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Archive for March, 2010

PostHeaderIcon Health Care: The Day After

It was never about Health.¬† It was never about universal health care.¬†¬† Access does not equal care and certainly not quality care.¬†¬† Yes, one side “won.”¬†¬† This is not a victory for you.

It is not a left-wing agenda.¬† It is not socialized medicine.¬† This is the first time the Federal Government has mandated the purchase of a private party product.¬† And from the very racketeering group that is the root cause of the problem in the first place.¬†¬† What a travesty.¬†¬† Another government subsidy.¬†¬† Effectively amounts to another “government bailout.”

As Michael Moore wryly said:

The larger picture here is that the private insurance companies are still the ones in charge. They’re still going to call the shots. And if anything, they’ve just been given another big handout by the government by guaranteeing customers. I mean, this is really kind of crazy when you think about it.

This is not the same as a state mandate for auto insurance.

The State of California is unrelenting on this point.  Driving is a privilege!  It is not a right.  If you do not drive, you are not mandated to purchase auto insurance.  Furthermore, the reality is auto insurance does not cost $5000-12,000 annually.

This is the first major landmark piece of legislation in American history that was passed by such a narrow margin without a single Republican vote.¬†¬† Social Security passed with bipartisan support in 1935 — 81 Republican Congressman and 16 Republican Senators.¬†¬† In 1965¬† Medicare passed with bipartisan support –¬† 70 House Republicans and 13 Senate Republicans.¬† In 2010 there was not one single Republican vote.¬†¬† And the margin in the House was razor thin — 220 to 212.

It also violates a well-tested political strategy — sell it first to the American people who will then pressure Congress to pass new legislation.¬† The public is not aboard.¬†¬† The latest Quinnipiac and Washington Post polls show the public still opposes this landmark Act.

AT&T has already made plans for a $1 billion write-off in advance of cost shifting.   And legal staff is hard at work looking for technical loopholes.  This just in from Robert Peer at the New York Times:

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: ‚ÄúThe fine print differs from the larger political message.¬† If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.‚ÄĚ

Everyone is giddy about “the win.” ¬† This is only the end of the beginning.

Remember the Telecommunications act of 1996?   It was enacted to guarantee local competition amongst the major carriers.  It never happened.

Now watch this interview with Michael Moore:

PostHeaderIcon Health Care Reform: Myths and Misunderstandings

Too often have I written about the endgame.¬† Shades of Mark Twain — reports of my death are exaggerated.¬† But this really is the ninth inning.¬† The problem is the president is looking for the long ball — the out of the park home run.¬† When he should have been hitting singles, or emulating the great Joe Montana — short yardage high percentage gains — not Hail Mary passes.

Ave, Imperator, morituri te salutant

The secret fate of all voting democratic House members.  The arm twisting in the house rises to epic proportions not seen since the days of the infamous Tom DeLay Рthe Hammer.

This will be a bad bill.¬† You are all unwitting pawns in this game.¬† It will solve nothing.¬† It cures nothing.¬† It has emboldened the insurance racketeers and Big Pharma.¬† It has only one potential good outcome — Rush Limbaugh has promised he will leave the country.

They have rolled Howard Dean and Dennis Kucinich.¬†¬† Other voices have been marginalized – Bernadine Healy, Robert Reich, Norman Goldman of Talk Left, Marcia Angell. And who will benefit from a fatally flawed passage?¬†¬† The rising unaffiliated — the independent vote.¬† This is a Greek tragedy.¬†¬† A Pyrrhic victory.

We are all too aware of the right wing echo chamber.  A well orchestrated score promoting stereotyped rat a tat answers.   How do they do this?

The same may be true in on the left as well.  We hear platitudes and assertions over and over again without challenge.

1. United States ranks number 37 in the world in healthcare.

Why repeat this assertion over and over and over again?  Because it makes a false point.

This figure is derived from life expectancy in the OECD  (organization of economic cooperation and development) countries.  The spread is narrow Рless than five years.

My friend Burton Goldberg, one of the most successful publishers of alternative medicine, constantly beseeched me on this issue — investigate life expectancy derivations.¬† Life expectancy is a highly complex mathematical formula that balances death with infant mortality.

A country with a high infant mortality has a lower life expectancy rate – at birth.

For the most perplexing reasons, the United States still has a relatively high infant mortality rate.  If the figures are adjusted for life expectancy after the age of 60 we rate number 5 in the world.   If life expectancy figures are adjusted after the age of 80 we rate number 3 in the world.

In other words, as we advance in age, the effect of infant mortality is factored out and the real life expectancy becomes more apparent.  We are not number 37 in the world.  We are in the top three.  Life expectancy figures beg a revised definition.

Life expectancy change with age

US Life Expectancy -- 3rd place by age 80

Furthermore, life expectancy is a dreadfully  inadequate measure of the health of a nation.  It says nothing about the quality of life.  HDI, (Human Development Index) may be a better measure.]  It says nothing about vibrancy, activity, mental health, social health, sexual health, or productivity.   It simply means that you crossed the finish line at a particular age.   No matter whether you dashed across or fell across the finish line and died.

In Anti-Aging Medicine, we talk about “squaring the curve.”¬† Increased Health Span and not Life Span.¬† A healthy life until old age followed by sudden death.¬† Not a slow inexorable painful march to the end.

2. The medical system suffers from over utilization.

Not as I see it.   Quite the opposite.  I see scores of patients who have pleaded for years for adequate and thorough lab testing only to needlessly suffer through unnecessary dysfunctional states   This is a natural consequence of HMO and PPO medicine.   Bottom-line cost-recovery medicine is a zero sum game.

3.  If you do not pass this bill everybody will end up in the emergency room.

There is such an appalling lack of medical input in this entire debate.   Urgent care medicine had its roots in the 1980s.   Originally funded and promulgated by astute entrepreneurs and ex-emergency physicians, these facilities answered the need for acute medicine outside of an emergency facility.   There are more than 8700 Urgent centers visits vs. 4600 emergency departments.     [And by the way, Emergency care represents less than 3 percent of the nation's $2.1 trillion in health care expenditures while covering 120 million people a year.]

This is market-oriented medicine.¬† A workable and elegant solution in response to a market demand for immediate care outside of exorbitant emergency rooms.¬†¬† They are successful and see all comers.¬†¬† In Atlanta alone, my good friend Jordan Rice, one of the leading Urgent Care entrepreneurs in the country boasts of the ability to see any and all comers — Medicaid and cash paying patients.

Even the original Medicare bill of a 1965 garnered 13 Republican votes in the Senate and 70 Republican votes in the House.¬† To pull every legislative trick in the book only underscores the thinness of support for this ill-conceived rewrite of our society.¬† To be honest, Michelle Obama’s anti-obesity campaign could have more far-reaching effects that all 2700+ pages of this legislative lunacy.