Consumer Directed Healthcare

By Richard C. Dillihunt
Guest column
Bangor Daily News
6/25/09

I have been a proponent of universal health care and single payer since retiring from the practice of surgery more than 10 years ago. During this decade I have never waffled on my conviction that our nation should transition to a system in which every citizen has an equal opportunity to obtain their health care from practitioners of their choice.

Further, I am convinced that the for-profit form of health care has morphed into an uncontrolled hierarchy of greed that has escaped from the normal restraints of personal ethics, compassion, empathy and basic unqualified concern for one an other without reservation. I feel that social justice should leap to the forefront of our decisions when an individual — any individual — has a health problem. Accordingly, it is obvious that universal health care has my support, and it is not surprising that polls of physicians, nurses and the general population concur.

Now, we have arrived at a point in the history of our nation where it is reasonable to say that universal health care is near at hand, and after trying practically everything else, the vast majority are convinced that a reform has arrived. Black, white, Republican, Democrat, Green, young, old, Catholic, Jew, Muslim, Asian, Native American, rich or poor — a modern melting pot has come to be, and we are all in it together. After a 10-year wait, I am delighted, the bus has arrived. I hope.

Single payer usually tags along when universal health care is the subject at hand. At times when being discussed, they are wed, and health care reform may be referred to as “universal single payer.” That’s too fast for many who look upon this as two separate entities. Not me, though. I believe we, as a nation, deserve both. I further believe that single payer will happen, and we need to work diligently to make this happen sooner, rather than later.

Another decade of waiting, with its stymieing of small business, its shameful financial effects on the middle class, its drain on state treasuries, its primary etiology in bankruptcy and its continuous release of wealth to special interests, cannot be tolerated by a nation already brought to its knees by mammoth fraud, greed and incom-petence. We cannot add health care to the list that includes Enron, banks, brokerages, insurance companies, a protracted automotive industry collapse, and stunning Ponzi schemes. We, as a nation, are on the ropes. The time has come to learn to say no. No more rip-offs. No more robbery. We have come to a fork in the road with a hairpin turn. We need to take the high road regardless of forks and turns, regardless of the consequences to those who have taken advantage of us. We cannot tolerate another hit.

Single payer is a great way to start. A great way to express the confidence we have in our federal government to do the right thing on our behalf. To show that we are tough at home as well as abroad. All we want is a fair and inexpensive accounting of expenditure of health care dollars. This is single payer, not socialized medi-cine.

When we hear criticism of the federal government, with critics saying they do not trust the government to run health care, then we simply should remind such skeptics that our federal government already administers and funds well over 50 percent of total health care expenditures by this nation. We should remind them and our-selves that the government already runs a stable of health care agencies which are national jewels, and include: Medicare, Medicaid, military medicine, Food and Drug Administration, National Institutes of Health, Centers for Disease Control and Prevention, Public Health Service, health care aid to the Third World, World Health Organization participation and aerospace medicine.

We are fortunate to have such a list — a list whose executives are employed by us and whose compensation is Main Street, not Wall Street. A list that could be enhanced enormously simply by adding single payer.

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Richard C. Dillihunt, M.D., a retired general, vascular and transplant surgeon, lives in Portland.

Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance
By: Catherine Arnst

Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.

Medically related bankruptcies have been rising steadily for decades. In 1981, only 8% of families filing for bankruptcy cited a serious medical problem as the reason, while a 2001 study of bankruptcies in five states by the same researchers found that illness or medical bills contributed to 50% of all filings. This newest, nationwide study, conducted before the start of the current recession by Drs. David Himmelstein and Steffie Woolhandler of Harvard Medical School, Elizabeth Warren of Harvard Law School, and Deborah Thorne, a sociology professor at Ohio University, found that the filers were for the most part solidly middle class before medical disaster hit. Two-thirds owned their home and three-fifths had gone to college.

But medically bankrupt families with private insurance reported average out-of pocket medical bills of $17,749, while the uninsured’s bills averaged $26,971. Of the families who started out with insurance but lost it during the course of their illness, medical bills averaged $22,658. “For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments, and deductibles that illness can put you in the poorhouse,” said lead author Himmelstein. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy.”

The study underscores President Barack Obama’s arguments in calling for health-care reform legislation this year. In a letter to Democratic Senate leaders this week, the President said: “Health-care reform is not a luxury. It’s a necessity we cannot defer. Soaring health-care costs make our current course unsustainable. It is unsustainable for our families, whose spiraling premiums and out-of-pocket expenses are pushing them into bankruptcy and forcing them to go without the checkups and prescriptions they need.”

Highest Costs for Diabetes, Neurological Illness
The study was funded by the Robert Wood Johnson Foundation and published online June 4 by the American Journal of Medicine. It will appear in the Journal’s August print edition. The researchers examined the court records of a random sample of 2,314 bankruptcy filings across the nation during early 2007, and also contacted those filers for written explanations. The researchers then followed up with extensive phone interviews of 1,032 of those filers.

They found that a number of medical factors contributed to a family’s financial disaster. More than 90% of medically related bankruptcies were caused by high medical bills directly or medical costs that were so high the family was forced to mortgage their home. The remaining 8% went bankrupt because a medical problem caused them to lose income. The authors were not able to track credit-card defaults caused by medical bills, but a 2007 study found that, of low- and middle-income households with credit-card debt, 29% used their plastic to pay off medical expenses.

Individuals with diabetes, one of the most common chronic diseases in the U.S., and those with neurological illnesses such as multiple sclerosis had the highest costs, an average of $26,971 and $34,167, respectively. Hospital bills were the largest single expense for half of all medically bankrupt families.

Dr. Woolhandler, an advocate of a single-payer health-care system, said lawmakers in Washington should reconsider health-care reform in light of the study. “Covering the uninsured isn’t enough,” she said. “Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it.”

Arnst is a senior writer for BusinessWeek based in New York.

Ever wonder how much it would cost to have knee surgery or any other type of surgery? 

Medical tourism is the practice of “outsourcing” healthcare services to an area outside of the patient’s home country.  Many common operations cost a fraction of what they might cost in the United States. 

As healthcare costs continue to rise, more and more patient’s are beginning to realize the potential cost savings!  Not sure I would be willing to leave the comforts of home, but I understand that some may not have the option…  

Medical Procedure       USA               Mexico       Cost Rica       India      Thailand   Korea

Angioplasty              Up to $57,000     $17,100      $14,000    $10,000     $9,000     $21,600
Heart Bypass            Up to $144,000    $21,100     $26,000    $10,000     $26,000   $26,000
Heart Valve Rep.      Up to $170,000    $31,000     $31,000     $3,000       $24,000    $38,000
Knee Replacement Up to $50,000       $11,500     $12,000    $9,000        $14,000   $19,800
Hip Resurfacing       Up to $30,000+    $13,400     $13,000    $10,000      $18,000   $22,900
Hip Replacement      Up to $43,000      $13,800     $13,000    $10,000      $16,000   $18,450
Special Fusion        Up to $100,000    $8,000       $16,000    $14,000      $13,000   $19,350
Face Lift                 Up to $15,000      $8,000       $6,500       $9,000       $8,600       $5,000
Breast Implants      Up to $10,000       $9,000       $4,000      $6,500       $5,700      $13,600
Rhino Plasty           Up to $8,000         $5,000       $6,000      $5,500       $5,400       $6,000
Lap Band/Bariatric  Up to $30,000       $9,200       $9,000      $9,500       $14,000    $11,500
Hysterectomy        Up to $15,000       $7,500       $6,000      $7,500       $7,000      $11,000
Dental Implant   Up to $2,000/10,000   $1,000       $1,100      $1,000       $1,000      $2,000

 *Prices are as of 2009 -  Prices are approximate and not actual prices and include estimated airfare for patient and companion.  Prices will vary based upon many factors including hospital, doctor’s experience, accreditation, currency exchange rates and more.  Not included are costs for meals, miscellaneous expenses and any hotel costs or tourism costs. 

Prices obtained from Medicaltourism.com.

There is a huge disconnect between Health care consumers and Health care producers
 
The normal Market driven consumer choice leverage is not being applied.
   
    Consumer choices based on price and quality; that drive Producers to lower costs and improve quality
 
We are mis-using the Term “Insurance” as it is currently applied to Health Care.
 
What is being called Health Insurance is really pre paid all you can eat health care consumption in the minds of the Consumers.
 
For example Fire Insurance - does it entitle the Consumer to unlimited consumption of Fire Fighting resources at no additional cost to the consumer ?
 
Unless and untill free market consumer choice forces are brought to bear on health care, the costs will continue to escalate at a rate much greater than either inflation or GDP growth.
 
This means on average paying more to get less. Having government beaurocrats in charge of this mis directed ship will only make things worse.
 
Consumer need to feel the economic pinch of their health care choices, and the economic benefit of their choice not to consume health care resources.

Craig

Insurance premiums cost $1,000 more per family to cover uninsured, study says
By ERICA WERNER - The Associated Press/WASHINGTON

Health insurance premiums for an average family are $1,000 a year higher because of costs of health care for the uninsured, a new report finds.

And private coverage for the average individual costs an extra $370 a year because of the cost-shifting, which happens when someone without medical insurance gets care at an emergency room or elsewhere and then doesn’t pay.

The report was released Thursday by advocacy group Families USA, which said the findings — which it calls a “hidden tax” — support its goal of extending coverage to all the 50 million Americans who are now uninsured. Congress and the Obama administration are working on a plan to do that.

Families USA contracted with independent actuarial consulting firm Milliman Inc. to analyze federal data to produce the findings.

“As more people join the ranks of the uninsured, the hidden health tax is growing,” said Ron Pollack, Families USA executive director. “That tax hits America’s businesses and insured families hard in the pocketbook, and they therefore have a clear financial stake in expanding health care coverage.”

The report found that, in 2008, uninsured people received $116 billion in health care from hospitals, doctors and other providers. The uninsured paid 37 percent of that amount out of their own pockets, and government programs and charities covered another 26 percent.

That left about $43 billion unpaid, and that sum made its way into premiums charged by private insurance companies to businesses and individuals, the report said.

The major government insurance programs — Medicare for the elderly and Medicaid for the poor — are structured in a way that doesn’t easily allow payments to insurers to adjust upward. And somebody has to pay.

In the case of people who are covered through their employers — most insured people under 65 are — the extra costs from the uninsured would be spread between the employer’s health plan contribution and what the employee pays, but the report didn’t attempt to quantify that division.

Ronald A. Williams, chairman and chief executive of Aetna Inc., gave the example of a local community hospital that provides care to someone without insurance who arrives at the emergency room. When it’s not paid for, the hospital has to raise its rates to insurance companies, and they pass that on in higher premiums, Williams said.

“Our members then say, ‘Well, why is health insurance so expensive?’” Williams said in an interview. “And the answer is because you’re paying for your own care as well as for the care of some of the uninsured in the community.”

Aetna was not involved in writing or funding the report but Williams appeared at a news conference Thursday with Families USA officials to release its findings.

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Copyright © 2009 ABC News Internet Ventures

Sky-rocketing health care costs are crushing family, business, and government budgets and threatening our economic future. Many Americans are struggling to make ends meet as the cost of care goes up while others face losing insurance as businesses struggle to cover employees. In order to get our economy back on track and get our fiscal house in order, we must finally get health care costs under control. President Obama recently told Congress “Health care reform cannot wait, it must not wait, and it will not wait another year.”

Over 9,000 Americans in all 50 states and the District of Columbia signed up to host Health Care Community Discussions.  Thousands more participated.  Friends, family, neighbors, and co-workers, representing the views of both health care patients and providers, came together in homes and offices, coffee shops and fire houses, universities and community centers, all with a common purpose: to discuss reforming the health care system.

The 3,276 group reports were systematically analyzed and the information generated by the Health Care Community Discussions captured in the report, Americans Speak on Health Reform: Report on Health Care Community Discussions.

NEOS Consumer Driven Healthcare launches version 2.1 of its employer self service HSA Management Module. NEOS CDH self service enables employers to easily manage the entire process of employee health savings account setup, plan creation, funding, and reporting, at a fraction of the administrative costs.

Accounts and plan data are easily accessed online by HR, for plan administration functions, and by employees for inquiry and contribution updates, regardless of employer size. Online reporting and analysis based on qualified medical expense data, as well as, premium and deductible data is always available. The real time data tools create a complete picture of plan participation and usage specific to the company.

