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July, 2009


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More Snake Oil In Obama's Medicine
By Edward W. Miller, MD

"I hope we shall crush in its birth the aristocracy of our moneyed corporations which dare already to challenge our government in a trial of strength, and bid defiance to the laws of our country." - Thomas Jefferson
Back in August 2007, Michael Moore's documentary, "SICKO" playing at local theatres, proved to be an excellent sales pitch for a "single-Payer" health system. "SICKO" was aimed at encouraging Americans to become more politically active in revamping our failing health-care apparatus.
Today, with the Obama administration and Congress debating health-care coverage for we Americans over the next century, it is vital that we use all the tools available to us, to see that we get a system we can live with.

Many Americans remain confused by the debate over our government's role in medical care, a confusion fostered by an insurance industry determined to hold onto its expensive share of the medical dollar. The industry, by massive lobbying, both in Washington and in state capitals, has managed to keep its hand in the till, extracting at least a third of the medical dollar while providing misinformation, reduced treatment options and added expense to an unwary public.

The insurance conglomerates, with millions of lobbying dollars, have also purchased our representatives to assist in stealing from the taxpayer. Today's array of 1300 HMOs and other market-driven health organizations function with a financial aggregate of over $2.5trillion, and represent the intrusion of big business between the taxpayer who needs and must pay for his health care, and the suppliers of that care.

Americans had hoped, with the arrival of Obama on the Washington scene, that an affordable, universal health-care system was just around the corner. However, in the recent months of our new President's term, this anticipation is being replaced by a fear that we're going to be stuck with the same old system dressed in drag by Obama.

As recently reported ( "When OBAMA was campaigning for the presidency, he promised to put fixing America's broken health care system at the top of his agenda as president. But supporters of the one solution that could actually work were at the bottom of his White House invitation list. At Obama's first White House health care summit, advocates of "single-payer" system-under which the government would cover everyone, eliminating the role of private insurers-weren't even invited."

Rep. John Conyers, the sponsor of Bill HR 676, that would establish single-payer system, had personally asked Obama for an invitation. The answer was no. However, because so many flooded the White House with angry phone calls, faxes and e-mails, and PNHP (Physicians for a National health Program) threatened to march in protest, the administration relented and reluctantly invited Conyers and Oliver Fein, president of PNHP, to attend.

As reported by Medical News-Washington Watch-Major healthcare stakeholders convened that Thursday, March 6th at the White House to launch this decade's move for healthcare reform. Citing failed healthcare reform movements in the past, Obama promised those physician groups, health insurance executives, pharmaceutical representatives, business leaders and members of Congress that this time things would be different saying: "This time... there is no debate about whether all Americans should have quality, affordable healthcare-the only question is how?"

Obama's health care plan follows the Democratic template-an emphasis on quickly increasing the number of people who have health insurance by spending significant money up front. Obama estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in, assuming that it will be paid for from savings in the system and from discontinuing some Bush Jr. tax cuts for those making more than $250,000 per year. However, our President appears to have surrendered to the same political forces that had defeated President Bill Clinton in his struggle for an affordable health-care system.

On the 15th of March, 2009 Clinton on the "Larry king Show", said:" When I was president Health care cost Americans 14% of the Country's total income. Now it costs 16.5%." adding: "The Insurance companies plus the Small Business Lobby joined to defeat my attempts to deliver a universal health-care system."

Obama says his health care reform plan will save the typical family up to $2,500 every year through:

Health information technology investment aimed at reducing unnecessary spending that results from preventable errors and inefficient paper billing systems;

Improving prevention and management of chronic conditions;

Increasing insurance industry competition and reducing underwriting costs and profits in order to reduce insurance overhead;

Providing reinsurance for catastrophic coverage, which will reduce insurance premiums;

Making health insurance universal;
However, as Michael Ragain, M.D. pointed about Obama's healthcare plan (March 07), "To implement this plan, an army of new bureaucrats must be hired by the government to keep a watchful eye on the doctors and hospitals to ensure quality. Healthcare providers will have to hire larger staffs to collect and report this data adding more cost to the system. High administrative overhead already is a major problem. A New England Journal of Medicine article stated that U.S. healthcare administrative overhead is twice that of the Canadian system. These researchers found that 31% of health care expenditures in the US went for administrative costs. Obama advocates that we increase this overhead further with no clear indication that quality will improve.

