Posts Tagged ‘healthcare’

“HEALTHCARE REFORM”: SOME HARD TRUTHS

Monday, January 23rd, 2017

Note (06FEB2017): More Republicans now plan not to repeal ObamaCare but to repair it. What would Mr. Peifer say (See below.)? Why? They have no credible replacement even though one has existed since 1994.

“But if thought corrupts language, language can also corrupt thought.” -George Orwell (1903-1950)

Elected and in-office, Republicans now face some hard truths associated with issues challenging this declining nation on fire. One is ObamaCare and the Republicans’ pledge to “repeal and replace” it. Words have power.

“Not on fire,” you say.

Witness the new President’s address at his inauguration; never mind the protests nationwide, some violent. Would you characterize it as conciliatory? Aggressive? Words have power.

“Healthcare”
In any debate, it is reasonable and appropriate to ask the opposition — the entrenched political establishment, Democrat and Republican — to define the terms that it uses; in this case, “healthcare”. Webster’s New Collegiate Dictionary (1977) does not list the term even. Whence cameth it?

What exactly is “healthcare”? As the term denotes, it is a governmentally concocted, pleasant-sounding euphemism that refers to caring for one’s health. (In contrast, “medicine” is not so pleasant-sounding because it denotes suffering.) “Healthcare”, however, is amorphous and includes everything from washing your hair to brushing your teeth to cutting your toenails. Simply put, “healthcare” is not synonymous with medicine. Words have power.

Another governmentally concocted euphemism, “healthcare-provider”, includes anyone and everyone who promotes himself as rendering advice, assistance, or instruction in the care of one’s health. It is intended to diminish the stature of the lynchpin in medical delivery, the physician. Words have power.

What is medicine? It the healing art based upon science the mission of which is the relief of suffering caused by disease and trauma. Its practitioners are known as physicians; those whom they diagnose and treat, patients. Words have power.

Repair Not Replace
Definitions notwithstanding, of “repeal and replace”, “repeal” is the easier; whereas, “replace”, the more difficult — the much more difficult. Accordingly, some Republican legislators now are talking about “repair” instead of “replace”. Surprised?

“An error lurking in the roots of a system of thought does not become truth simply by being evolved.” -John Frederick Peifer

The basis of this “repair” seems to be a new, politically concocted term — “Health Savings Accounts”, which are merely “Medical Savings Accounts” in new verbal clothing. Country-club Republicanism as its worst! The average American cannot afford a car, let alone a “Medical Savings Account” by whatever name.

“Catastrophic Coverage”?
Some opponents of ObamaCare, such as Tucker Carlson at Fox News, are promoting “Catastrophic Coverage” rather than basic medical coverage. “Catastrophic Coverage” may play well on television, but basic medical coverage offers the biggest bang for the medical buck.

Who most needs “Catastrophic Coverage”? The unproductive old.

It has been known for years, for example, that, during the last year of life, Medicare recipients spend 30-cents of every dollar expended on medical care during their entire lifetime. Of the 1% of Medicare beneficiaries with the highest costs in any given year, approximately 50% die. Of the 5% with the highest costs, approximately 40% die. Of the elderly who survive, 50% are demented by the age of eight-five. Therein lie the reasons that Medicare alone is bankrupting these United States of America. Hard truths!

PART TWO

Today, a major question facing physicians and the rest of American society is whether the consequence of past declines in mortality is an increase in active life-expectancy or merely an expanded and grotesque period of frailty, enfeeblement, and dependency. Apparently, the answer is the latter.

“Diaper, madam? Catheter, sir? Don’t worry. The young and productive will be paying tomorrow for the old and unproductive today.”

Not a pretty picture! Even physicians do not like looking at it. Chronic, debilitating illness — not dying — is becoming our worst medical enemy, individually and socially.

Meanwhile, who least need “Catastrophic Coverage”? The productive young who generally require only acute medical care for acute medical problems with occasional exceptions. Therein lies the reason that premiums would be so cheap to insure, really insure, all American young for serious medical events.

