. The first country to adopt it for clinical use was Australia in 1998 then Canada in 2000. The most recent country to adopt it was Thailand in 2007. The United States is scheduled to adopt it in 2013. Just in time for the major pieces for the healthcare reform pieces to take effect. The mad rush to pass healthcare reform makes a lot of sense when this time table is taken into consideration. It finally brings the US healthcare system into the global healthcare system overseen by the WHO.

How will our healthcare system change when 30 million new people will be covered and will need healthcare? The system in British Columbia, Canada provides an example of what we can expect. They have adopted a healthcare system that has clinical treatment guidelines set forth by a protocols advisory committee. Our healthcare reform system also sets up an advisory panel that will use evidence based medicine.

These advisory panels set up treatment flow sheets that will make it easy for healthcare providers such as physician assistants to provide care. Now I understand how Governor Rendell can make the statement that he did a couple of weeks ago that health care providers are “just as good as primary care physicians”. Although we have a shortage of physicians, the statement is clearly based in the premise that anyone can use algorithms to cookbook medical care. All you need to do is connect the dots.

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The vote is done and we have awakened to a new era. Under the guise of  coverage for pre-existing conditions and the security of knowing that you can’t be kicked off your insurance when you really need it, the democrats have pushed through a bill which will lead to the end of health care as we know it.

Besides taxing us from everything from our unearned income, to payroll taxes to medical devices we can look forward to paying into a pot for the next four years. I only hope the money will be available for health care.  As it stands now, it will be used to set up yet another government bureaucracy run by various task forces and yet another Czar to oversee the entire mess. If we’re lucky they will actually use the money for the intended purpose, but I have visions of the social security lock box. It is hard to believe that this will end up any better than Medicare, The Post Office or Social Security – big, bloated and bankrupt.

The bill sets up committees to study ways to deliver care.  A committee to study what another committee is supposed to do? Sounds like bureaucracy at its finest. It is hard to believe that that money used to ‘study’ things will be used for patient care. By the time 2014 rolls around what money will be left to implement medical care?

The government sold health care reform with 5 basic talking points:

1.  You won’t be able to be kicked off of your insurance when you really need it

• Turns out that the insurance companies CAN kick you off if they pay a fine. It is not hard to imagine that an insurance company will figure out pretty quickly that it would be cheaper to pay the fine than to pay for coverage of a long term chronic illness.

2.  You won’t be denied medical care for pre-existing conditions.

• If the insurance company deems that you have lied on the application you will be denied coverage.
• Sick children are no longer considered to have pre-existing conditions, but what about women who are pregnant?

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If the goal of the President’s proposal was to drive doctors into hospital based practices or community health centers, or if it was to break the spirit of providers and bend them to the will of the government that holds the threat of criminal prosecution over their heads if they are found to be Medicare cheats, or if the goal was to dumb down the practice of medicine by ramping up the power of the HHS secretary and the evidence-based medicine posse, then the President’s proposal for health care reform was successful.

However, we as physicians are individuals. There are approximately 890,000 doctors currently practicing in the US. Those of us who want the autonomy to practice medicine the way we were trained, those of us who run a private practice who are entrepreneurs at heart, those who are tired of being pitted against our patients and other physicians (the specialist vs. primary care physician meme), and those who are just sick and tired are NOT going to take this. Those of us who can will retire or leave medicine all together. Those within the system will simply opt out.

The President’s summit on Thursday amounts to nothing more than six hours of theater. Not one physician in Congress has been invited to attend. The physicians for single payer have also not been invited. It is his chance to hear from the people on the front line, and it is obvious this bill is NOT about the health of our people. It is about raising revenue, controlling the medical industrial complex completely. How else can you explain the proposal for the government to a) take over control of the cost of insurance premiums; b) limit provider medical decisions based on cost, and c) control what is medically covered for the patient. Under the proposed health care reformed, the government will control how much an insurance company can charge, decide what is covered medically, and sanction the provider for deviating from the norm.

These are some of the proposal highlights that concerned me the most:

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I have been reading various articles and listening to pundits for months talk about healthcare reform. They have discussed ad nauseam everything from complete government takeover with single payer on one hand to free markets on the other.

Next week, we will be witness to the President’s healthcare forum. This is what we know so far:

• Tort reform is pretty much off the table.

The trial lawyers lobby has seen to that.

• There seems to be no political will to apply anti-trust regulations

This will continue to benefit the health insurance industry since they will be able to continue to run fiefdoms in various markets guaranteeing their market share and profits.

• The public option is really NOT an option.

If it does get implemented it will be a glorified version of Medicare Advantage where the program is administered by the insurance companies. A particularly sweet win-win situation for them since it means we will have to pay them whether we want private insurance or not.

• More taxes

We will be paying money into a governmental black hole for the next 4 years in the hopes that we will get inexpensive, comprehensive health coverage in the end. I have just two words about that – Medicare and Social Security (enough said).

