Category: Health

President Obama has not read the House bill that he supports. Obama says that all persons can keep their own private plan. But the House health bill page 16 says that private plans will be illegal in five years. So yes – you can keep your plans for a limited number of years.

Congress passed the cap and trade energy bill and NOBODY read the bill. Do you really believe Obama when he promises to reduce health care costs and add 15-40 million to the roles? The American public is too smart for that kind of double talk. Remember – if you don’t speak up — and do read the bill — then you are part of the problem. Complacency can kill a democracy.

August is the month to contact your congress representatives and say what you think.

Sam Farr meets August 10 6pm in Monterey at 409 Pierce Street at Monterey Institute of International Studies, Irvine Auditorium. Sam Farr is in Santa Cruz Aug. 12 at the First Congregational Church at 900 High Street, 6 pm. And he is in in Hollister at the San Benito County Board of Supervisors Chambers at 481 Fourth St., Hollister, CA

Obama Health Plan Draws Majority Disapproval in Poll

By Kristin Jensen

Aug. 5 (Bloomberg) — President Barack Obama’s effort to revamp the U.S. health-care system is drawing increasing disapproval from Americans worried about higher deficits, a Quinnipiac University poll shows.

The July 27-Aug. 3 poll found that 52 percent of American voters disapprove of the way Obama is handling the health-care issue and 39 percent approve. That’s a switch from the 46 percent who approved and 42 percent who disapproved in late June, the university’s polling institute said.

Almost three-quarters of the respondents said they don’t believe Obama’s promise that Congress can pass a health-care measure without adding to the budget deficit. And 57 percent say the legislation should be dropped if it adds “significantly” to the deficit, Quinnipiac said.

“It’s obviously a problem for the people who are trying to push health-care reform,” said Peter Brown, assistant director of the Hamden, Connecticut-based polling institute, in an interview with Bloomberg Television. “The White House and Democratic leadership are very concerned that the month of August not become the time when the plan died.”

The House of Representatives left Washington on July 31 for a five-week recess after putting off a vote on legislation until September. One of the two Senate committees with jurisdiction over health care is still struggling to craft bipartisan legislation, and the Senate also gave up on meeting Obama’s goal of passing the measure in August.

Persuading Voters

House and Senate lawmakers are grappling with issues such as whether to create a government-run health-care plan that would compete with private insurers, whether to mandate that employers offer health insurance to their workers, and how to pay for a plan that may cost $1 trillion over 10 years.

House Democrats are now trying to persuade voters in their home districts that the effort to cover millions of uninsured Americans and reduce health-care costs is worthwhile; the poll suggests they have a lot of work to do.

“The average voter out there is skeptical about government,” Brown told reporters in Washington today.

Affecting Care

A plurality of 39 percent of respondents said they don’t think proposed changes would affect their own care, while 36 percent said the legislation would hurt the quality of their care and 21 percent said they would expect an improvement. Almost three-fifths say Congress shouldn’t pass a health-care measure unless it receives at least some Republican support.

White House spokesman Robert Gibbs yesterday accused a group opposing the health-care overhaul plan of disrupting town-hall meetings convened by Democratic lawmakers by “manufacturing” outrage.

Leaders of Conservatives for Patients’ Rights, which has staged rallies against Obama’s health-care plan, “have bragged about organizing and manufacturing” anger expressed at the public meetings, Gibbs told reporters.

Richard Scott, the group’s chairman, said in a statement that “no one needs to manufacture anger or concern” because the American public “is threatened by a massive government takeover” of health care.

Some Approval

As other recent polls have shown, Quinnipiac found support for individual elements of the plans that Obama and Democratic leaders in Congress are proposing, even amid some disapproval.

The Quinnipiac poll showed that 62 percent of voters favor allowing Americans to opt into a government-run insurance program, compared with 32 percent who don’t. Three out of five respondents support subsidies to help lower-income Americans buy insurance, 61 percent support higher taxes on the wealthiest Americans to pay for the overhaul and 54 percent agree that employers should provide insurance or pay a penalty.