Fooling The Public
To paraphrase Abraham Lincoln, “You can fool all of the people some of the time and some of the people all the time, and them’s pretty darn good odds.”

Be not fooled by self-styled gurus on television or in the newspaper spinning misinformation. Be not fooled by power-hungry professional politicians seeking to retain control of medicine.

Remember Obama’s promises about the benefits of ObamaCare, such as keeping your doctor and your plan? Once again, those who direct public opinion are acting against the Public Good by promoting inefficient systems politically based and politically directed.

Science And Medial Delivery
A patient’s seeking medical care is a behavior. A physician’s providing medical care is a behavior.

There is a science that describes behavior as well as thoughts, feelings, and physiological responses. That science is Biobehavioral Science.

“What?” you say. “Biobehavioral Science? Never heard of it!”

Therein lies the problem not just for you but for nearly all humanity. Guess what? Ignorant about Biobehavioral Science themselves, were they not, the politicians would not want you to hear of it; especially its derivative, the Science of Human Behavior. To them, it would represent an anathema.

Were they willing to listen, they would screech in terror, “Specificity, Objectivity, and Accountability? Never! Never, I tell you!”

Any system not scientifically based and scientifically directed to deliver medical care to a population must be, by its very nature, fatally flawed and fated to failure — doomed to delivering care that is of decreasing availability and decreasing quality. Less availability. Lower quality.

“An ounce of prevention is worth a pound of cure.” ―Benjamin Franklin

Do you care? Actually, few do until they fall ill or become injured. Too late!

We already are suffering from the Sovietization of American medicine; whereby, for example, you see “Doctor Nurse” not “Doctor Doctor”. When you do see “Doctor Doctor”, he — or increasingly she — is looking mainly at the computer-screen not at you. Why? In order to fulfill the increasing regulatory demands of governmental bureaucrats for increasing documentation of decreasing care.

Meanwhile, a scientifically-based, scientifically-directed, detailed plan for delivery of universal medical care by a competitive private sector characterized by the following attributes is available and has been available for more than 20 years. It is characterized by the following:
1) Simple;
2) Straightforward;
3) Free of special taxes;
4) Minimal regulations;
5) Minimal bureaucracy;
6) Free of fraud at taxpayers’ expense; and
7) Acceptable to insurance companies.

No, it is not the failed ClintonCare. In fact, the opposite.

Will the politicians ever acknowledge it, let alone adopt it? Fat chance! Unless, of course, you make them. It’s your health. It’s your life.

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MEDICINE: QUANTITY IS NOT QUALITY

Monday, July 23rd, 2012

To reiterate from a previous posting (1), so-called healthcare is not synonymous with medical care. The difference is not mere semantics. “Healthcare” is cutting your toenails. Medical care is treating a cancer with surgery then radiation then chemotherapy.

Recently, a fellow named H. W. Brock . . . neither a Medical Doctor nor a biobehavioral scientist but a financial type . . . wrote a piece claiming a resolution to the problematic situation of delivering medical care in the USA.(2) His resolution? Increase the supply.

Unfortunately for Mr. Brock, his postulates are invalid. As he confuses”healthcare” with medical care, he confuses quantity with quality.

The elements of his so-called supply-sided resolution? 1) Federal training of more physicians. 2) Financial aid for physicians-in-training. 3) Financial incentives for physicians going where shortages exist, medically and geographically. 4) More foreign-trained physicians. 5) Reformation of medical malpractice. 6) Fewer redundant diagnostic tests. 7) More nurses and other para-medical personnel replacing physicians. 8) Promotion of cheap, “retail”, quasi-medical shops.

As always, the devil is in the details. Let’s look at Mr. Brock’s recommendations.

1 & 2) Training more physicians may be a good idea, but who’d be financing the training? With monies from where?

The individual states? The concept of state-based financing is nothing new. State-based budgets, however, are strained . . . California, for example, is broke. Increasing state-based funding for training more physicians seems rather unlikely.

Who’s left? The federal government? The concept of federal financing also is nothing new. It’s been on-going for years through Medicare and other programs; e.g., Title VII of the

“Health Professions Educational Assistance Act” of 1976. Okay, why not just increase it and expand it?