 NEOS CDH has also improved its secure healthcare document services for EOBs, Statements, Out of Pocket Receipts, and other healthcare attachments. These improvements include enhanced search capabilities and additional privacy options for personal image storage and retrieval.

NEOS Consumer Driven Healthcare is a HIPAA compliant third party administrator with a focus on CDH administrative services and products. NEOS is a provider of services and applications that drive self service functionality coupled with superior customer service. NEOS offices are located in Phoenix, Arizona.  Additional information about NEOS Consumer Driven Healthcare can be found online at www.NEOSCDH.com.

For NEOS Consumer Driven Healthcare:

By Karen Sampson

Barack Obama’s American Recovery and Reinvestment Act of 2009 was signed on February 17, and is already beginning to filter out funds to hopefully stimulate the economy. One of the principal goals of the package is to reform the health care system while creating jobs and insuring more Americans. Through measures to support the unemployed, integrate cutting-edge information technology systems into medical networks, and insuring more children, the act may in some way affect how you receive health care. Find out how.

1.  Health care industry set to go tech: One of Obama’s umbrella strategies for reforming health care and stimulating the economy involves pumping money into health care technology systems. He hopes to create a health information network for hospitals, rural and urban clinics, and other health care centers by making all medical records electronic; making existing medical technologies more accurate and effective; and reducing errors in medical care. This technology boost to the health care system will, Obama hopes, save money, create jobs, and improve the standards and delivery of health care and medical information. The Dallas Business Journal reports that the stimulus package will invest $19 billion for health information technology.

2.  The unemployed will still receive health care benefits, at least temporarily: Obama plans to ease the burden of health care costs for the unemployed and reduce the number of uninsured Americans by extending Medicaid benefits to the unemployed, at least for a time. Individuals who get unemployment checks would also be able to receive Medicaid, as would their spouses and children who are under the age of 19, reported the New York Times in January. States will receive federal aid to help ease Medicaid costs. In late February 2009, TheState.com reported that Obama “released $15 billion in economic stimulus Medicaid funds for states” to disperse.

3.  Children’s Health Insurance Program Reauthorization Act of 2009: The Senate and House reformed the Children’s Health Insurance Program under this legislation, which extends insurance to nearly 4 million more children by reworking the Social Security Act. The program will help families of low-income children who do not qualify for Medicaid pay for their health insurance, and states will still be able to set their own income eligibility requirements. The program is funded by a tax increase on cigarettes.

 4.  Governors hold power over releasing funds: While the federal government has designed and approved the health care stimulus package, governors are in charge of actually releasing funds, creating eligibility requirements when appropriate, and overseeing the implementation of the stimulus plan in their states. In late February, governors like Louisiana’s Bobby Jindal (R), opposed many parts of the economic plan and may reject at least some of the money that is coming to their state from the federal government. The New Orleans Times-Picayune reports on Nola.com that Jindal will most likely accept the Medicaid supplements, but according to Medical News Today, other governors are begrudging about accepting funds that are meant to be used in a specific way. Instead, governors like New Hampshire Gov. John Lynch (D) are arguing for more flexibility in how they disperse the federal funds.

 5.  Federal government helps states fund COBRA for unemployed: The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives individuals who are laid off, retired, switching between jobs, or have dependents at the time they stop working the option to continue their group health benefits for a limited time. Some beneficiaries may have to pay for the group rate insurance, however, but the U.S. Department of Labor holds that “COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage.” Under Obama’s stimulus plan, the federal government will provide states with subsidies to help offset the costs of COBRA. They will pay for up to 65% of COBRA premiums “for eligible workers who are involuntarily terminated,” according to the accounting firm Amper, Politziner and Mattia. Qualifying workers include those who have been involuntarily terminated on and after September 1, 2008, and qualifying employers include those who are subject to COBRA legislation, as well as small employers who are subject to State Continuation legislation.

 6.  Job training funding for those entering health care industry: In another measure to stimulate the economy while improving health care standards, Obama plans to increase job training opportunities for those entering the health care industry. The stimulus budget has allotted $750,000,000 “for a program of competitive grants for worker training and placement in high growth and emerging industry sectors,” $500,000,000 of which will go to renewable energy programs. The rest will be distributed by the Secretary of Labor “giv[ing] priority to projects that prepare workers for careers in the health care sector.”

 7.  Preventive care takes precedent: In his address to Congress in February, Barack Obama outlined the promised benefits of his economic stimulus benefits, highlighting the fact that the health care reform boasts “the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.” According to a report by NPR, this move would also create jobs, at least in the short term, even if it did not result in sustainable medical research projects, as hoped.

8.  A contract for accountability: In order to promote accountability in health care reform and to make sure that all of this funding is actually helping the economy and the health care industry, Obama’s plan includes a contract between the federal government and the Institute of Medicine. The stimulus package outlines that the $1.5 million contract will require the Institute to “produce and submit a report to the Congress and the Secretary [of Health and Human Services] by not later than June 30, 2009, that includes recommendations on the national priorities for comparative effectiveness research” that will eventually be subjected to public commentary and review.

9.  Health IT dominates in all areas of medical industry: The stimulus package lists several ways in which new health care information systems and technologies will help the facilitation of medical care and the industry as a whole. These include the exchange of patient medical records and a subsequent reduction in wait times at hospitals and health care facilities; the increase of telemedicine technologies for those living in rural areas and who do not have access to cutting edge medical resources; “technologies that help reduce medical errors;” and “technologies that meet the needs of diverse populations.”

10.  Total health care stimulus cost: $150 billion: The total cost of all these (and more) health care reforms under the American Recovery and Reinvestment Act of 2009 is $150 billion, according to the Dallas Business Journal, including $17 billion for Medicare and Medicaid incentive programs, $2 billion for technology grants, and $19 billion for a health information technology movement.

By: MARLA

I have no figures to quote or studies to point to, just my innate sense that the un- & under-insured in our country may be using a disproportionate amount of health care dollars by accessing care for lower priority health issues at facilities designed to offer a higher level of care (i.e. accessing emergency rooms for colds).  I’m sure we’ve all heard the “common wisdom” that this is so.  Assuming that it is, it seems to me that it would reduce the cost of healthcare across the board if appropriate care could be provided in the appropriate setting by appropriate practitioners.

Another factor that I haven’t noticed being addressed is the shortage of key medical personnel, such as nurses, general practitioners, family doctors, obstetricians, dentists and others.  While these shortages affect everyone, they can be more significantly detrimental in underserved areas.

Additionally, it seems to me that having under- and un-insured individuals go for long periods of time without health care ultimately results in the care they eventually receive costing more and requiring longer periods of care.  To eliminate this, it would seemingly make sense to work to get them insured sooner rather than later.  In order to accomplish this, underwriting and financial access issues would need to be addressed. 

One last thought:  the development of medications and technologies to combat disease is universally beneficial.  Sharing the responsibility, costs and benefits universally would also seem to make sense and would, hopefully, accelerate the discovery of new treatments and cures.

To that end, I offer the following suggestions and ask for your thoughts in refining and expanding them:

 1.  Offer tax incentives to hospitals, clinics & urgent care centers who work in underserved areas a minimum of 30 hours/week.  The 30 hours to encompass a minimum of 1 hour before 7 AM and 1 hour after 7 PM at least 2 days/week and 3 hours on Saturday and Sunday.

 2.  For facilities opening in underserved areas willing to safely and appropriately renovate and/or remove and rebuild “blight” structures, Federal money should be made available to the local police department for the purpose of providing security.  The amount of money to be applied to be based on factors such as local population and crime rate in facility’s immediate vicinity.

 3.  Salaries paid to health care professionals (doctors, nurses, technicians) and limited to 2 administrators/site in underserved areas to be tax exempt for the first $100K (gross and unadjusted).

 4.  Create a federal insurance program (like the federal flood insurance program) for catastrophic illness (i.e. cancer, ESRD, Alzheimer’s, HIV) and require all health insurance carriers to contribute 1% of every policyholder’s premium to the program’s fund.  In years in which the carriers net profit exceeds 20% above the average net profit for the previous 5 years, they would be required to pay 10% of the net profit above 20% to the fund.  Upon confirmed diagnosis, the federal program would repay to the insurance carrier 75% of all care costs (including medications) paid on behalf of the insured.  Claims with any of the defined diagnosis codes denied would be subject to review by the same board that currently reviews Medicare claim denials.  GAO to do random financial and performance audits, with every carrier with audits performed a minimum of once every 5 years.  Deliberate fraud punishable by repayment to fund of 100% of monies paid for all patients from catastrophic fund for entire period of fraud plus a 10% penalty and posting of a bond equal to 33% of the amount of the fraud.  Said bond to be maintained for 5 years and to be released only upon completion of passing GAO audit.  Subsequent fraud would result in forfeiture of bond and loss of license in all states to sell health care coverage to Federal Employees and Medicare members for a period of 5 years.

 5.  Make health insurance premiums paid by individuals who do not qualify for coverage through an employer-sponsored plan 100% tax deductible up to an adjusted annual income of $200K with the deduction reduced by 10% for each $25K over $200,001.

 6.  Make payroll deducted employee health insurance contributions (including both fully and self funded plans) pre-tax for those whose adjusted income is less than $200K.

 7.  Reduce the threshold for claiming out of pocket medical costs as a tax deduction from 7% of adjusted income to 5% for adjusted incomes less than $200K.

 8.  Offer interest free scholarships in medical fields to highly qualified candidates where there is lower enrollment but a higher public need (i.e.:  nurses, family practitioners, obstetricians, general dentistry).

 9. Offer grants to cover 100% of tuition towards specific medical degrees in return for 2 year commitment to actively practice a minimum of 1300 hours/year in under-served areas (i.e.:  Indian reservations, low-income urban areas)

 10.  Standardize health insurance underwriting for specific chronic conditions on the condition they be certified by a physician to be under control for a minimum of 1 year with either diet/lifestyle change or medication at time of application (i.e.:  Type II diabetes, asthma, cholesterol, high blood pressure).  The rating factor applicable to these conditions when they meet the controlled criteria should be standardized (i.e.:  asthma +1.5%, Cholesterol +3.0%).

 11. Cancer survivors who have been certified to be in remission for a minimum of 5 years and have no other risk factors must be offered coverage with the pre-existing condition rated in the same manner as those conditions referred to in item 10.

 12.  Insured individuals who actively reduce their health risks (i.e. appropriate weight loss or gain, smoking cessation, reduced cholesterol, etc) may, at their discretion, request a review of their physical condition by their family/primary physician 2 months prior to the renewal of their policy to present to the insurer which is to be considered in determining renewal rates.  Significant, maintained health improvement should be “rewarded” with consideration when underwriting renewal rates (i.e.:  if rate increase would have been 8% consideration might allow for a reduction to a 6% or 7% rate increase). 

 13.  A public access website should be created using Medicare accumulated data showing a RANGE OF AVERAGE cost of care for the most common diagnoses and treatments by zip code (i.e. New patient office visit/consultation in zip code 60606:  $180 - $215).  (Although this information is more typically available to members of insurance plans through their secured websites, for uninsured individuals, gathering this information in order to make informed health care decisions is very difficult.)

 14. If medical procedures can be performed safely and more cost effectively overseas, allow 50% of travel exclusively for the performance of these procedures to be tax deductible if not covered by an insurer.  If the patient is insured, insurer must cover the procedure cost at the benefit level specified by the COC, assuming the procedure cost is a minimum of 25% less than if performed in-country:  i.e.:  if their in-country contracted rate for San Diego, CA for a hysterectomy is $1400 with the patient responsibility of 20%, the insurer would pay up to $1050 to the out-of-country provider with the patient paying 20% of the actual cost.  Insurance carrier has the right to ‘vet’ the out-of-country facility to ensure appropriate care and safety.  Insurance carriers would be permitted to negotiate contracts with out-of-country facilities and make a listing of “approved” facilities available upon request to insured’s.  Insurance carriers would NOT be permitted to pressure insured’s to receive care out-of-country.