A requirement that individuals obtain insurance drew fire from respondents, with 68 percent opposed and 26 percent in favor. All the plans so far have some sort of mandate on Americans to obtain coverage, with help for those with lower incomes.

The poll included 2,409 registered voters nationwide and has a margin of error of plus or minus 2 percentage points.

To contact the reporter on this story: Kristin Jensen in Washington at kjensen@bloomberg.net

To: Congressman Sam Farr (for Monterey and Santa Cruz County, CA)
From: Dr. Cameron Jackson, licensed psychologist

I am opposed to the current the Health Care Reform bill which Speaker Pelosi and the Democratic leadership offer Americans. I am worried and concerned how you, Mr. Farr, may vote because per your web site statistics you vote the Democratic Party line 98% of the time.

Now is the time that you, Mr. Farr, need to show independence from the Democratic Party line. Right now America is under one party rule by the Democratic Party. That is not healthy. The basic Robert’s Rules of Order that protect the minority Republican and Independent positions are not respected by Congress. Nancy Pelosi, the Rules Committee and members of Congress need to read or re-read Democracy in America by DeTocqueville. Protect the rights of the minority to speak! Have real debate! And please Mr. Farr don’t push bills down the throats of Americans just because of One Party Rule.

One question every American should pose and which I ask you: do you plan to give up your private health care coverage which all members of Congress get and use the same health care plan that the Democrats offer? If your answer Mr. Farr is No, that you plan to keep your private insurance plan — then the health care plan proposed by Obama and the Democrats is not good enough for We the People whom you represent.

I strongly oppose governmental interference in the health care decisions that people now make with their doctors. Of note in the current bill: The bill requires that medical doctors must have end of life and end of care discussions every 5 years.

I strongly oppose the government – at one swoop — taking over a fifth of the economy. The health care sector amounts to about 20 percent of the economy. The government does not have a good record for keeping down costs nor running anything efficiently.

New business need to grow on shoe-string budgets. This plan will drive small business out of business and prevent new ones from starting. With all the unemployed who have enormous talents and capabilities we need to do everything we can to encourage new business. Saddling on small businesses required costs for medical care is simply dumb.

Each person is a unique person with a unique medical history. Deciding whether to have surgery or not – whether to have chemo or not — is best done without government interference. Do we want the “compassion” of the IRS and the Department of Motor Vehicles affecting important medical decisions? No, we want the compassion and clinical judgment of our doctors without government interference.

written by Dr. Cameron Jackson, licensed psychologist
cameornjacks@gmail.com

Let’s see how sensible this line of thinking is: Add 15 to 40 million to health care rolls. Yet Obama promises we are going to cut health care costs. Does that add up?

And the newly minted public program will abide by the same rules as the private programs.

Do you think a publicly run health organization will be any better run than 1) the post office. That’s why we all love Fed EX and don’t care about all the junk mail we get through our mail box.

Health care should be just like buying cereal: you can choose the no sugar or additives, shredded wheat, or buy the expensive little containers with 12 varieties of sugar. You choose and you pay with your dollars.

Likewise, if you are healthy and age 25 you should be able to shop for a policy that gives you no frills and only helps if you end up in a terrible accident. Choice is a good thing for people.

This is from a blog called Heritage:

“According to the May 5th New York Times, Senator Charles Schumer (D-NY) has proposed a health care reform “compromise” on the creation of a new public plan to compete with private health insurance. No doubt Schumer is trying to convince moderates that they should ignore Rep. Jan Schakowsky (D-IL) frank admissions that a public plan is just the first step of an unprincipled strategy to achieve government run health care.