• If you don’t like your insurance too bad

People who don’t like their private insurance plan will not be able to access the exchange system.

We are at a crossroads.

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Did you ever wonder exactly what evidence-based medicine is? The National Center for Clinical Excellence bases it in on the philosophy “that as much medical practice as possible ought to be carried out using proven algorithms based on empirically valid evidence from controlled scientific experiments, rather than individual clinical judgment.”

Congressional health care reform relies heavily on both Evidence-based guidelines and evidence-based individual decision making to set the standards of care for medical treatment and outcomes. In fact, House bill 3962, in an effort to control costs, creates a new layer of government bureaucracy that inserts itself between the doctor and the patient. A national health commissioner and task forces will evaluate and decide everything from what medications a physician will be allowed to prescribe for a patient, to what surgery will be approved, to what outcomes will be expected for a particular medical condition. The ‘universal healthcare Czar’ along with the task forces will also decide whether or not hospitals will be reimbursed for care rendered based on predetermined outcomes. For example, if a patient is re-admitted within a prescribed number of days after discharge, the hospital will not be reimbursed for care given. It does not take into account factors such as how ill a patient may be. This new layer of government effectively removes the power of the individual physician and patient to decide what is the best course of treatment.

Why should you care?

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It has become clear that health care reform in its present state has nothing to do with delivering quality healthcare to the American people.

The idea of universal coverage, with protection against insurance company wrongs (e.g., denying patients for pre-existing conditions and limiting the insurance company’s ability to deny coverage when you really need it) has been the sheep’s clothing cloaking a bill designed to destroy our healthcare system. In short, the proposed healthcare reform will doom us to a future that has the potential to make us sicker by limiting our access to screening exams such as mammograms, and limiting our access to physicians while making us pay more for the privilege.

The vote in Massachusetts was a stand against those in the government who are bent on telling us that they know what is best for us. I have been astounded by the complete contempt in which those in power hold the American people. A majority of the people in this country think the healthcare reform effort is going in the wrong direction. Although the vote in Massachusetts made it clear that there was major opposition to the current bill, I have doubts that the voices of the majority will be heard and this debacle will be stopped.

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A few weeks ago we were told that CT scans and mammograms can increase the risk of cancer. Since the rush to deploy the new total body scanners in our airports has been a topic of hot debate. There has been a burning question that has not been answered that needs to be. If CT scans and mammograms are no longer considered safe, what makes the total body scanners safe to use?

The technology used in the full body scanners is either backscatter x-ray or millimeter waves . Both use a form of radiation call terahertz photons (T-rays). T-rays are a form of infrared energy that lies between radio waves at the low-end and microwaves at its higher end. It may be non-ionizing unlike x-rays; however, the energy is able to penetrate tissue, clothing, paper, plastic, wood and ceramics among other things.

The TSA website represents the full body scanner as a safe method of screening. However, not only are we giving up our privacy, we are also playing Russian roulette with our safety. It is important to note:

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In a recent article published in The Atlantic Jonathan Gruber, an economist from MIT was enthused over the Senate’s healthcare bill because of its kitchen sink approach to the problem of rising healthcare costs. “I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill.” This quote is a distillation of the problem I have with the whole healthcare reform effort. It seems like a case of throw it up on a wall and see if it sticks.

From the beginning of the debate and the resultant bills in Congress there has been no thought put into the root cause of the high cost of healthcare. As usual the players who were allowed to sit at the table were the ones who had the most to lose if the status quo really changed. Special interest groups (i.e., unions, hospitals corporation, medical insurance industry, pharmaceutical industry, and the AMA) each flooded Washington with money and controlled both the argument, and the perceived solutions for the mess that has become our healthcare system. At no point were physicians on the front line who deliver patient care or patients who are victims of the health insurance maze given a voice in the process let alone a seat at the table.

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The health care reform bill (HR 3962) that just passed the House of Representatives is bad on so many levels it is difficult explain. As it stands, it will destroy the doctor-patient relationship and change the practice of medicine as we know it.

We have one of the finest health care systems in the world. It has been built on a foundation of choice. Doctors were free to choose the care that they deem necessary to treat their patients, and patients were free to seek the medical care of their choice. Initially, the foundation was shaken by the rise of the managed care system with capitation. However, over the past 10 years, capitated plans which limit access to specialists have given way to the rise in power of insurance companies. They have used their anti-trust exemption to craft a system that has used monopoly to increase profits on the backs of both doctors and patients.

Unfortunately, the House does not address necessary changes that would lead to meaningful reform, such as breaking the monopoly strangle-hold that insurance companies enjoy, reigning in the enormous profits of the pharmaceutical industry, tort reform, or crafting a healthcare system based on wellness and prevention and not the management of disease. Instead HR 3962 creates a layer of government bureaucracy that inserts itself between the doctor and the patient by creating a national health commissioner and task forces that will evaluate and decide everything from what medications a physician is allowed to prescribe to a patient, to what surgery will be approved, to what outcomes will be expected for a particular medical condition.

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