 15. The US should seek to enter into an agreement with other like-minded countries to create an international fund (contributions to which would be pro-rated based on each country’s population) the purpose of which would be to subsidize pharmaceutical and scientific research into treatments and cures for cancer, HIV, Parkinson’s, Alzheimer’s, etc.  Distribution of funds to be determined by a board of independent, non-political scientists, medical professionals and representatives from organizations such as WHO, NIH, CDC, etc and their international counterparts.

Contracts to Limit Posting Physician Ratings Online Hold No Interest for Many Patients
By RADHA CHITALE
ABC News Medical Unit
March 5, 2009—

Patients are likely to seek health care information wherever they can these days, from friends, other patients and, increasingly, the Internet. They may also have the urge to add their own voices to the mix.

For these patients, Web sites such as Angie’s List and RateMDs.com can be a place to opine and rate their physician experience.

But information on the Internet is still information on the Internet, which means it is of uncertain credibility. And inaccurate physician ratings have the power to do a lot of damage when patients forget to take them with a grain of salt.

A company called Medical Justice from Greensboro, N.C., has been attempting to remedy what it calls misinformation by heading off would-be posters with a waiver, to be signed pre-treatment, in which patients promise not to contribute to online rating sites about their doctor.

But the idea of signing such a waiver does not sit well with some patients.

“I would not use a doctor that pushed that in any way,” said Danielle Panetta, 34, who has type-1 diabetes and visits specialists monthly to care for her disease. “It’s not legally binding as far as I’m concerned.”

Preventing the Inevitable?
Restricting online activity in any way may be a losing battle.

According to a study from the Pew Internet and American Life Project, 74 percent of adults in the United States go online and, of those, 80 percent look for health information online. Another study from 2006 showed that 29 percent of Internet users had looked online for information about a particular doctor or hospital.

“If there are doctors who are nervous, they should be nervous,” said Susannah Fox, author of the Pew studies. “This is a tried-and-true activity online, researching a product or service before you buy it.”

But Dr. Jeffrey Segal, CEO and founder of Medical Justice, says the waiver his company developed is not trying to restrict information but that the company is more interested in quality control.

“There is a disconnect between what we expect of health care in general and the system out there asking patients to rate their doctors,” Segal said, pointing out that the average doctor, who may see thousands of patients each year, may have only five ratings on a site.

Good Luck With Quality Control
“Patients are granted additional privacy protection above and beyond that mandated by law. In return, patients are asked not to post on online rating sites without the doctor’s permission,” Segal said. “It’s been characterized incorrectly as a gag [order].”

Segal said that the “additional privacy protection” includes physicians refraining from giving patient information to companies that may wish to market to people with specific health problems.

Still, attempts at quality control on the Internet appear to be dubious, at best.

Dave deBronkart, 59, who blogs at The New Life of e-Patient Dave, pointed out that his own excellent physician could get a handful of nasty reviews online.

“That’s just the nature of democracy,” deBronkart said. “I do think it’s hopeless to try to hold back the tide. And it’s going to be bumpy along the way but things will improve. … When things are transparent, things improve eventually.”

How Is Your Doctor?
And patients are looking for transparency in their health care information.

Jim Conway, senior vice president at the Institute for Healthcare Improvement in Cambridge, Mass., said the state of Massachusetts has been conducting consumer research in the past six months about what people want to know in terms of healthcare. One of the top three things users want to know is what other people think of their hospitals and their doctors.

“The perspective of the consumer is unbelievably important,” Conway said. “In helping people make decisions around where they’re going to seek care.”

But patients know that consumer rating sites, particularly anonymous, unmonitored ones, are not the be-all and end-all source for physician information.

“It’s a good thing for patients to have access to but you’ve got to watch out,” said Panetta, an attorney in Boston, Mass., who is also actively involved in diabetes patient advocacy. “The people that are more likely to use it are going to be people who have an axe to grind, and it may be because they’re crazy.”

Segal pointed out that defamers could also be competitors, former employees or ex-significant others. Nor is there a way to monitor undeserved praise.

The Waiver Is a Questionable Solution
But a waiver such as the one Medical Justice proposes doctors use may not be the solution.

“I don’t see how that kind of contract could actually protect the physician in any other specific way than they would have without the contract,” Panetta said.

As with other printed defamatory comments, Panetta said, the doctor could ask the host site to remove the comments and, if they did not, he or she could sue, which may not be effective.

“I think it doesn’t work for any of the parties,” Panetta said. “You can’t contract away liability.”

Straining the Relationship?
But the wrong kind of contract can set the tone for the important doctor-patient relationship.

“Great patient care is the result of a partnership and trust-relationship between the patient and the people taking care of the patient,” Conway said. “I worry that the introduction of something like this could begin to break down trust.”

Segal believes the waiver, if presented correctly, can address the trust issue head on while acknowledging the patient’s need to voice opinions about his or her experience.

“We don’t want to repackage the problem because we know the inevitability of useful Internet rating sites,” Segal said. “Try and view the program as a way to move the process forward where patients and doctors share in the solution rather than engaging in adversarial relationships.”

Preventing Internet users from using the Internet as they like is a tall order, doubly so when it comes to healthcare where seeking out others’ opinions is ingrained.

Blogger deBronkart knows exactly what he would do if his doctor confronted him with a waiver asking him not to post comments about him online.

“I would decline,” he said. “But I would look him right in the eye and say, ‘You don’t need to worry about me shafting you.’”
Copyright © 2009 ABC News Internet Ventures

Next 24 Months Could Spell Disaster for Country’s Health Care System
OPINION By STEPHEN G. BROZAK, DANIEL T. MALLIN and LAWRENCE F. JINDRA, M.D.
Feb. 19, 2009—

If 24 months ago, someone had predicted a catastrophic real estate price collapse, auto company bankruptcy, stock market decline, bank failures and rising unemployment, that person would have been called alarmist. At risk of being called histrionic, we are predicting that health care in the United States is in danger of collapsing within 24 months.

Eighty years ago, in 1929, as hospitals tried to find a way to stay in business in the face of a failing economy, Blue Cross was founded by a group of Dallas teachers who agreed to pay about 12 cents a week for up to 21 days of hospitalization a year at Baylor University Hospital. The American Hospital Association supported the origination of Blue Cross because it was a way to guarantee regular revenue during hard times.

For the schoolteachers, paying $6 per year for insurance was a way to assure they would receive at least minimal care if they became gravely ill. Since then, expectations and costs for payer-provided health care have grown dramatically.

In our current period of reduced expectations, most Americans continue to expect high-quality healthcare at affordable prices when they walk into a doctor’s office or if they are admitted to a hospital. But that is changing.

Hospitals in Trouble
More and more, Americans have to wait for insurance company permission before receiving life-saving medical treatment or, if they are on Medicaid, they have to go to specific city and county hospitals to be treated. Hospitals are in financial jeopardy, reimbursements to doctors discourage preventive medicine and there is a severe and growing shortage of nurses.

The U.S. Food and Drug Administration, which has the responsibility to assure that drugs are safe and effective, is in disarray, and pharmaceutical research and development has become a singularly focused quest for blockbuster drugs, those that create $1 billion or more of revenue per year.

The U.S. hospital system is currently the weakest link in the health care chain. The total number of hospital beds in the U.S. has dropped since 1981and the number of beds per 1,000 people has declined from more than four per 1,000 to a little over 2.5 per 1,000 in 2006.

Hospital finances are precarious. More than half of hospitals are technically insolvent or at risk of insolvency. According to the American Hospital Association, in 2007, uncompensated care costs were $34 billion, with an additional $31.9 billion gap between costs and payments to hospitals for Medicaid and Medicare patients. In addition to philanthropy, some hospitals are forced to rely on unpredictable sources of funding, such as gift shop revenue or parking fees.

Hospitals now spend nearly $100 billion per year to provide uninsured patients with health services. During the 2008 election, the total number of uninsured in the U.S. was between 40 million and 50 million people. That number is growing, and uncompensated hospital care continues to increase as the number of uninsured goes up.

Money Woes
For every percentage of increase in the unemployment rate, 2.5 million people become uninsured. With the unemployment rate jumping about 3 percent since mid-2007, that translates to another 7.5 million uninsured.

Even without unemployment problems, fewer employers are paying for health insurance, and even among those that do, plans are transferring more cost to the patients through increasing co-payments, larger deductibles and changing rules on what is covered and what is not. Two groups of Americans are experiencing growing insurance coverage gaps — children who reach the age when they are no longer eligible for their parents’ insurance coverage and older workers, who lose their jobs and are not yet eligible for Medicare.

The medical system pays more for treating sick patients than for preventing disease. Doctors in preventive specialties are reimbursed much less than those who attempt to reverse the consequences of years of neglect. For example, cardiac and thoracic surgeons, who perform surgery to limit damage from high cholesterol, earn on average, two-and-a-half times more than family medicine and internal medicine specialists, who monitor patients and prescribe medicines to prevent the need for such surgeries.

People who suffer from largely preventable diseases, such as heart disease, stroke and diabetes, incur more medical costs than healthy people their age and die at higher rates than the healthy population. One disease, diabetes, kills more than 75,000 people in the U.S. annually, and is closely linked to the national epidemic of obesity, which is clearly preventable.

It is estimated that by 2020, the shortage of nurses will reach 1 million. Nurses perform most of the patient care in the country’s 4,897 community hospitals. Nurses monitor patients, track vital signs and administer drugs. If a hospital patient takes a turn for the worse, it is the nurse who will be first to respond and take action. Yet, staff nurses earn less on average than a real estate property manager, who isn’t exposed to deadly diseases, doesn’t have to make life-or-death decisions and isn’t required to regularly work nights and weekends. It is not surprising that there is a growing gap between the need and availability of registered nurses.

The Drug Problem
The FDA, and other agencies, which have responsibility for ensuring the efficacy of drugs and the safety of food we consume, are on the verge of collapse. The current problem with peanut product purity is only the most recent in a long line of failures to protect the food Americans consume. These failures frequently lead to illness, and in some instances, death. There was an even more dramatic failure this past summer when heparin, a life-saving blood thinner, was found to have been made with adulterated ingredients. As a consequence, as many as 62 people are believed to have died.

For a half-century, most pharmaceutical research and development has been carried out by large pharmaceutical corporations. But R&D has been hammered by decreasing profits and increasing corporate bureaucracy.

Though large pharma is focused on blockbuster drugs, the need for mundane cures is more necessary than ever. As early as 2005, more people died from antibiotic-resistant infections than from HIV/AIDS, and the threat of these so-called superbugs increases every year. R&D on new antibiotics is at a virtual standstill because, according to the prevailing large-pharma model, developing yet another antibiotic doesn’t pay.

In 2008, only 21 first-of-a-kind drugs were approved by the FDA, but 46 new or updated black-box warnings (the highest level warning) were issued in the first nine months of the year, which indicates problems that were identified only after the drugs were approved. At the same time, development-stage biotechnology companies, where most of the really innovative R&D takes place, are finding it almost impossible to raise the cash they need to keep their doors open.

Consumers Hindered by Lack of Information
All these problems are enhanced by lack of information. The average patient knows more about the cost of a brake job on an automobile than the cost of medical care. Patients are finding it harder and harder to make informed choices. Ask a physician about the cost of a procedure or diagnostic test and you are liable to get a non-answer. Charges and reimbursements vary by insurance carrier and individual plan to the point where there can be a wide variety of differences among them. Explanation of Benefit reports are often confusing and lack critical information, so it is difficult for patients to identify which procedure or examination is being reported.

The U.S. health care system is sick. We can wait until the patient needs heroic intervention before taking action, or we can treat the patient now, before the cost goes higher and before thousands of people suffer needlessly.

Today, 80 years after the first Blue Cross plan was created, we need a new mechanism that will enable Americans to continue receiving the medical care that will keep us healthy and provide for us in the event of disaster. Based upon the experience of Great Britain and Canada, it is clear that such a mechanism should not be purely governmental. It is equally clear that our present system, which is largely based on private funding, is inadequate. What is required is a uniquely American solution to the health care challenge that melds private and public funding in a way that benefits the patient and provides economic continuity for caregivers.