Schumer’s compromise would require that the public plan and private plans would abide by the same rules and regulations. But even the NYT identifies some huge holes in his claim. Would the public plan be subject to state premium taxes, like private health plans, or state insurance laws, or solvency requirements with the private plans in states with which it is competing? Could the public plan be allowed to become insolvent? Or will it become another candidate for an eternal Congressional bail out? We have even more questions than the NYT does:

Will public plan officials be subject to the same state and federal tort laws?
How about the same accounting standards as private companies?
Could they be sued for breach of contracts?
Will they have to negotiate rates and benefits like private plans, set up provider networks, and set prices in the market, just like private plans do today? Market prices? (No special advantages, remember)
Will the officers of the public plan be able to reject doctors or medical professionals who do not meet quality standards like private plans can do today, or will they be forced to take any willing provider?
Will the benefit setting of the public plan be transparent and benefits packages be completely transparent, defining clearly what is and is not covered? No confusion on these points, like that which afflicts Medicare beneficiaries today.

Would the public plan officers have budgets to market their products, just like private plans? Would those marketing costs be subsidized by the taxpayer or paid out of public plan premiums? ( Otherwise, looks like those awful administrative costs would be incurred by the taxpayers).

Of course, Senator Schumer and his colleagues invite us to ponder a problem in elemental logic. If the public plan and the private plans are really going to abide by the exact same rules, what is the point of a public plan in the first place?

Of course, the public health plan would be a wholly owned subsidiary of Congress Inc. That means that it would be a political institution, just like every other government sponsored enterprise, including Fannie Mae and Freddie Mac. It will be ground zero for special interest lobbying – by doctors, hospitals, drug companies, and insurers, as well as every special interest to the left of Pearl Jam, on a scale unprecedented in health care history.

If Fannie and Freddie, and AIG and the Automakers, and the Big Banks and whatever else is in line for a big bailout at taxpayer expense is “too big to fail”, guess what would be the congressional response to a shortfall in the income of a newly minted, congressionally created public health plan with millions of enrollees? There’s no guess work here. Unless you believe in Unicorns.”

The essence of Obama’s response 6-24-09 to rationing of health care:
Maybe that 100 year old mother should take a pain pill and not get pacemaker surgery said Obama 6-24-09 when two doctors questioned his plans for rationing health care. This remark was made in response to a question by one of the doctors concerning a a real 100 old mother who is now 105 and living with vitality of spirit says her daughter. The daughter helped her get a pacemaker when first denied. Take a pain pill old woman!! No pacemaker for you!!

That strikes me as a cold, calculating remark. Obama will cut health care costs on the bodies of the old. Once a person is no longer making money in Obama terms that person has lost value. By the time a person is a 100 the value of that person has shrunk to barely above zero. I guess that is why Obama when a Senator could support third trimester abortions. He probably thinks that the fewer the people there are in the world the fewer people the government has to feed, cloth and provide health care for.

Obama sidestepped and did not answer when asked whether he would opt out of the health care program he and Congress get if he had a loved one that needed a procedure not covered by the NEW plan Obama wants.

The following is from:

Views on Government-Funded Health Insurance
According to the latest ABC News/Washington Post poll, 62 percent of Americans support creating a government-funded entity to offer health insurance to those who don’t get it elsewhere. But if that caused many private insurers to go out of business because they couldn’t compete, support plummets to 37 percent.

The White House has shown some flexibility about a government-run plan. In a meeting with a bipartisan group of governors today, the possibility was raised of states offering public plans of their own instead of just one federally administered plan, according to a source with knowledge of the meeting. And White House chief of staff Rahm Emanuel told Democratic senators Tuesday night that the president was open to “alternatives” to the public plan.

Sawyer asked Ron Williams, the CEO of Aetna Insurance, “Is the president right that you need to be kept honest?”

Williams said he disagreed with the notion of a public plan.

“It’s difficult to compete against a player who’s also the person refereeing the game,” Williams said. He proposed working to “solve the problem as opposed to introduce a new competitor who has rule-making ability.”

Gibson pointed out that the president constantly makes the argument that if you like your insurance you won’t have to change it. And yet from the audience, John Sheils, senior vice president of The Lewin Group, a health care policy research and management consulting firm, estimated that up to 70 percent of those with private insurance would end up on the public plan.

