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Health Care Reform: Myths and Misunderstandings

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 – the 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 – less 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.

Health Care Reform: a Postmortem Requiem

Health Care Reform: a Postmortem Requiem

Last night health care reform died.   What went wrong?   A plethora of explanations from all the usual suspects to follow.   You will hear some rumblings of dissent — press on.

The simple answer:  everything was wrong.   This never was about health care reform.  This was always an attempt at health insurance reform.  And in that regard it was a miserable failure.  The bill, as passed by the Senate, was a cruel proposition.  The ultimate lay away plan: pay me now and you might be able to enjoy your coerced purchase in four years.  Do you know how much can change in four years?  Everything.

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Keith Olbermann Sounds the Death Knell

Keith Olbermann Sounds the Death Knell

Keith Olbermann, always impassioned, penetrating and reflective. The chorus rises: this bill with it’s mandated participation in the insurance protection scheme cannot be supported.

A bad and corrupt bill is worse than no bill at all. The President’s high stakes gamble is overtaken by the raging storm of job insecurity and … the economy.

Visit msnbc.com for breaking news, world news, and news about the economy

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Howard Dean Says It’s Time to Kill This Bill

Howard Dean Says It’s Time to Kill This Bill

Howard Dean at his most articulate and unambiguous self.   The time has finally come.    There is nothing left to support.   It’s now face saving time.   It is not about Joe Lieberman.   He’s just become the Mannie Ramirez of the Senate.

“It’s not health care reform … and it’s too bad it’s come this.”

“You are going to be forced to pay, on average, 27% of your money to pay CEOs $20 million a year…”

[starts at about 4:08 into this clip]

Visit msnbc.com for breaking news, world news, and news about the economy

HealthCare Napkins: It’s Not About HealthCare

HealthCare Napkins: It’s Not About HealthCare

Single payor is not the answer.   But this is an illuminating sketch of “HealthCare 101” coming into the bottom of the 8th inning.   What is missing is the critical distinction between big business vs small business in medicine.   Your old fashioned GP was in small business much as he/she always protested to the contrary.
Trying to Please Everyone and No One – part 2

Trying to Please Everyone and No One – part 2

Where is this train wreck headed?  Wending its way through the various Senate and House subcommittees, the health care reform debate of 2009 is approaching a crescendo.    What do we have to show?   The question I posed in a previous post still has yet to be answered – just what is the problem?  Is the problem greater access?  Is the problem escalating insurance premiums?  Is the problem stratospheric and ruinous hospitalization bills?  Is the problem rapidly declining quality of care?  Or is this simply become a matter of whose team wins?  The bill fails — the president sinks.

Andrew Weil concludes:

But what’s missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what’s even worse than its stratospheric cost is the fact that American health care doesn’t fulfill its prime directive — it does not help people become or stay healthy.

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Trying to Put Genie Back in the Bottle

Trying to Put Genie Back in the Bottle

We have seen the emergence of “evidence-based medicine” in the last 10 years.  This has been an effort to further legitimize and give scientific basis to common medical therapies.  A medical version of “show me the money.”  I have always thought this was rather inane, since it presumed that all medicine for the last 2000 years has been unscientific and irrational.  Although the reality is medicine is not nearly as scientific as asserted.  Only 10-20% of medical practice is based on sound scientific principles.   This rankles most physicians who believe that conventional medicine is scientifically-based.  The highest form of medicine is the practiced art using scientific principles and technology.

A series of US Task Force recommendations are being rolled out by the Department of Health and Human Services.  These are well-intentioned and rational.  Examining the literature and epidemiology of medical practices in an effort to determine what is safe, sane, practical and effective.   The trap is “effective” as you will see.

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Health Care Reform: Pleasing Everyone and No One

Health Care Reform: Pleasing Everyone and No One

After countless months the debate marches on.   Congressional House and Senate bills proliferate.  I have lost track.  It is beyond our comprehension trying to read through each of these bills.

There have been many lost opportunities.  This has never been about health care reform.  This is about health insurance regulation.  If you carefully sift through all the heartache stories and testimonials, you will see the real drama – unexpected hospitalizations.   So the real crisis is coverage of catastrophic loss – astronomical hospital bills.  Routine appendectomy — $50,000.  Complicated heart attack — $250,000+.   Catastrophe loss should have been the starting point.

Insurance is not the answer.   It is the problem.   Insurance subsidizes high costs.

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Political Health Endgame: You Deserve Better Solutions

Political Health Endgame: You Deserve Better Solutions

Post-war Britain, and Londoners in particular, had suffered mightily after two years of punishing aerial bombardment.  The East End of London had been reduced to rubble.

Winston Churchill, arguably the greatest leader and politician of the 20th century, was turned out of office.  A new day dawned.  Anuerin Nye Bevin, a “firebrand” Socialist, was determined to remake the British health care system.  On July 5, 1948 he became the first Minister of Health.   Out of his uncompromising efforts was born the National Health System.  Bevin became known as the father of the NHS.  The pride and joy of Britain today.   Out of crisis comes opportunity.   And so it is today.   With crisis, opportunity comes aknocking.

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The Law of Unintended Consequences

The Law of Unintended Consequences

As I wrote many weeks ago, the health insurance industry will not lose this battle …  any more than the too-big-to-fail Banks have … all at immense public expense.

Max Baucus‘ political contributions from the health care and finance industry are well documented.  Now they have enlisted Tom Daschle and Bob Dole.   What a pair — Tweedle Dee and Tweddle Dum.   I have never understood what qualified Tom Daschle as a health care expert?   His ties to the industry?  A deposed ex-Senate Majority Leader?

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