Steve Brozak is president of WBB Securities, an independent broker-dealer and investment bank specializing in biotechnology, medical devices and pharmaceutical research.
Copyright © 2009 ABC News Internet Ventures

By: Dan Heffley - HealthNews

Much has been written and discussed regarding the plight of the uninsured. Various programs and subsidies have been proposed to help alleviate this problem. It’s important to ask, who exactly constitute the uninsured? Most experts define uninsured as people who routinely pay at least 10 percent of their annual income toward medical expenses, not including insurance premiums. Federal law allows the deduction of medical expenses that exceed 7.65 percent of gross income. The burden of increased healthcare costs are not only affecting the uninsured, but also people that have insurance. Of the people that are still fortunate to have jobs that subsidize their medical care, most employers are increasing deductibles, co-pays, and out-of-pocket costs to keep their health plans in place. Premiums are going up and with it, including the employees’ share of those premiums. How can people manage these costs?

There are a number of things you, as the consumer, can do to help with potentially higher out-of-pocket costs. Oftentimes spousal or family coverage can be really expensive. That’s because the employer typically doesn’t subsidize any portion of dependent healthcare. If you’re family members are in good health, it may be helpful to enroll them in a comparable individual plan. (Depending upon the state you live in, group coverage may be their only option if they are uninsurable.) On the portion of healthcare that you pay on a group health plan, whether for yourself or your dependents, be sure the amount you pay is taken out before taxes as well. Another way to help minimize medical expenses is to enroll in voluntary products if your employer offers them. These are payroll-deducted plans that start around $4 a week. They usually are taken out of your paycheck before any taxes are taken out, reducing their cost further. These voluntary plans pay an amount per occurrence for accidental injuries, certain sicknesses, lost time from work, etc. to offset the increased exposures from employers trying to manage their bottom line.

When you are faced with medical debt it may be tempting to ignore it. In a word, don’t. The bills themselves won’t go away. Typically they are turned over to a credit agency that then starts harassing you to pay. The best thing to do is to work out payment arrangements with the providers before it goes into collection. When a bill goes into collection, the provider is paying that agency a fee to attempt to collect the debt for them or giving them a percentage of what is ultimately collected. It’s far better to try and negotiate the balance due directly with the providers than to try to negotiate after they have already put it into the collection agency’s hands. If you aren’t able to negotiate your bill down don’t be tempted to put it on a credit card. Putting it on a credit card totally eliminates your chance of reducing the bill through negotiating with the provider. Additionally, should you miss a payment on a credit card, the interest rate could be hiked to 29 percent or higher. The interest that a collection agency charges shouldn’t be anywhere near that high. Same thing with second mortgages. Although you may be able to write off the interest, the additional time it takes to pay off your mortgage translates into many, many times the original amount of the medical debt and also puts you at a greater risk of foreclosure.

Many people are eligible for assistance with their medical bills and don’t even know it. It’s important to know not only federal programs, but state-specific programs designed to help those faced with high medical expenses. Even pharmaceutical companies have programs to enable people to purchase their necessary medication at reduced prices. The key is to explore your options.

You don’t have to be a slave to your medical debt. The key is preparing. Supplemental programs can be very helpful and doesn’t cost the employer anything. Help and various options are available to help you manage medical debt once you get it. The key to this is being informed. Doing a little research before you throw your hands up in despair is always a smart choice.

Until next time, stay healthy!

By Nancy Shute - US News - January 21, 2009

Autism tops Barack Obama’s medical to-do list, according to the new president’s website. Whitehouse.gov launched at 12:01 pm yesterday, even before the new president had taken his oath of office on the Capitol’s West Front. Autism is the only disorder or disease mentioned explicitly in Obama’s 24-point agenda. Heart disease and cancer don’t get the call. Neither does diabetes, or other chronic diseases. But there are four hefty bullet points addressing autism. Obama called for:

1. Increased funding for research, treatment, screenings, public awareness and support services for autism spectrum disorders.

2. “Life-long services” for people with autism spectrum disorders, as children and as adults. Many parents struggle to find and pay for screening and treatments for their children, but there is even less coverage and capacity for adults with autism-based impairments

3. More funding for the 2006 Combating Autism Act, as well as improving state and federal autism programs.

4. Universal screening for all infants for autism disorders, as well as re-screening for all 2-year-olds. This is the biggie; children are currently screened only if parents or pediatricians voice a concern, so too many children aren’t diagnosed until they enter elementary school. The earlier treatment starts, the more effective it is, and a national screening program would help reduce the number of kids falling through the cracks. It would also be a huge undertaking, at a time when both government and privately insured health care is foundering.

That second bullet point would be a huge help for families who are struggling to provide care. In a recent survey, 52 percent of parents of children with autism said their family finances were drained by treatment and care, compared to 13 percent of typical families.

The 2006 Combating Autism act promised almost $1 billion over five years for autism research and development, but Congress hadn’t appropriated $200 million per year, even before the economy hit the skids. The Obama manifesto gives a big fat hint that for autism, at least, the hard times cited in the new president’s inaugural address won’t mean big cuts in funding.

Still, universal screening for autism will be a huge challenge. There’s no blood test that can be used to diagnose autism, as there is for hereditary diseases like galactosemia and sickle cell, which are screened for using a heel stick while a newborn is still in the hospital. With autism, parents and doctors instead need to observe a child and look for delays in language, social interactions, and gross motor skills. The Centers for Disease Control and Prevention recommends that pediatricians screen children during well-baby visits at 9 months, 18 months, and 24 or 30 months. (Here’s the CDC’s page on screening for autism.) But many doctors don’t get around to doing those screens, and until very recently the recommended tests weren’t sensitive enough to pick up mild autism spectrum disorders. Early screening for autism is a terrific idea. Making it happen will be a tall order, even for the can-do Obama team.

Report Finds People Living on Unemployment Benefits Can’t Afford COBRA
By LISA STARK
Jan. 9, 2009—

Yvonne Brustad said it was devastating enough to lose her job in September, but on top of that she lost the health insurance that came with it.

Her husband, too, was suddenly without coverage. He is self-employed and relied on her health insurance plan.

The Minnesota couple is now insured once again, but at a staggering cost. Through a federal law called COBRA that allows laid-off workers to continue with their employee-provided health insurance, Brustad pays a whopping $1,200 per month for health benefits. But she collects only $1,612 per month in unemployment benefits, meaning 75 percent of her unemployment check goes to health insurance for her and her husband.

A new study released Thursday shows her experience is hardly unique, exposing major holes in a system that’s supposed to be a health care lifeline for uninsured workers.

The report, by the health care advocacy group Families USA, shows why most of those who lose their jobs simply can’t afford to take advantage of COBRA coverage.

“I think it’s horrible,” Brustad said. “It’s cleaning me out. Yeah, we have a roof over our head and we’re managing to eat, but how much longer if I have to come up with funds to pay for health insurance? I feel like I’m caught between a rock and a hard place.”

Brustad is using savings to stay afloat.

“At least I had a few thousand dollars put away,” Brustad said. “Think of those who don’t.”

Under COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act of 1985, people can stay on their employee-provided health insurance for up to 18 months after losing a job. The employee has to pick up the entire cost of the health care premiums — both the portion they paid before, as well as the portion that was covered by their employer.

Families USA found that workers nationwide would have to spend an average of 30 percent of their unemployment check to pay for insurance coverage for an individual, and an astonishing 84 percent of their unemployment check for health insurance for a family.
“COBRA, from an academic standpoint, sounds like a wonderful remedy,” said Families USA Executive Director Ron Pollack. “But from a practical standpoint, it is a ruse.”

The study found that in nine states, the average COBRA premiums for family coverage actually exceed the average unemployment insurance benefit. In Arizona, for example, the average monthly unemployment check is $937, and family COBRA coverage runs $1,084.

Four out of five people who are eligible for COBRA do not take advantage of it, according to the Kaiser Family Foundation and Health Research and Educational Trust.

There is now a push to use President-elect Obama’s economic stimulus plan to offer help to cover COBRA costs.

America’s Health Insurance Plans, an industry trade association, has called for a subsidy to help pay for COBRA coverage. Families USA agrees that a “substantial subsidy” would be one way to go.

The other option, the groups said, is to allow unemployed workers to temporarily obtain health coverage through Medicaid, with the federal government picking up the extra Medicaid costs.

Pollack said such ideas are “likely to be controversial,” but he believes one or both of them are “likely to be in the final stimulus package.”

For now, though, Brustad and others like her are forced to struggle on their own.

Brustad said she and her husband may only be able to continue to pay for health care for another month or so, adding that, over the years she had read about people losing their health insurance and thought, “it’s that awful.”

Now, she said, “It is me.”

“We can’t say, ‘If you don’t have a job or earn enough you are not entitled to health care,’” she said. “You just can’t say those things to people anymore.”
Copyright © 2009 ABC News Internet Ventures

ABC News’ Brian Hartman Reports:

In what amounts to a final poke in the eye of groups that promote abortion rights, the Bush administration has issued a long-awaited rule that protects doctors, nurses and other health care workers who refuse to provide services that offend them.

Democrat-allied groups like Planned Parenthood, the National Abortion Rights Action League and Moveon.org have been railing against this “provider conscience” rule since it was first proposed back this summer.

The rule requires any “entities” that receive federal funds to give their workers the freedom to recuse themselves from providing any services they find morally repugnant. It’s not just about abortion. This also gives health care workers and medical researchers the freedom to refuse to do anything they find offensive — like providing birth control, sterilizing patients or sharing family planning information.

The rule appears in the Federal Register tomorrow, just in time for it to kick in before Obama takes office. For democrats to unravel it will require either an act of Congress or a repeat of the lengthy rulemaking process.

In the notice for the rule, the administration writes this is necessary, in part, to address a critical shortage of doctors and nurses.

“The Department is concerned about the development of an environment in sectors of the health care field that is intolerant of individual objections to abortion or other individual religious beliefs or moral convictions. Such developments may discourage individuals from entering health care professions. Such developments also promote the mistaken belief that rights of conscience and self-determination extend to all persons, except health care providers,” the notice says.

HHS officials insist the rule, while new, creates no new restrictions. They say it simply enforces laws already on the books.

The Federal Register notice says: “This rule implements federal laws protecting health care workers and institutions from being compelled to participate in, or from being discriminated against for refusal to participate in, health services or research activities that may violate their consciences, including abortion and sterilization, by entities that receive certain funding from the Department.”

Sharon Camp, president of the Guttmacher Institute, which promotes reproductive health and education, calls this claim “disingenuous.”

“In fact, by redefining key terms it vastly expands these laws’ reach,” Camp wrote in a letter of protest she filed with HHS. “The regulation conflicts with and undermines a host of other federal and state laws and policies designed to help Americans obtain needed reproductive health information and services.”

These criticisms are acknowledged in the text of the rule itself, but it downplays complaints that this will lead to more limited access to birth control.

“We have found no evidence that these regulations will create new barriers in accessing contraception unless those contraceptives are currently delivered over the religious or moral objections of the provider in such programs or research activities.”

Even before this rule kicks into affect, President-elect Barack Obama’s Transition Team already is reviewing ways to, as National Abortion Rights Action League puts it, “fix the damage the Bush administration has done” to the democrats’ reproductive health agenda. The Wall Street Journal took a good look at the Obama team’s options yesterday.

And you can read the new rule for yourself right HERE.

On Women by Deborah Kotz

Women’s health activists are fist-bumping each other over Obama’s slam-dunk win, and they’re hoping that he’ll reverse some of the policies put in place by Bush. Yesterday, I had a chance to catch up with Planned Parenthood President Cecile Richards in between her strategy meetings and blogging for the Huffington Post. She predicted seven things that would change in the new administration.

1. No more federal funds for abstinence-only education. Two years ago Obama told a conservative Christianaudience that abstinence-only education was not enough to prevent teen pregnancy and that he “respectfully but unequivocally” disagrees with those who oppose condom distribution to prevent HIV transmission, according to the reproductive health blog Reality Check. He’s also an original co-sponsor of the Prevention First Act, which mandates that all federal sex-education programs be medically accurate and include information about contraception. That legislation could be resurrected in the new Congress.

2. No more global gag rule. On Bush’s first day in office in 2001, he reinstituted the “global gag rule” that restricted federally funded health clinics in foreign countries from performing abortions or even providing referrals or medical counseling on abortion. “We think there’s going to be a change in that approach and that these clinics will be allowed once again to offer a full range of family planning services,” Richards says.