Obama's plan also calls for a ten billion dollar federal investment in healthcare information technology over five years. He purports this will improve quality and save money. Will it? The data suggests otherwise. A study published in The Archives of Internal Medicine clearly showed information technology did not make a quality difference."

Speaking at the Annual Conference of the American Medical Association at the Chicago Hyatt Regency on 15 June, Obama noted: Today, we are spending over $2 trillion a year on health care-almost 50 percent more per person than the next most costly nation. And yet I think many of you are aware, for all of this spending, more of our citizens are uninsured, the quality of our care is often lower, and we aren't any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do. "In his lengthy talk, covered on TV, no significant additions were made to his previous discussion on health care before the business community on March 6th.

Though the insurance industry uses he term "Socialized Medicine" to conjure up images of government bureaucratic interference in medical care, in those countries with national health insurance, both doctors and patients actually have more freedom in making clinical decisions than in the U.S., where insurance bureaucrats are busy both directing and limiting patient care."

The $780 billion economic stimulus bill that Obama signed into law also allocates $19 billion to convert all patient medical records into a digital format by 2014, thus implementing the "Health information technology" part of his plan. However, M. Eric Johnson, director of the Center for Digital Strategies at Dartmouth College, says that thousands of sensitive medical records have already been leaked over peer-to-peer networks from computers at hospitals, clinics and elsewhere... and, as a result she is convinced that Obama's "medical Record Plan" would only further threaten patient's privacy.

Patient's privacy is not the only issue however. The digitalization of the country's medical records, while our so-called "Patriot Act" is still in force, would allow access to this mountain of personal date to not only to the FBI, the CIA and Homeland Security people, but to the staffs of every HMO in the country, thus permitting this $2.5 trillion insurance giant to pick and choose which patients are cheaper to insure, and to either deny or increase the insurer's cost on the riskier crowd. A patient's medical record is often filled with personal data, shared with his physician, which belongs in his doctor's office and should never be made a document for scrutiny by other agencies.

Under "single-payer" plans, which Canadians and most Europeans enjoy, government foots the bill. The suppliers, physicians, hospitals, clinics, pharmacists, radiologists and other specialists, nursing homes, etc., bill government directly for their services. Since government guarantees these services, there is nothing to "insure." With government paying the provider directly that expensive middleman, the insurance industry, is kept out of the picture.

With single-payer plans, physicians have a variety of choices: they may practice alone or in clinic or hospital groups. Hospitals can stand-alone or join other hospitals and clinics to combine resources. Medicare, basically, is "single-payer," a form of socialized medicine.

Unfortunately, much of organized medicine in the U.S. has made a Faustian bargain with the insurance industry. Early in the 1990's the AMA, already bought by those giants, launched a massive e-mailing (300,000) to its members discrediting the Canadian system as "socialized medicine," and, joining the insurance companies, hired a public relations firm, Burston-Marstellar, not only to sell "managed care" in the U.S., but also to discredit Canada's health plan both here and in Canada. (BM earned $82.1 million in lobbying fees in 1992-93.) The firm, with offices in Canadian cities, had been feeding misinformation into the local Canadian press, undermining Canadians' trust in their own system.

During the 1930's depression, efforts by Frances Perkins, FDR's appointee, to provide a Single-Payer System for medical care was undermined by the AMA. Morris Fishbein, M.D., editor of the Journal of the American Medical Association (JAMA) from1924 to 1950, campaigned against "Single Payer", saying that "Socialized Medicine was a step towards communism." In the 1960's President Ronald Reagan, under pressure from the AMA campaigned against "Single Payer", calling it "Socialism." His anti-single payer campaign was called "Operation Coffee-Cup."