“There are a whole series of ways that we could design this,” the president said, arguing that employers would be given a “disincentive” to shift their employees to the public plan.

Another neurologist, Dr. John Corboy of the University of Colorado Health Science Center, asked the president, “What can you do to convince the American public that there actually are limits to what we can pay for with our American health care system and if there are going to be limits, who’s going to design the system and who’s going to enforce the rules for a system like that?”

Obama, however, didn’t directly answer the question.

Related
WATCH: Obama’s ‘Uniquely American’ Health Care PlanWATCH: Watch Full ‘Prescription for America’ ProgramTRANSCRIPT: ‘Prescription for America'”If we are smart, we should be able to design a system in which people still have choices of doctors and choices of plans that make sure that necessary treatment is provided but we don’t have a huge amount of waste in the system,” he said.

He said he had “great confidence” that physicians “are going to always want to do right thing” if they have the right information and a payment structure that focuses on evidence and results and not tests and referrals.

“We should change those incentive structures,” the president said. “Our job this summer and this fall,” he said, is to “identify the best ways to achieve the best possible care.”

The president cited the Mayo Clinic as an example of a medical center where experts had figured out the most effective treatments and eliminated waste and unnecessary procedures.

Sawyer said that e-mails ABC News had received argued that “the Mayo Clinic is exactly the point,” indicating that private companies are solving this problem, and raising the question as to why the government needs to get involved.

“And, unfortunately, government, whether you like it or not, is going to already be involved,” Obama said, citing Medicare and Medicaid.

One questioner — Marisa Milton, vice president of health care policy for the HR Policy Association, a public policy advocate for human resource executives — said that “other industrialized nations provide coverage for all their residents” with “high quality care” without spending more money.

“A lot of those countries employ a different system than we do,” the president said. “Almost all of them have what would be considered a single-payer system in which the government operates what is essentially a Medicare for all.”

The president said he didn’t think it wise to attempt to “completely change our system root and branch” since health care is one-sixth of the U.S. economy. It “would be hugely disruptive,” he said, arguing that citizens would be forced to change their doctors and insurance plans “in a way I’m not prepared to go.”

End-of-life issues were raised as well; right now it is estimated that nearly 30 percent of Medicare’s annual $327 billion budget is spent on patients in their final year of life.

Jane Sturm told the story of her nearly 100-year-old mother, who was originally denied a pacemaker because of her age. She eventually got one, but only after seeking out another doctor.

“Outside the medical criteria,” Sturm asked, “is there a consideration that can be given for a certain spirit … and quality of life?”

“I don’t think that we can make judgments based on peoples’ spirit,” Obama said. “That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people.

“We’re not going to solve every single one of these very difficult decisions at end of life,” he said. “Ultimately that’s going to be between physicians and patients.”

“End-of-life issues were raised as well; right now it is estimated that nearly 30 percent of Medicare’s annual $327 billion budget is spent on patients in their final year of life.

Jane Sturm told the story of her nearly 100-year-old mother, who was originally denied a pacemaker because of her age. She eventually got one, but only after seeking out another doctor.

“Outside the medical criteria,” Sturm asked, “is there a consideration that can be given for a certain spirit … and quality of life?”

“I don’t think that we can make judgments based on peoples’ spirit,” Obama said. “That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people.

“We’re not going to solve every single one of these very difficult decisions at end of life,” he said. “Ultimately that’s going to be between physicians and patients.”

By JEROME GROOPMAN and PAMELA HARTZBAND

“Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit.

The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records — a computer-based system that would contain every patient’s clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

The basis for the president’s proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking.

To be sure, there are real benefits from electronic medical records. Physicians and nurses can readily access all the information on their patients from a single site. Particularly helpful are alerts in the system that warn of potential dangers in the prescribing of a certain drug for a patient on other therapies that could result in toxicity. But do these benefits translate into $80 billion annually in cost-savings? The cost-savings from avoiding medication errors are relatively small, amounting at most to a few billion dollars yearly, as the RAND consultants admit.