3. Better coverage for contraception and pregnancy. While Richards says women’s health activists had to “battle the current administration to get emergency contraception approved over the counter,” they’re now hoping that Obama’s proposed health plan will make contraception more affordable to women. It could force drug plans to cover birth control pills as they would any other drug. (Many still do not.) And it could include more comprehensive prenatal coverage; some women shell out $5,000 or more to have a baby. I’m also curious to see whether Obama reverses a Medicaid rule that last year stopped allowing discounted birth control pills to be dispensed on college campuses.

4. Reversal of the “conscience” regulation that threatens women’s access to birth control. Obama will probably reverse a new rule, opposed by most medical organizations including the American Medical Association and the American College of Obstetricians and Gynecologists, that’s slated to be enacted in the next few weeks by the Department of Health and Human Services. It allows doctors and other healthcare workers to opt out of certain practices that some of them find morally objectionable—like prescribing birth control pills, inserting IUDs, or dispensing emergency contraception (a.k.a. the morning-after pill) to rape victims—without fear of losing their jobs. Read more about this here.

5. Increases in funding for reproductive health clinics serving uninsured. While Title X federal funds were recently increased for Planned Parenthood and other family planning clinics, Richards hopes an Obama administration will provide further increases. “We’re currently meeting the needs of 3 million women,” she says, “but an additional 14 million who need our services aren’t getting them.”

6. Fixing gender disparities in health insurance premiums. While Obama’s proposed health plan is probably a pipedream in this economic climate, it could (if ever enacted) ensure that women who buy individual policies aren’t discriminated against because of their gender. A recent analysis of 3,500 health plans from the National Women’s Law Center found that insurers charged 40-year-old women anywhere from 4 percent to 48 percent more than they charged men of the same age. “The average woman uses healthcare more because she spends an average of 5 years getting pregnant and 30 years trying not to,” explains Richards. “It’s certainly not fair that she pays more, and this is the kind of issue that Obama wants to address.”

7. Improved access to morning after pills and abortions for U.S. military women serving overseas. Women who become pregnant while serving overseas are immediately shipped home. They aren’t allowed to get surgical abortions in military hospitals, nor do they have access to medical abortions early in the pregnancy using Mifeprex, a combination of two medications. Obama’s health plan includes coverage for abortions, and he could join with the Democrat-led Congress to enact legislation that ensures that soldiers get the same health benefits as the rest of us.

Deborah Kotz, senior writer for U.S. News & World Report

What does President Elect Barack Obama’s Health Care Plan mean for the healthcare industry?  Do you think he will have the ability to impact the health care delivery system in his first term?

Which Presidential candidate do you think will have the biggest impact on the state of the healthcare industry? 

By JULIE PACE
The Associated Press
Thursday, October 23, 2008; 1:07 PM

SENECAVILLE, Ohio — Even if the issue doesn’t often get star billing on the campaign trail, health care remains a huge issue for voters. It seems like everyone’s got a story to tell about their medical challenges and how they do _ or don’t _ get insurance coverage.

An Associated Press-Yahoo News survey taken last month shows that 78 percent of voters say health care is a very important or extremely important issue.

Both presidential candidates have promised that, if elected, they’ll propose significant changes to the way Americans purchase health insurance, a process that is often cumbersome, confusing, and that has left 47 million people in the Unites States uninsured.

Republican presidential nominee John McCain is proposing a tax credit of up to $2,500 for individuals and $5,000 for families so people can buy the insurance of their choice. That credit would replace the tax break that people currently get when they obtain health coverage through their employer.

Democrat Barack Obama’s plan calls for the government to subsidize health coverage for millions of Americans who otherwise could not afford it. He has also proposed a government-run plan that couldn’t turn away people with certain pre-existing health problems.

A look at how three American households grapple with finding and paying for health care:

___

KRISTOPHER YGLESIAS, 34, Keller, Texas.

Ygelesias doesn’t consider himself a gambler, but he knows he’s taking a risk by going without health insurance.

The father of three used to pay about $1,000 a month to buy coverage through his employer, but concluded it wasn’t worth it.

“I decided I simply can’t afford to put that much money out when I don’t use it,” Yglesias said.

Yglesias now pays for everything from routine doctor’s visits to prescriptions in cash. When his third child was born, he arranged a payment plan with the hospital and doctors.

Yglesias said his medical costs are lower now that he pays his own way than they were when his family was covered by insurance. But the family has never had to face the costs of treating a catastrophic accident or illness.

“If something terrible were to happen, we would have a very serious problem,” he acknowledges. “We would be exposed to huge financial burden that we wouldn’t be prepared to handle.”

Yglesias doesn’t see himself purchasing conventional insurance again, unless significant changes are made. However, the registered Republican likes McCain’s plan to give families a tax credit to use toward the purchase of health insurance..

“That would be a solution I would jump on without any question,” said Yglesias, who plans to vote for McCain.

___

TINA LAWRENCE, 48, Toledo, Ohio

Lawrence’s job as a software programmer has taken her to three different universities in the past two years. Each time she switched employers, she also had to switch insurance companies.

That meant spending hours reading the fine print for each plan. One didn’t offer vision coverage. Another raised her copays.

“The plans vary greatly,” Lawrence said. “It can really be a hassle.”

Lawrence’s husband and daughter, a college student with diabetes, also are covered under her plans. Fortunately, she said, she hasn’t experienced any gaps in coverage as she’s moved between jobs, but she’s faced frequent worries about what her newest plan will offer.

Lawrence said she would support a plan that allowed individuals to keep their existing insurance when they switch employers, as long as it meets certain coverage standards. However, she’s wary of any proposals that could cause employers to stop offering insurance.

“With some of the costs that we incur, there’s just no way we could do that,” said Lawrence, a Democrat who is voting for Obama.

___

DeLYNN GIBEL, 58, Senecaville, Ohio

It took doctors more than a year to diagnose DeLynn Gibel’s husband with multiple sclerosis.

With no health insurance offered through their jobs, and no money to purchase coverage on their own, the Gibels’ year’s worth of tests and treatments left the family with $30,000 in medical bills.

The only option, Gibel said, was to declare bankruptcy.

“You don’t have enough money to make ends meet on a fixed income,” she said. “You always hear that, but until you actually experience that, it’s completely different.”

Because of his illness, John Gibel is now covered under Medicare. His wife stays home to take care of him.

But the couple is facing a new problem. DeLynn Gibel was recently diagnosed with Type 2 diabetes. The medical bills are starting to pile up again, including a $15,000 bill for a three-day hospital stay.

Gibel, a Republican, is voting for McCain. She hopes health-care reform will be part of the next president’s agenda, but is worried that her needs won’t be a top priority.

“We’re so busy taking care of other places, and other countries and rebuilding for them, that the American people are just lost in the picture somewhere,” Gibel said.

© 2008 The Associated Press

By Don McCanne, M.D., PNHP Senior Health Policy Fellow
Huffington Post
October 10, 2008

John McCain and Barack Obama both recognize that there are serious problems with our health care system, and that the voters want something done about it. They would both use public policies to modify the private health insurance market to accomplish their goals. Although it would seem that their goals are similar, the specifics are quite different because they have started from very dissimilar perceptions of the primary flaws in health care financing.

John McCain believes that employer-sponsored plans and government health programs insulate individuals from the costs of health care, creating an excessive demand for health care. He believes that our financing problems would be solved if we put individuals in charge of purchasing their own health care and health care coverage in a marketplace that controls costs through competition. He does understand that coverage is now too expensive for the majority of us, so he would use government tax credits to help pay for private plans. He would also have the states establish “guarantee access plans” that would insure those who cannot otherwise obtain coverage because of preexisting conditions, though these high-risk pools would be exorbitantly expensive.

Barack Obama believes that the high costs of health care and health care coverage have created a financial burden for individuals and small businesses. He also recognizes that many health plans no longer prevent those with health care needs from facing financial hardship, because of inadequate benefits and excessive cost sharing. He would provide a regulated market of plans of a quality similar to those that federal employees have. Although both Sen. Obama and Sen. McCain recommend systemic reform measures designed to reduce costs, Sen. Obama understands that health plans would still be too expensive, so he would not require everyone to purchase them.

Under Sen. McCain’s proposal, greater numbers would go without insurance simply because health plans would still remain unaffordable even with the tax credits. In a deregulated insurance market, those who obtain coverage and have health care needs would find that affordable plans would no longer provide adequate protection against financial loss. It has been estimated that about 65 million people would be uninsured ten years into his program.

Under Sen. Obama’s proposal, ten years out about 33 million individuals would be without insurance simply because their incomes would be too high to qualify for welfare programs, but too low to be able to pay for private plans.

The problem with both proposals is that they depend on the obsolete model of private health plans. The costs of health care in the United States are much higher than in any other nation. They are so high that the private insurance industry is no longer capable of providing us with insurance products that cover all reasonable essential health care services at a premium that we can afford. Our national health expenditures are now $7900 per person. For a family of four, that’s over $31,000. With a median household income of $50,000, we could never expect to pay the health care tab through private health plans. (An employer-sponsored family plan currently averages $12,600, but we pay much of the difference in direct and indirect taxes for high-cost individuals in Medicare, Medicaid, the VA system, safety-net institutions, and other public programs.)

Our dysfunctional, fragmented system of financing health care through a multitude of private plans and public programs is highly inefficient, inequitable, wasteful, and ineffective in slowing the twin epidemics of uninsurance and underinsurance, while health care costs continue to spiral out of control.

Replacing our current financing system with a single, universal risk pool that is publicly-administered and equitably-funded through public financing would create an administratively-efficient system in which everyone is automatically included, for life.

The $2.4 trillion that we are already spending is more than enough to provide comprehensive services for everyone, providing that we adopt the efficiencies of a single payer system. With our own public, single payer monopsony, we would be able to demand much greater value in our health care purchasing by realigning incentives to improve our primary care infrastructure and to reduce administrative waste and the overuse of non-beneficial high-tech services, leaving more funds for high-tech care that does improve our health outcomes.

Sen. McCain wants each of us to go out and shop for our own health care and health insurance coverage, even if we can’t pay for it. His “you’re on your own” approach rejects the notion of social solidarity, even though all other wealthy nations accept solidarity as a fundamental foundation of a just society.

Sen. Obama has said that if we were starting from scratch, he would recommend adopting a single payer system. He’s right. The current financing system is such a disaster that we really should jettison it and start over with single payer system: a new and improved Medicare that covers every single one of us, at a price that we can afford.

By Josef Woodman
 
The new phenomenon of medical tourism—or international health travel—has received a good deal of wide-eyed attention of late. While one newspaper or blog giddily touts the fun ‘n sun side of treatment abroad, another issues dire Code Blue warnings about filthy hospitals, shady treatment practices, and procedures gone bad. As with most things in life, the truth lies somewhere in between.

In short, I’ve found the term “medical tourism” is something of a misnomer, often leading patients to emphasize the recreational more than the procedural in their quest for medical care abroad. Unlike much of the hype that surrounds contemporary health travel, Patients Beyond Borders focuses more on your health than on your travel preferences. Thus, throughout this book, you won’t see many references to the terms “medical tourism” or “health tourism.” In the same way business travelers don’t normally consider themselves tourists, you’ll begin to think more in terms of medical travel and health travel.

My research, including countless interviews, has convinced me: With diligence, perseverance, and good information, patients considering traveling abroad for treatment do indeed have legitimate, safe choices, not to mention an opportunity to save thousands of dollars over the same treatment in the United States. Hundreds of patients who have returned from successful treatment overseas provide overwhelmingly positive feedback. They persuaded me to write this impartial, scrutinizing guide to becoming an informed international patient. I designed this book to help readers reach their own conclusions about whether and when to seek treatment abroad.

So, why go abroad for medical care? Here are seven reasons.

1. Cost savings.  Most people like to get the most for their dollar. The single biggest reason Americans travel to other countries for medical treatment is the opportunity to save money. Depending upon the country and type of treatment, uninsured and underinsured patients, as well as those seeking elective care, can realize 15 to 85 percent savings over the cost of treatment in the United States. Or, as one successful health traveler put it, “I took out my credit card instead of a second mortgage on my home.” As baby boomers become senior boomers, costs of healthcare and prescriptions are devouring nearly 30 percent of retirement and preretirement incomes. With the word getting out about top-quality treatments at deep discounts overseas, informed patients are finding creative alternatives abroad. The costs listed in this table are for surgery (except as noted), including the hospital stay in a private, single-bed room. Airfare and lodging costs are governed by individual preferences. To compute a ballpark estimate of total costs, add $5,000 to the amounts shown in the table for you and a companion, figuring coach airfare and hotel rooms averaging $150 per night. For example, a hip replacement in Bangkok, Thailand, would cost about $18,000, for an estimated savings of at least $15,000 compared with the U.S. price. The estimates above are for treatments alone. Airfare, hospital stay (if any), and lodging vary considerably. Savings on dentistry become more dramatic when “big mouth-work” is required, involving several teeth or full restorations. Savings of $15,000 or more are common.

