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.

While people like Moore make easy pronouncements about it being alright to wait for medical care because it is your patriotic duty, the reality is people are suffering because of these decisions. Physicians are put in the untenable position of watching their patients suffer needlessly and in some cases die. As physicians we take an oath to do no harm. It is time for physicians and patients to make our voices heard before choices are legislated away.

In reality, Obamacare will potentially put more people in a broken system that will systematically delay and deny care all in the name of cost savings for the false feel good meme of universal coverage.

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:

1. It does nothing to change the exemptions that were given to the hospitals, and other Medicare providers that make up a majority of Medicare spending thereby protecting them from the reach of the IPAB.
2. It will further decrease the already below market rate of Medicare reimbursements to doctors making it even more difficult to provide both quality care for the Medicare patient and to keep their practices open.

However, if the goal is to limit healthcare costs by reducing access to physicians, restricting choice of treatments, restricting access to medication and technology, and/or hoping that people will either be to sick or too frustrated to access the system while playing the crony politics of rewarding those who helped craft Obamacare, then it is well on its way.

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.

-          The costs associated with implementing the various provisions of the bill will continue to rise

-          The cost of premiums to individuals, families and businesses will continue to rise

-          The ability of patients to be able to choose their physicians will continue to decrease

-          The one-size-fits-all policies of Dr. Berwick and CMS will move forward and the devastating effects  on the delivery of quality individualized health care will become unavoidable.

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?

It is conceivable that they can use a loophole in HIPPA to flout the regulations and share or sell the medical information that they obtain on their Google Health Website that was launched in May 2010. While Google states in their privacy policy that they will not sell your private health information, it is charged by Consumer Watchdog that they have been lobbying Congress to do just that.  If this is allowed, they would join pharmacies and pharmaceutical companies in the ability to make a profit off of private health information. Furthermore, it opens up the possibility that the government would have direct access to your health information through the window that Google is purported to provide the government through agencies such as Medicare and National Security Agency. For example, if you put on your form that you had some medical condition or habit that you declined to disclose to your doctor, you may unknowingly be sharing that information with insurance companies and possibly the government. In short, Google is held to a different standard then a physician. They potentially could be allowed to share your health information since they are not limited by the strict confidentiality of the doctor patient relationship (if a doctor disclosed such information he/she would be fined up to 250,000 and receive 10 years in jail). The Department of Justice has broadened the definition so that the physician can now be found in violation without having specific knowledge of the violation.  i.e.,  the physician is now guilty until proven innocent.  The most recent DOJ interpretation of criminal breach of HIPPA regulations:

Knowingly
The DOJ interpreted the “knowingly” element of the HIPAA statute for criminal liability as requiring only knowledge of the actions that constitute an offense. Specific knowledge of an action being in violation of the HIPAA statute is not required.

Google is one example of the growing list of companies with a creepy connection to the government. Like the Food Safety Bill S510 which has given control of our food supply to big Agra, and the Healthcare Reform Bill that has given control of our healthcare system to big Pharma, insurance companies and corporate hospitals, this appears to be yet another example of the insertion of a corporate middleman between us and our right to privacy. First it’s the carrot then the stick – put your health information voluntarily on their website, and like the social media websites put yourself in the position to have it be used against you.

Most recent list of approved government waivers: http://www.hhs.gov/ociio/regulations/approved_applications_for_waiver.html

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.

A second board created by the stimulus bill called The National Coordinator for Health Information Technology “will determine treatment at the time and place of care”. They are charged with deciding the course of treatment for the diagnosis given by the doctor. Now it becomes obvious why there has been a big push towards the implementation of universal electronic medical record use. It becomes a tool to completely control the physician and the patient. Those physicians and hospitals that choose to practice individualized patient care in consultation with their patients will be punished because they are not “meaningful users of the system over time.” Beginning January 1, 2013 penalties for doing the right thing for a patient will cost the doctor $100,000 for the first offense and jail for the second offense. This will have a chilling effect and may be the straw that completely breaks the foundation of good medicine – the doctor patient relationship.

46% of physiciansin a survey by The New England Journal of Medicine stated that they would leave the practice of medicine if Obamacare was implemented. This will only further decrease the quality of healthcare when the 30 million more people enter the system. Maybe that’s why there is a big push in the healthcare bill to increase the number of other providers such as physician assistants and nurse practitioners. There is no question that rationing will become our future. If you add 30 million more people into a system with fewer resources how could you possibly avoid rationing? Perhaps those members of Congress who passed this nightmare don’t care since they made sure that it wouldn’t apply to them.

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.

Studies have pointed to the willingness of over 75% of people to go through the naked body scanners. This is the biggest reason why these machines have been deployed. If we believe that the risks outweigh the benefits, then it is time to know what our rights are and to exercise them. In the name of national security and because of fear, we as citizens have given up our right to be considered innocent before being proven guilty.

-Know your rights: Going through the body scanners is Not Mandatory at airports in the US (they are mandatory in the UK). You have the right to “opt-out” and have a pat down.

See:  The current list of airports with body scanners

Although, it may feel uncomfortable or strange to submit to a pat down, it beats subjecting yourself to potentially harmful radiation and the voluntary loss of your privacy. This is just the beginning of a slippery slope.

If Janet Napolitano doesn’t want to go through the body scanners why should we?

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.

The rising cost of private medical insurance premiums and deductibles in the current economic environment also lead to the rationing of healthcare. This is not surprising since the bill was written by and for the corporate medical cabal (i.e., the medical insurance and pharmaceutical industries, the Hospital Corporation of America and the American Medical Association) that make profit their number one priority instead of the health of our citizens.

By appealing to our lowest common denominator we have been divided and distracted by playing either the fear, race and/or class cards ad nauseam while nothing has been done to control the real reasons for the high costs of healthcare.  For example:

• Medicare still cannot import cheaper medications that would decrease the healthcare costs of senior citizens.
• Those with health savings accounts cannot use their account to buy cheaper over the counter alternatives or nutritional supplements. They can only buy prescription drugs.
• Healthcare reform now covers preventative tests, but there has been a movement towards limiting the indications for testing (eg, mammograms to detect breast cancer and PSA to diagnose prostate cancer).
• Nothing has been done to stop insurance companies from hoarding profits while systematically raising premiums.
• There has been no mention of tort reform.

Why have none of these changes been implemented? Perhaps it is because this is a system that is set up to fail. When people get so fed up with waiting for treatment, or no longer want to put up with being denied care because a decision is made that the costs outweigh the benefits, the government will be ready to step in with the solution of the single payer system. Unfortunately, when that happens medical care in the United States as we know it will be lost forever, and we will be saddled with a system that even the British find untenable.