Wait! Congressman John Boehner recently stated flat-out, “We’re broke!” . . . not that a lack of funds usually stops federal spending. Under ObamaCare, for example, Big Government ironically will spend tens of millions that it doesn’t have to train “physicians’ assistants” under “Expansion of Physician Assistants Training (EPAT)“. Meanwhile, current funding for training physicians through Medicare is being slashed. Music to your ears, Mr. Brock?

Stop! Look! Listen! Those who love individual liberty never should forget that government . . . especially Big Government . . . is a dangerous servant and a terrible master. “He who pays the piper calls the tune.” The federal government already is directing American medical care through Medicare and Medicaid. How would Mr. Brock block further empowering its dictatorial control over physicians via increased financing of their training?

Now, who’s left? Private enterprise? Only Big Business could afford financing medical training on a meaningful scale. What would be any reward to any business, say, to offer scholarships? What would be “the catch” for the physician?

3) Rewarding physicians financially for going where shortages exist, medically and geographically, also may be a good idea. Who should do the rewarding? The federal government? Individual states? Under-served municipalities? Private enterprise? Governments already do, to some extent. What must the physician promise in return for increased funding? Mr. Brock might consider that using oneself as chattel for a mortgage is unconstitutional.

4) Importing more foreign-trained physicians may sound like a good idea economically. Is it a good idea medically? On average, is an American-trained physician more competent than a Grenada-trained physician who passed the examination designed by The Educational Commission on Foreign Medical Graduates . . . even without the time-honored cheating?(3) Under whose knife would Mr. Brock care to put himself when his is the life at stake?

5) Reforming medical malpractice, unquestionably, is a good idea. America has become a nation imprisoned by lawyerism. Too many laws; too many lawyers; too many lawyer-politicians; not enough law . . . think the now-disgraced, lawyer-politician John Edwards or the honest companies bankrupted by greedy lawyers (4).

Who’ll perform the legal reform? A federal government dominated by lawyers? On what constitutional grounds . . . not that the federal politicians and bureaucrats care about the Constitution unless it suits them to do so? The fact is that both physicians and lawyers are licensed by the individual states not by the federal government. Isn’t reform a task for the states . . . but, ah, the ease and joy of central versus provincial (i.e., state-based) control; eh, Mr. Brock?

6) Who can argue against reducing the number of redundant diagnostic tests and procedures? Aren’t many of those tests ordered, however, to preëmpt unfounded lawsuits?

Defensive medicine aside, Mr. Brock neglects to tell us The How. Rap physicians’ knuckles? Fine physicians? Imprison them? Execute them? Nothing as quick and simple as negative versus positive control; eh, Mr. Brock?

7) Allowing nurses and other para-medical personnel to masquerade as physicians may increase the supply of “healthcare-related” services but can it maintain quality of service? Nurses aren’t trained to make diagnoses. Sorry, Mr. Brock, it’s true. With all due respect to nurses, essentially, they’re necessary, valuable, and hopefully caring technicians trained to carry out physicians’ orders. With the use of improving technologies, as time passes, they may become competent to do more. Even so, should nurses and other para-medical personnel operate with no medical supervision? Moreover, who, ultimately, should be responsible . . . medically and legally? Mr. Brock gives us no clue whom to sue.

During the days of the now-defunct Soviet Union, its dictators boasted having an ample supply of “physicians”. . . well, not exactly physicians but physicians-in-name; what we in the USA now call “nurse-practitioners”. The average Soviet citizen rarely was attended by a legitimate physician . . . only the politicians, high-level governmental bureaucrats, and military officers. Do we Americans really want the Soviet-style medicine that Mr. Brock is promoting?

Furthermore, will lower fees compensate for lower quality? Even if they do, won’t those lower fees gradually rise towards the fees charged by real physicians?