2. Better-quality care.  Veteran health travelers know that facilities, instrumentation, and customer service in treatment centers abroad often equal or exceed those found in the United States. Governments of countries such as India and Thailand have poured billions of dollars into improving their healthcare systems, which are now aggressively catering to the international health traveler. VIP waiting lounges, deluxe hospital suites, and staffed recuperation resorts are common amenities, along with free transportation to and from airports, low-cost meal plans for companions, and discounted hotels affiliated with the hospital. Moreover, physicians and staff in treatment centers abroad are often far more accessible than their U.S. counterparts. “My surgeon gave me his cellphone number, and I spoke directly with him at least a dozen times during my stay,” said David P., who traveled to Bangkok for a heart valve replacement.

3. Excluded treatments.  Even the most robust health insurance plans exclude a variety of conditions and treatments. You, the policyholder, must pay these expenses out of pocket. Although health insurance policies vary according to the underwriter and individual, your plan probably excludes a variety of treatments, such as cosmetic surgeries, dental care, vision treatments, reproductive/infertility procedures, certain nonemergency cardiovascular and orthopedic surgeries, weight loss programs, substance abuse rehabilitation, and prosthetics—to name only a few. In addition, many policies place restrictions on prescriptions (some quite expensive), postoperative care, congenital disorders, and pre-existing conditions. Rich or cash-challenged, young or not-so-young, heavily or only lightly insured, folks who get sick or desire a treatment (even one recommended by their physician) often find their insurance won’t cover it. Confronting increasingly expensive choices at home, nearly 40 percent of American health travelers hit the road for elective treatments. In countries such as Costa Rica, Singapore, Dubai, and Thailand, this trend has spawned entire industries, offering excellent treatment and ancillary facilities at costs far lower than U.S. prices.

4. Specialty treatments.  Some procedures and prescriptions are simply not allowed in this country. Either Congress or the Food and Drug Administration has specifically disallowed a certain treatment, or perhaps it’s still in the testing and clinical trials stage or was only recently approved. Such treatments are often offered abroad. One example is an orthopedic procedure known as hip resurfacing, a less expensive alternative to the traditional hip replacement still practiced in the United States. While this procedure has been performed for more than a decade throughout Europe and Asia, it was only recently approved in the United States, and its availability here remains spotty. Hundreds of forward-thinking Americans, many having suffered years of chronic pain, have found relief in India, where hip resurfacing techniques, materials, and instrumentation have been perfected, and the procedure is routine.

5. Shorter waiting periods.  For decades, thousands of Canadian and British subscribers to universal, “free” healthcare plans have endured waits as long as two years for established procedures. “Some of us die before we get to the operating table,” commented one exasperated patient, who journeyed to India for an open-heart procedure. Here in the United States, long waits are a growing problem, particularly among war veterans covered under the Veterans Administration Act, for whom long queues are becoming far too common. Some patients figure it’s better to pay out of pocket to get out of pain or to halt a deteriorating condition than to suffer the anxiety and frustration of waiting for a far-future appointment and other medical uncertainties.

6. More “inpatient friendly.”  As U.S. health insurance companies apply increasing pressure on hospitals to process patients as quickly as possible, outpatient procedures are becoming the norm. Similarly, U.S. hospitals are under huge pressure to move inpatients out of those costly beds as soon as possible. Medical travelers will welcome the flexibility at the best hospitals abroad, where they are often aggressively encouraged to spend extra time in the hospital post-procedure. Patient-to-staff ratios are usually lower abroad, as are hospital-borne infection rates.

7. The lure of the new and different.  Although traveling abroad for medical care can be challenging, many patients welcome the chance to blaze a trail, and they find the creature comforts often offered abroad a welcome relief from the sterile, impersonal hospital environments so often encountered in U.S. treatment centers. For others, simply being in a new and interesting culture lends distraction to an otherwise worrisome, tedious process. And getting away from the myriad obligations of home and professional life can yield healthful effects at a stressful time. What’s more, travel—and particularly international travel—can be a life-changing experience. You might be humbled by the limousine ride from Indira Gandhi International Airport to a hotel in central New Delhi or struck by the simple, elegant graciousness of professionals and ordinary people in Thailand, or wowed by the sheer beauty of the mountain range outside a dental office window in Mexico. As one veteran medical traveler put it, “I brought back far more from this trip than a new set of teeth.”

This article is based on excerpts from the second edition of Patients Beyond Borders (2008), the flagship of a landmark series of consumer guides to international medical travel that have helped thousands of patients plan successful health journeys abroad. Healthy Travel Media, publisher of the guides, has become a global clearinghouse for useful information about medical and wellness travel.

Copyright © 2008 U.S. News & World Report, L.P. All rights reserved.

Routine Medical Screenings May Not Deliver as Promised, One Doctor Says
OPINION by NORTIN M. HADLER, M.D.

Sept. 26, 2008-

Most of us believe that when a doctor orders screening tests, that’s a serious step toward keeping illness at bay. The screening test can find factors that place us at risk for diseases we might develop in the future or find hidden diseases. In either case, we will be treated.

Screening tests are considered a triumph of modern public health medicine. I only wish it was that straightforward.

It turns out that many of the commonly recommended screening tests fall far short on this promise. They fall so far short that no one should have them without first discussing them with their doctor.

If you are not convinced you will be advantaged by having the test, why bother?

Let me illustrate this with three of the commonly recommended tests. I will explain why I have never let anyone check my cholesterol or my PSA, and why I have submitted to colonoscopy once, and never again.

Blood Cholesterol
Blood cholesterol level is a risk factor for heart and other blood vessel diseases — but not much of a risk factor. If you have the worst LDL and HDL cholesterol we find occasionally in the population, you have a year or two of life expectancy at risk.

For nearly all who are told they have “high” cholesterol, the amount of time on earth that they are risking is measured in months. I’m not sure we can even measure such a small risk, or that I care.

But if you do, the next question is crucial. Can we do anything to my cholesterol that reduces the risk? That’s not the same question as can you lower the cholesterol? We can do that very well, and we do lower the cholesterol of millions of Americans thereby reducing the risk factor. But does that reduce the risk?

There are scientific studies asking this question. The treatment does not reduce the risk of dying from heart disease. The most optimistic analysis of these scientific studies leads to the following conclusion: 250 people who have not had a heart attack would have to swallow a statin drug every day for five years to spare a heart attack.

Do you believe we can even measure such a tiny effect? Is it worth your while to take these pills for years? Would it be worth it if you had to pay out-of-pocket?

PSA Testing
PSA stands for Prostate Specific Antigen. It’s a normal protein in the prostate. A small amount gets into the bloodstream normally.

Greater amounts get into the bloodstream if the prostate is inflamed by infection. Prostate cancer is another cause of more PSA getting into the bloodstream.

Prostate cancer is a normal part of aging; by age 70, essentially all men have prostate cancer. Furthermore, nearly all men will die with their prostate cancer and not from it.

The challenge for screening is not to find prostate cancer, but to find the prostate cancer that will kill a man before his time. That’s a tall order, and one for which PSA screening is a double-edged sword. After all, if you want to be sure you will not die from prostate cancer before your time, you will have to submit to a procedure, usually a major surgical procedure that offers a 15 percent likelihood of incontinence and more of impotence.

In a clinical trial in Scandinavia, a great number of aging men were divided into two groups. Those who were offered and opted for surgery for their elevated PSA gained very little for the experience compared to those who were not offered surgery. They gained too little for me to opt for the surgery if my PSA was elevated. Therefore, I won’t let anyone check my PSA. You need to have this discussion with your doctor before you opt to have a screening PSA.

Colonoscopy
A few rare families and rare diseases aside, colon cancer is another disease of the sunset years.

Like prostate cancer, it is slow to grow and slow to spread but it is far less common than prostate cancer. The treatment, surgical removal, has far less likelihood of complications than prostate surgery.

The screening is not a blood test; it’s hunting for the cancer directly. More and more, this is done by inserting a tube into the colon and looking inch-by-inch. It’s not a perfect test, requiring patience as much as dexterity.

And it has complications, many of which relate to the removal of polyps which are grape-like growths on a stalk that have very little potential for harm (if they develop into cancer at all, it takes decades).

So we are back to our critical question. The issue is not whether one can find a cancer and remove it, but whether one can find and remove the cancer that is likely to cost me time on this earth.

I don’t care if I develop colon cancer in my 80s; something else is likely to kill me long before it can. I don’t care if I develop colon cancer in my 70s either, for the same reason. Furthermore, screening me in my 40s is largely an exercise in futility; colon cancer is so very, very rare in 40-year-olds that the chances of a complication of colonoscopy far outweighs the chances of finding the rare cancer. It’s in the 50s and 60s that finding and removing the rare colon cancer is likely to be meaningful to that person and worth the risks to all those who don’t have colon cancer.

Hence, I had my one colonoscopy. In fact, I settled for a partial look (flexible sigmoidoscopy) because that was good enough risk assessment for me and the procedure is gentler and safer.

I am not alone in realizing the limitations of these tests and others such as mammography or even the annual physical examination. Many a researcher has been recruited to the task of improving screening tests. However, until we have much better screening tests, no person should be screened unaware of the limitations of the test.

Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of Worried Sick: A Prescription for Health in an Overtreated America and The Last Well Person.

Some argue an independent panel should gauge presidents and presidential candidates’ health
By Allison Van Dusen for Forbes.com

American presidents generally don’t like to talk about their health problems. Few people knew, for instance, that during their presidencies, Woodrow Wilson had suffered a massive stroke that left him partially paralyzed or that John F. Kennedy was taking as many as eight medications a day to deal with extensive back pain, digestive problems and the hormonal disorder known as Addison’s disease.

As the 2008 presidential race heats up, two University of Michigan medical historians argue in the June 4 issue of the Journal of the American Medical Association that given the poor track record of past presidents to share medical details and the already strong interest in the health histories of nominees Sens. John McCain and Barack Obama, Congress should appoint an impartial panel to evaluate presidents and presidential candidates’ health.

We asked one of the authors, Dr. Howard Markel, director of the Center for the History of Medicine at the University of Michigan, to explain the concept and who it will really help.

Howard Markel:  If you’re healthy, nothing. If there’s something slightly there, you don’t want to give your opponent or opponent’s spinner any kind of leeway to knock you down. With the era of the permanent campaign, instant communication and the 24-7 news cycle, no one wants to give out information that might hurt [his or her] chance to win an election. We have found out that anything can and will be used against them.

Should a president’s or presidential candidate’s health be of concern to the public?

Absolutely. The president is the most powerful person on the planet. Their mental, physical health and well-being, really does effect the global market, war, peace, political legislation–all sorts of things with the stroke of a pen. The caveat is that you really can’t predict based on a medical evaluation today what’s going to happen a year from now. You could be cleared as completely healthy and a year later have a debilitating heart attack. But it’s important for people to know. We make decisions based on where people go to worship, their income, where they went to college. From my perspective, as a physician and historian of medicine, this is a big piece of data we want to know.

Why do you think there currently isn’t a method to assure impartial, candid health evaluations for future presidents and presidential candidates?

It’s all about control. It’s only gotten worse with each successive campaign cycle. You have to control the information getting out that might hurt you, even information you don’t think would hurt you. Sen. [Barack] Obama smoked cigarettes. There’s no evidence he has lung cancer or heart disease. But in this era, smoking cigarettes is looked down upon much more negatively than when FDR was running for president and had a cigarette in his mouth.

Explain the method you propose.

Once somebody is president, he needs to be examined on a regular basis, annually or more frequently. We want nominees to be examined too. And it’s critical that they’re not examined by their own physicians. If I’m physician to the president I’m probably going to like that job. There’s a conflict of, do I do something that will get the president upset enough to fire me?