Other potential cost-savings are far from certain. The impact of medication errors on malpractice costs is likely to be minimal, since the vast majority of lawsuits arise not from technical mistakes like incorrect prescriptions but from diagnostic errors, where the physician makes a misdiagnosis and the correct therapy is delayed or never delivered. There is no evidence that electronic medical records lower the chances of diagnostic error.

All of us are conditioned to respect the printed word, particularly when it appears repeatedly on a hospital computer screen, and once a misdiagnosis enters into the electronic record, it is rapidly and virally propagated. A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer — 48 compared to seven in the paper-based cohort.

But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient’s weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error.

Throughout their report, the RAND researchers essentially ignore downsides to electronic medical records. Rather, they base their cost calculations on 100% compliance with the computer programs “adopted widely and used effectively.” The real-world use of electronic medical records is quite different from such an idealized vision.

Where do the RAND policy analysts posit major cost-savings? They imagine that the computer will guide doctors to deliver higher quality care, and that patients will better adhere to quality recommendations embedded in the computer programs. This would apply to both preventive interventions like vaccines and weight reduction, and to therapy of costly chronic maladies like diabetes and congestive heart failure. Over 15 years, the RAND analysts assert, more than $350 billion would be saved on inpatient care and nearly $150 billion on outpatient care. Unfortunately, data to support such an appealing scenario are lacking.

A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that “current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems.” Similarly, researchers from the Brigham and Women’s Hospital and Harvard Medical School, with colleagues from Stanford University, published an analysis in 2007 of some 1.8 billion ambulatory care visits. These experts concluded, “As implemented, electronic health records were not associated with better quality ambulatory care.” And just this past January, a group of Canadian researchers reviewed more than 3,700 published papers on the use of electronic medical records in primary care delivered in seven countries. They found no solid evidence of either benefits or drawbacks accruing to patients. This gap in knowledge, they concluded, “should be of concern to adopters, payers, and jurisdictions.”

What is clear is that electronic medical records facilitate documentation of services rendered by physicians and hospitals, which is used to justify billing. Doctors in particular are burdened with checking off scores of boxes on the computer screen to satisfy insurance requirements, so called “pay for performance.” But again, there are no compelling data to demonstrate that such voluminous documentation translates into better outcomes for their sick patients.

Even before these new data, there were studies casting doubt on the benefits of electronic medical records. In response, the RAND researchers boldly stated, “We choose to interpret reported evidence of negative or no effect of health information technology as likely being attributable to ineffective or not-yet-effective implementation.” This flies in the face of the scientific method, where an initial hypothesis needs to be modified or abandoned in the face of contradictory results. Rather than wrestle with contrary information, the report invokes the successes of computer-based systems in saving money in industries like banking, securities trading, and merchandizing, using ATM machines, online brokerage and bar-coded checkouts. Medical care of human beings — treatment of acute and chronic illnesses and the even more complex process of effecting lifestyle changes like smoking cessation and weight loss to prevent disease — is not analogous to buying bar-coded groceries and checking-account balances online.

Some have speculated that the patient data collected by the Obama administration in national electronic health records will be mined for research purposes to assess the cost effectiveness of different treatments. This analysis will then be used to dictate which drugs and devices doctors can provide to their patients in federally funded programs like Medicare.

Private insurers often follow the lead of the government in such payments. If this is part of the administration’s agenda, then it needs to be frankly stated as such. And Americans should decide whether they want to participate in such a national experiment only after learning about the nature of the analysis of their records and who will apply the results to their health care.

All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution.

We both voted for President Obama, in part because of his pragmatic approach to problems, belief in empirical data, and openness to changing his mind when those data contradict his initial approach to a problem. We need the president to apply real scientific rigor to fix our health-care system rather than rely on elegant exercises in wishful thinking.

Drs. Groopman and Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.