Opponents of "Single Payer" use the word "Socialism" to confuse the American audience. Of course "Single Payer" is a socialist concept, but as any student who stayed awake in civics class understands, it has been those socialist programs, which like mortar, have held our capitalist system together for over 250 years. Just as the Amish join together to assist in raising a neighbor's barn, just as we Americans join to hire police to prevent crime, firemen to make our houses safer, garbage men to carry out waste, sewage plants to clean us up and so on. Without these services we support and pay-for with our taxes, community life would be impossible.

No physician likes restrictions on either his fees nor his choice of treatment, but "Managed Care" actually represents "minimal care," i.e., the only level of care possible after the insurance industry has taken its bite from the medical dollar. The patient meanwhile, under Obama's Computer-driven-plan will be herded into some select group on the basis of income, race, sex, age or medical history only to discover that the special relationship with his physician has been taken away. Both provider and patient will pay the price.

As an example: A letter to doctors working for Kaiser Permanente HMO in Ohio warned physicians: "Do not discuss proposed treatment with Kaiser Permanente members prior to receiving authorization from an outside company that sets guidelines for the treatment." Doctors wishing to recommend treatments not covered by the HMO in which the patient is enrolled may find their ability to do so severely limited by such "confidentiality clauses."

Howard B. Dean III, politician and physician, as a recent guest on the TV "NOW" Show, noted that medical care in the US eats up 16.5%of our GNP (Gross National Product), whereas in European countries such as France and Germany who enjoy Single-Payer systems, that particular share of GNP runs from 6 to 7%.

According to the American Medical Association, 38% of physicians in the United States 50 years or age or older are planning to retire within the next three years. The primary reason is frustration due to managed care regulations.

We in Marin have recently had the opportunity to learn how "Managed Care" could destroy a medical practice. An article in the Marin Independent Journal (MIJ), Tuesday, September 25, 2007, entitled: "Insurance costs could doom West Marin Medical Center" described in detail how General Practice physician, DR. MARGARET "Molly" Bourne who, in 2007 was still enjoying a close relationship with roughly 4,000 patients at her small family practice clinic, had complained to MIJ staff writer, Rob Rogers, that the demands of managed care and the tendency of insurance companies to repeatedly question her medical decisions-and sometimes to refuse to pay for her patients' treatments-could cause her to close the practice by January.

"The practice of medicine has changed from medical care to managed care," said Bourne. "I like running my own business, and I don't like being told by an insurance company what drugs to prescribe or what protocols to follow. The insurance companies pick and choose what they'll pay for, and it's not enough to be able to sustain my practice. I bounced a lot of checks in the last year because I haven't been able to pay myself." As the MIJ article noted: reimbursement from insurance companies requires so much paperwork that three of Boume's four employees work full-time at processing forms and documents. Bourne said: "All of (the insurance companies) ask for different variables, they want me to keep electronic medical records, rather than paper. That's the direction in which health care is going. But those programs are expensive. In addition, the insurance companies often do not reimburse us for the cost of treatment for several months, making it difficult to cover expenses.

"Sometimes," she said, "the companies refuse to pay for needed care at all. There is not a single company who will pay me to see someone for depression, so I can either lie and list the reason for the visit under a different code, or eat the cost myself."

Since the MIJ article was published, Molly Boume has left the Clinic and now supervises Hospice in three local counties. She enjoys her new position, but says she misses he old patients.

Molly's problems both professional and financial are not uncommon. Financial considerations today severely limit today's graduating physicians from choosing general practice, particularly in rural areas.

In 1984, 87% of public medical school students graduated with medical school debt. The median amount, $22,000. For private medical schools, the median amount was $27,000. By 2003, the median debt had risen to $100,000 and $135,000, respectively. These indebted graduates are thus forced to choose specialties which pay more, since family practice in the US today pays too little to permit debt pay-off, hence more foreign-trained physicians in rural USA.

Less than 48 hours ago, the biggest corporations in the country declared war on President Obama's agenda. The scale of the attack is mind-boggling. The right-wing lobbyists at the U.S. Chamber of Commerce will spend $100 million to defeat Obama's plans for health care and a clean energy economy. They call it their "most important project" in nearly 100 years." (MOVEON, 12 June 2009)

In this time of crisis, we Americans should lobby our representatives and demand "Single Payer" This is a campaign we cannot afford to lose.

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