An independent panel would be appointed by Congress with all sorts of doctors, dermatologists, neurologists and cardiologists, so that [everything] is covered, but also other experts, such as lawyers and ethicists, to help in terms of publication of such a report. They would be independent umpires who don’t have a dog in the race.

It’s also critical that nominees and presidents are evaluated because the 25th amendment of the U.S. Constitution … is vague in how it defines disability. How it’s defined today compared to 1967, when the amendment was ratified, has changed markedly. We need clear definitions.

At the annual checkup, nominees could voluntarily say there are categories they want to opt out of disclosing. They may have a genetic screening and carry a trait … that they don’t want reported. They may say they want to talk about that with their children, but it has no bearing on their ability to govern.

What do you say to people who feel this is too big an invasion of the president’s or candidates’ privacy?

We offer patients confidentiality, and that’s critically important for regular patients. But let’s face it: The president of the United States and the nominees for president of the United States are the most public patients in the world. They have long since given up any elements of privacy. We know whether they like hot dogs or the Yankees. With health, it’s just too important.

What about those who might argue that disclosing information about the president’s health could affect global politics?

If the president has a serious illness, like let’s say a stroke, that’s serious. We need to know about that right away. The vice president needs to be put in place by the 25th amendment. If it’s a long-standing [health problem], you’ve got a little bit more leeway.

I would argue it’s a bigger threat to national security by hiding it than by disclosing it. Transparency is way better than opaque policies–that’s one thing history teaches us again and again.

There have been a series of articles that discuss deathrow inmates and their request for clemency due to the fact that they are obese.  The inmates claim an even greater risk of experiencing excruciating pain and suffering than other inmates due to the fact that they are overweight.

Similar lawsuits have been filed in several states which have led to the halting of executions in Texas, Delaware and New Jersey.

The men in these articles have tortured, raped and killed innocent people.  What gives them the right to life? They took a life, if not, several.  What about the rights of the victim’s family to see justice for the loss of a loved one?

What kind of message would we be giving criminals?  By halting executions, are we telling “would be” criminals to fatten up to commit heinous crimes so that they may not face the death penalty?  I don’t think the victims of these men had a choice in the way their lives ended so abruptly!

Here are the articles, if you would like to read them…   

http://www.cnn.com/2008/CRIME/08/25/death.penalty.fat.ap/index.html

http://abcnews.go.com/TheLaw/story?id=3684431

The NHS should not always attempt to save someone’s life if the cost is too much, the medical regulator has ruled

By Robert Winnett, Deputy Political Editor

The National Institute for Health and Clinical Guidelines (Nice) has ruled for the first time that saving a life cannot be justified at any cost, in a review of its ethical guidelines.

The ruling - made by the board of the controversial organisation - contradicts advice it received from its own ‘Citizens Council’ which offers advice from a representative sample of the general public.

Nice is facing growing criticism over the number of drugs it is now rejecting which are available throughout Europe and in America. Last week, it refused to sanction four kidney cancer drugs which can double life expectancy.

It has now rejected the so-called “rule of rescue” which stipulates that people facing death should be treated regardless of the costs. The rule is based on the natural impulse to aid individuals in trouble.

In a report on “social values judgement” the regulator says: “There is a powerful human impulse, known as the ‘rule of rescue’, to attempt to help an identifiable person whose life is in danger, no matter how much it costs. When there are limited resources for healthcare, applying the ‘rule of rescue’ may mean that other people will not be able to have the care or treatment they need.

“Nice recognises that when it is making its decisions it should consider the needs of present and future patients of the NHS who are anonymous and who do not necessarily have people to argue their case on their behalf…The Institute has not therefore adopted an additional ‘rule of rescue’.”

The ruling contradicts the advice of Nice’s Citizens Council, which said that a rule of rescue was an essential mark of a humane society. The report said that where individuals are in “desperate and exceptional circumstances” they should sometimes receive greater help than can be justified by a “purely utilitarian approach”.

Doctors have also criticised the ruling. Tony Calland, chairman of the ethics committee of the British Medical Association, said: “We would be opposed to ignoring a rule of rescue when it introduces a degree of flexibility around extreme cases. So what if you waste a few pounds if you are doing your best for humanity?”

Nice defended its ruling last night saying that the Citizens Council provided useful input to its decisions but that the organisation’s role was to determine how best to allocate the health service’s limited resources.

Nice is facing increasing accusations that it is giving undue weight to financial considerations - rather than medical benefits - when making decisions on whether to allow drugs or other treatments on the NHS. Doctors and patients have alleged that they are treated with contempt by the organisation and that life-saving drugs are being unfairly denied.

The Daily Telegraph disclosed yesterday that Nice is preparing to offer patients advice on the medical benefits of drugs that are not available on the NHS. The disclosure is likely to anger patients who face paying tens of thousands of pounds for expensive drugs which may prolong their lives.

Research Shows Return Trips to Battle Increase Troops’ Alcholism, Suicide Risks

By MARILYN ELIAS
USA TODAY
Aug. 15, 2008—

Multiple combat deployments to Iraq are increasing serious mental health problems among soldiers, triggering drug and alcohol abuse and contributing to record suicide levels, suggest reports out Thursday at the American Psychological Association meeting in Boston.

In a typical unit headed to Iraq, 60 percent are on their second, third or fourth deployment, lasting about a year each, says U.S. Army Col. Carl Castro, who directs a medical research program at Fort Detrick, Md.

More time in Iraq means heavier exposure to violence, which leads more soldiers to develop symptoms of post-traumatic stress disorder (PTSD) and depression, Castro told the psychology meeting. By their third tour to Iraq, more than a quarter of soldiers show signs of mental problems, such as PTSD, and it’s about 1 out of 3 for those exposed to heavy combat, according to a U.S. Army Surgeon General report in March on more than 2,000 soldiers.

In another report at the meeting, deployment correlated with more heavy drinking and illegal drug use, according to anonymous questionnaires given to about 34,000 active duty troops, Reservists and National Guard members. Deployed Reserve troops had the highest traumatic stress symptoms and rates of “seriously considering suicide,” according to the Defense Department-funded study by RTI International, Research Triangle Park, N.C.

National Guard and Reservists sent to Iraq and Afghanistan are disproportionately represented in returning veteran suicides, according to a Departmentof Veterans Affairs analysis. There were 115 Army suicides and 935 reported attempts in 2007, a record high, show Army reports.

“There are concerns about the reserves,” says Lynn Pahland, a health promotion policy director in the Defense Department. But the military is increasing efforts to prevent, identify and treat troubled troops,she adds.

At a crisis hotline for veterans, about 75 percent of the 400 calls a weekcome from Reserve and National Guard troops or their families, says Shad Meshad, president of the National Veterans Foundation (1-888-777-4443), which runs the line. “Many have been sent back three or four times,” he says.

On Wednesday, a Texas Reservist going to Iraq for the fourth time called “in a hysterical state” because his house is being foreclosed on, and his wife is taking the kids and leaving him. Says Meshad: “We’re just trying to help him out with the financial stuff and keep him from hurting himself.”

Copyright © 2008 ABC News Internet Ventures

Terminally Ill Denied Drugs for Life, But Can Opt for Suicide

By SUSAN DONALDSON JAMES
Aug. 6, 2008 —

The news from Barbara Wagner’s doctor was bad, but the rejection letter from her insurance company was crushing.

The 64-year-old Oregon woman, whose lung cancer had been in remission, learned the disease had returned and would likely kill her. Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.

What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.

“It was horrible,” Wagner told ABCNews.com. “I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die. But we won’t give you the medication to live.”

Critics of Oregon’s decade-old Death With Dignity Law — the only one of its kind in the nation — have been up in arms over the indignity of her unsigned rejection letter. Even those who support Oregon’s liberal law were upset.

The incident has spilled over the state border into Washington, where advocacy groups are pushing for enactment of Initiative 1000 in November, legalizing a similar assisted-death law.

Opponents say the law presents all involved with an “unacceptable conflict” and the impression that insurance companies see dying as a cost-saving measure. They say it steers those with limited finances toward assisted death.

“News of payment denial is tough enough for a terminally ill person to bear,” said Steve Hopcraft, a spokesman for Compassion and Choices, a group that supports coverage of physician-assisted death.

Letter’s Impact ‘Devastating’
“Imagine if the recipient had pinned his hope for survival on an unproven treatment, or if this were the first time he understood the disease had entered the terminal phase. The impact of such a letter would be devastating,” he told ABCNews.com.

Wagner, who had worked as a home health care worker, a waitress and a school bus driver, is divorced and lives in a low-income apartment. She said she could not afford to pay for the medication herself.

“I’m not too good today,” said Wagner, a Springfield great-grandmother. “But I’m opposed to the [assisted suicide] law. I haven’t considered it, even at my lowest point.”

A lifelong smoker, she was diagnosed with lung cancer in 2005 and quit. The state-run Oregon Health Plan generously paid for thousands of dollars worth of chemotherapy, radiation, a special bed and a wheelchair, according to Wagner.

The cancer went into remission, but in May, Wagner found it had returned. Her oncologist prescribed the drug Tarceva to slow its growth, giving her another four to six months to live.

But under the insurance plan, she can the only receive “palliative” or comfort care, because the drug does not meet the “five-year, 5 percent rule” — that is, a 5 percent survival rate after five years.

A 2005 New England Journal of Medicine study found the drug erlotinib, marketed as Tarceva, does marginally improve survival for patients with advanced non-small cell lung cancer who had completed standard chemotherapy.

The median survival among patients who took erlotinib was 6.7 months compared to 4.7 months for those on placebo. At one year, 31 percent of the patients taking erlotinib were still alive compared to 22 percent of those taking the placebo.

“It’s been tough,” said her daughter, Susie May, who burst into tears while talking to ABCNews.com. “I was the first person my mom called when she got the letter,” said May, 42. “While I was telling her, ‘Mom, it will be ok,’ I was crying, but trying to stay brave for her.”

“I’ve talked to so many people who have gone through the same problems with the Oregon Health Plan,” she said.

Indeed, Randy Stroup, a 53-year-old Dexter resident with terminal prostate cancer, learned recently that his doctor’s request for the drug mitoxantrone had been rejected. The treatment, while not a cure, could ease Stroup’s pain and extend his life by six months.

Playing With ‘My Life’
“What is six months of life worth?” he asked in a report in the Eugene Register-Guard. “To me it’s worth a lot. This is my life they’re playing with.”

The Oregon Health Plan was established in 1994 and the physician-assisted death law was enacted in 1997. The state was recently hailed by a University of Wisconsin study as having one of the nation’s top pain-management policies.

The health plan, for those whose incomes fall under the poverty level, prioritizes coverage — from prevention first, to chronic disease management, treatment of mental health, heart and cancer treatment.

“It’s challenging because health care is very expensive, but that’s not the real essence of our priority list,” said Dr. Jeanene Smith, administrator for the Office of for Oregon’s Health Policy and Research staff.

“We need evidence to say it is a good use of taxpayer’s dollars,” she said. “It may be expensive, but if it does wonders, we cover it.”

The state also regularly evaluates and updates approvals for cancer treatments. “We look as exhaustively as we can with good peer review evidence,” she said.

The health plan takes “no position” on the physician-assisted suicide law, according to spokesman Jim Sellers.

The terminally ill who qualify can receive pain medication, comfort and hospice care, “no matter what the cost,” he said.

But Sellers acknowledged the letter to Wagner was a public relations blunder and something the state is “working on.”

“Now we have to review to ensure sensitivity and clarity,” Sellers told ABCNews.com “Not only is the patient receiving had news, but insensitivity on top of that. This is something that requires the human touch.”

Sellers said that from now on insurance officials will likely “pick up the phone and have a conversation,” he said.

But a 1998 study from Georgetown University’s Center for Clinical Bioethics found a strong link between cost-cutting pressures on physicians and their willingness to prescribe lethal drugs to patients — were it legal to do so.

The study warns that there must be “a sobering degree of caution in legalizing [assisted death] in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care.”

Cancer drugs can cost anywhere from $3,000 to $6,000 a month. The cost of lethal medication, on the other hand, is about $35 to $50.

Advocates for the proposed Washington law say that while offering death benefits but not health care can be perceived as a cost-cutting, “respectable studies” say otherwise.

“The reason is that hospice care, where most patients are at the end of life is relatively inexpensive,” Anne Martens, spokesman for Washington’s Death With Dignity Initiative, told ABCNews.com.

But even those who support liberal death laws say Wagner’s predicament is reflective of insurance attitudes nationwide.

Case Is Not Unique
“Her case is hardly unique,” said Michigan lawyer Geoffrey Fieger, who defended Dr. Jack Kevorkian’s crusade to legalize physician-assisted deaths. “In the rest of the country insurance companies are making these decisions and are not paying for suicide,” Fieger told ABCNews.com. “Involuntary choices are foisted on people all the time by virtue of denials.”

“I am surprised there hasn’t been a revolt in this country,” he said. “It happens every day and people are helpless.”

Indeed, one executive suffering from a rare and potentially fatal form of liver cancer is fighting his insurance company for coverage. Oncologists from a major teaching hospital in New York City have prescribed Sutent — a medication that costs about $4,000 a month and could extend his life expectancy.

“Most of my objections are that some second rate guy on the staff of the insurance company is second-guessing one of the foremost authorities and trumping his judgment,” said the 57-year-old executive, who didn’t want his name used to protect his privacy.

“I am fortunate to have the financial resources and the ability to fight these people who would rather these you die,” he told ABCNews.com.

Dr. Jonathan Groner, clinical professor of surgery at OSU College of Medicine and Public Health in Columbus, Ohio, said some patients may want to prolong their lives for a life-cycle event, like a birth or wedding.

“A course of chemo would not cure, but would subdue the cancer long enough to be meaningful,” he told ABCNEWS.com. “There are many people with slow-growing but nonetheless metastatic cancer for whom death, while inevitable, is many years away.”

“The problem with the Oregon plan is it sounds like administrators, not physicians, are making treatment decisions,” he said. “And if a patient can get assisted death paid for but not cancer treatment, the choice is obvious.”

Derek Humphry, founder of the Hemlock Society and author of “Final Exit,” who helped write the Oregon Death With Dignity Law, said only about 30 people a year choose an assisted death, which must be approved by two doctors.

“It’s purely optional and the patient and doctor can walk away from it,” the 78-year-old told ABCNEWS.com. “It’s not the mad rush our enemies predicted and for our residents it has worked out well.”

His own wife, Jean, was diagnosed with fast-growing breast cancer in 1975 and asked him to help find drugs to help her die. At 42, she chose to take them and ended her life.

Humphry says the Oregon Health Plan’s approach to coverage is sound.

“People cling to life and look for every sort of crazy cure to keep alive and usually they are better off not to have done it,” he said.

Meanwhile Wagner has faith in her medicine, not assisted death. Now, at the request of her doctor, the pharmaceutical company Genentech is giving her Tarceva free of charge for one year.

“The doctor did say it would put a lid on the cancer and I am hopeful,” she said.

Wagner’s daughter Susie May says her mother is a fighter. “I think we all knew that this is her last hope,” she said.

Even Wagner’s ex-husband, Dennis Wagner of Springfield, has weighed in on the ethical dilemma.

“My reaction is pretty typical,” he told ABCNews.com. “I am sick and tired of the dollar being the bottom line of everything. We need to put human life above the dollar.”
Rana Senol of ABC News Research contributed to this report.

By TARA PARKER-POPE

A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.

The relationship is the cornerstone of the medical system — nobody can be helped if doctors and patients aren’t getting along. But increasingly, research and anecdotal reports suggest that many patients don’t trust doctors.

About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication.

The distrust and animosity between doctors and patients has shown up in a variety of places. In bookstores, there is now a genre of “what your doctor won’t tell you” books promising previously withheld information on everything from weight loss to heart disease.

The Internet is bristling with frustrated comments from patients. On The New York Times’s Well blog recently, a reader named Tom echoed the concerns of many about doctors. “I, as patient, say stop acting like you know everything,” he wrote. “Admit it, and we patients may stop distrusting your quick off-the-line, glib diagnosis.”

Doctors say they are not surprised. “It’s been striking to me since I went into practice how unhappy patients are and, frankly, how mistreated patients are,” said Dr. Sandeep Jauhar, director of the heart failure program at Long Island Jewish Medical Center and an occasional contributor to Science Times.

He recounted a conversation he had last week with a patient who had been transferred to his hospital. “I said, ‘So why are you here?’ He said: ‘I have no idea. They just transferred me.’

“Nobody is talking to the patients,” Dr. Jauhar went on. “Everyone is so rushed. I don’t think the doctors are bad people — they are just working in a broken system.”

The reasons for all this frustration are complex. Doctors, facing declining reimbursements and higher costs, have only minutes to spend with each patient. News reports about medical errors and drug industry influence have increased patients’ distrust. And the rise of direct-to-consumer drug advertising and medical Web sites have taught patients to research their own medical issues and made them more skeptical and inquisitive.

“Doctors used to be the only source for information on medical problems and what to do, but now our knowledge is demystified,” said Dr. Robert Lamberts, an internal medicine physician and medical blogger in Augusta, Ga. “When patients come in with preconceived ideas about what we should do, they do get perturbed at us for not listening. I do my best to explain why I do what I do, but some people are not satisfied until we do what they want.”

Others say the problem also stems from a grueling training system that removes doctors from the world patients live in.

“By the time you’re done with your training, you feel, in many ways, that you are as far as you could possibly be from the very people you’ve set out to help,” said Dr. Pauline Chen, most recently a liver transplant surgeon at the University of California, Los Angeles, and the author of “Final Exam: A Surgeon’s Reflections on Mortality” (Knopf, 2007). “We don’t even talk the same language anymore.”

Dr. David H. Newman, an emergency room physician at St. Luke’s-Roosevelt Hospital Center in Manhattan, says there is a disconnect between the way doctors and patients view medicine. Doctors are trained to diagnose disease and treat it, he said, while “patients are interested in being tended to and being listened to and being well.”

Dr. Newman, author of the new book “Hippocrates’ Shadow: Secrets from the House of Medicine” (Scribner), says studies of the placebo effect suggest that Hippocrates was right when he claimed that faith in physicians can help healing. “It adds misery and suffering to any condition to not have a source of care that you trust,” Dr. Newman said.

But these doctors say the situation is not hopeless. Patients who don’t trust their doctor should look for a new one, but they may be able to improve existing relationships by being more open and communicative.

Go to a doctor’s visit with written questions so you don’t forget to ask what’s important to you. If a doctor starts to rush out of the room, stop him or her by saying, “Doctor, I still have some questions.” Patients who are open with their doctors about their feelings and fears will often get the same level of openness in return.

“All of us, the patients and the doctors, ultimately want the same thing,” Dr. Chen said. “But we see ourselves on opposite sides of a divide. There is this sense that we’re facing off with each other and we’re not working together. It’s a tragedy.”

By BENJAMIN BREWER, M.D.

With gas prices hovering around $4 a gallon, my patients are cutting back on medical care.

A 59-year-old woman decided not to have a mammogram this year. At her age, she should be screened for colon cancer, too, but she is holding off until she becomes eligible for Medicare at 65.

Despite having some medical insurance as a self-employed cleaning woman, she is pinching pennies by scrimping on preventive care. If she develops cancer of the colon or breast she won’t have saved anything. This year she is taking her chances. 
 
Rising deductibles, stiff drug co-payments and increasing prices for just about everything are forcing some hard choices about health. Care that doesn’t strike patients as critical is getting delayed. As the economy squeezes my patients, they are showing up sicker.

A patient quit smoking so he could afford gas for the 40 mile commute to work in a packaging plant. He has been living paycheck to paycheck for years and his rent just went up. I was glad that something finally motivated him to stop smoking.

The bad news was that he came to the office with severe pneumonia two days after refusing to let an E.R. doctor admit him to the hospital. My patient was afraid of the expense and all the time he would go without pay from work.

To make matters worse, he didn’t fill the antibiotic prescription he was given either. The $50 co-payment was unaffordable, he said. This is a case when an insurer would have been better off picking up the antibiotic tab to avoid a larger expense. But there’s no easy way for a doctor to override a plan’s co-pay or to let an insurer know its rules are about to make something very expensive happen.

When the patient came to see me, his condition had deteriorated. I persuaded him to let me admit him to the local hospital. He was in such bad shape that he was soon transferred to the ICU of a large medical center. His care will end up costing tens of thousands of dollars.

It was no surprise to me to read recently that claims severity and costs for health insurers took an unexpected jump this year. Many patients are not able to bear even a moderate expense to save their insurance companies the cost of major claims.

A 53-year-old patient couldn’t avoid a trip to see me when his finger was fractured in a log splitter. After X-rays and having his fingertip sutured together, the man required several trips to the office for dressing changes and monitoring for infection.

He’s been unable to work as a laborer in the month since he got hurt. With no money coming in, he’s racked up $200 in office co-payments for visits that his insurance won’t be covering. We’re carrying his balance until he can get back to work.

He isn’t the only one in arrears. As a result of lean times, accounts receivable from uninsured patients in my practice is trending up. About 5% of our patients are uninsured.

Patients are still having babies at the same rate. But elective procedures, preventive exams and compliance with prescriptions are all down.

Some of my patients are taking themselves off medications. Just last week I encountered patients who stopped their cholesterol medication and urinary incontinence medications. I’m getting fewer refill requests for E.D. drugs, like Viagra, too.

I noticed an uptick in patients canceling appointments and just not showing up over the last few weeks. More people are asking for advice over the phone and trying to avoid an office visit.

Many of our patients travel 20 or 30 miles to see us, and I think gas prices are affecting no-show and cancellation rates, particularly with low income patients.

My total number of office visits is off 5% from last year. Another indication of the slowdown is that I’m getting my nursing home rounds done. I’m pretty well caught up on my daily deluge of paperwork, too. When things are busy, I almost never get those things accomplished.

It occurred to me in an idle moment that I would be a lot busier if the $600 government stimulus checks had been spent on a basket of basic primary care services. That would have paid for 130 million people to have had most of their health needs met for a year. Instead, folks around here seem to be spending more on $4 gas.

http://online.wsj.com/article/SB121675678304374527.html?mod=2_1566_topbox

Will Giving Doctors More Money to Coordinate Care Pay Off?

By JULIE APPLEBY
July 14, 2008

States, the federal government and private insurers are experimenting with an idea to cut costs and make patients happier: Paying primary-care doctors extra money to oversee and coordinate patients’ care.

The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family physician helped patients through hospitalizations, coordinated specialist care and provided routine screenings. Such efforts may save money by reducing hospitalizations, ER visits and disease.

Dubbed “medical homes,” the concept is a modern twist on an idea first promoted in the 1960s. Under most pilot projects being tested, primary-care doctors who have established medical homes will receive additional fees ranging from just a few dollars a month per patient to more than $35,000 a year per doctor from states, Medicare or other insurers.

Medicare this year will choose eight states to test whether paying primary-care doctors more per month to treat patients with chronic illnesses in medical home settings results in better care and lower costs than traditional practices.

The concept aims to change rushed doctor’s appointments and fragmented specialist care by creating patient care “teams,” which could include nurse practitioners, nutritionists or other medical staff. Medical homes also offer longer office hours, electronic medical records and same-day appointments.

The idea is that patients would turn to a trusted adviser, either the doctor or another team member, for preventive and routine care and rely on that person to help coordinate needed screenings, specialist visits and other care, says Terry McGeeney, head of TransforMED, a subsidiary of the American Academy of Family Physicians that helps doctors create such practices.

While health maintenance organizations and managed care companies aimed for such coordination, many didn’t pay doctors adequately for it, instead rewarding them financially for restricting care, says McGeeney. Under medical homes, he says, doctors won’t prevent patients from seeing specialists or ordering tests.

It’s not clear how well such plans will work. North Carolina saved $231 million in 2002-03 by setting up medical homes in its Medicaid program.

Joseph Antos, an economist at the conservative American Enterprise Institute, says no one argues with the goal, but: “If all we’re doing is rearranging the deck chairs on the medical Titanic, and spending more money, that’s clearly not something we want to do.”

The idea appeals to doctors such as Joseph Mambu, who set up his Pennsylvania practice as a medical home. They recreate “the old-fashioned doctor who has the time to get to know you,” he says. “This is our last, best hope to save primary care.”

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