8) Promoting cheap, “Wal-mart style” quasi-medical shops to handle “common minor ailments” . . . shops already appearing in supermarkets . . . staffed by quasi-physicians acting in isolation from real medical support undoubtedly will increase availability of “healthcare-related” services. Mr. Brock neglects to state, however, who determines what is a “common minor” ailment. The customer? The nurse? The assistant to the absent physician? The check-out clerk? As a financial type, Mr. Brock might keep in mind that there’s a cost to everything. How about your life, Mr. Brock? Still a good value?

No, Mr. Brock, your “solution” won’t resolve the situation-in-question. Fortunately, however, there is a valid resolution, and it comes from biobehavioral science . . . not from the pseudo-science of economics nor from the polemic of politics nor from the mumbo-jumbo of mysticism (www.inescapableconsequences.com).

So, what’re the odds favoring us Americans resolving scientifically the current dilemma in delivery of medical care? After all, we have the way. We have the means. Ah, but do we have the will? What say, Mr. Brock?

References
1) Categories/Biology & Medicine/”Healthcare” Reform/ ‘Healthcare’ Is Not Medicine”.

2) Brock, HW: “A Supply-Side Solution for Health Care”. Barron’s, 23 July 2012, page 30.

3) Lyons, RD: “Cheating On Exams For Doctors Causes Alarm”. The New York Times, 03April 1984.

4) “The Tort Bar Burns On”. The Wall Street Journal, 23 July 2012, page A12.

“HEALTHCARE” IS NOT MEDICINE

Monday, September 6th, 2010

Walter Reed Army Medical Center (WRAMC) has several divisions, one of which is Walter Reed Army Institute of Research (WRAIR). Entering the Army as a Captain in the late 1960’s, I was assigned to WRAIR as a Research Psychiatrist.

Instead of being stationed at “The Main Section” in D.C., I was stationed at “The Annex” in Silver Spring, Maryland. The facility had been a girls’ school expropriated by the Army during WWII. Dedicated to research, unlike at The Main Section, the atmosphere among officers and enlisted men was relatively cordial and informal.

One afternoon, I stood chatting with Gerry, a draftee assigned to the Department of Psychiatry, one part of the Division of Neuropsychiatry. The young man obviously was quite intelligent and well-educated. We’d been chatting about nothing in particular when the conversation drifted to our respective, future plans.

“What are yours when you leave?” he asked.

“Academia,” I replied. “Continue my research . . . UCLA, in fact. Yours?”

“Harvard School of Public Health.”

“Really? Why not medical school?”

“I can see that you can’t.”

“Can’t see? Can’t see what?”

“The future! It’s right in front of you. In fact, it’s already begun . . . Medicare and Medicaid. I’m here to tell you, Doctor, that, someday soon, the federal government is going to control you guys, and I’m going to be one of the controllers. You’ll be saluting me, so to speak.”

“Yeah, right!” I replied, dismissing his prediction.

“That is right. Guys like me will be controlling guys like you . . . physicians, I mean . . . and all the rest in medicine, as well. I’ll be one of the experts doing the controlling. Who knows? Maybe, I’ll even be in Congress. With all due respect, you’ll be doing exactly what I tell you to do . . . Sir.”

His arrogance notwithstanding, I wandered to my office wondering if Gerry could be right. Some years later, I learned how right he was.

How did it happen? How did self-styled, bureaucratic “experts”, few with any medical training, become the controllers and physicians the controlled?

The causes have been multi-dimensional. One was via the manipulation of language. Words became politicians and bureaucrats’ weapons against physicians and patients. Words have power. Words can kill.

In his classic novel, 1984, George Orwell eloquently described how governments simplify language and pervert it to fulfill their own, tyrannical goals. He called it “newspeak”. Those in the federal government have borrowed a page from Mr. Orwell’s book and applied his ominous depiction to all four cornerstones of American society . . . government itself, law, education, and medicine.

Prior to Medicare/Medicaid, the federal politicians exerted little control over physicians. Medicine was a “cottage-industry” with hundreds of thousands of independent offices. These independent physicians collectively held too much power over too large a segment of the economy to suit the politicians. Smashing that power became a top priority for vote-hungry politicians; make voters dependent upon politicians not physicians for medical care. One element of their strategy would be through words . . . propaganda. Through words, reduce the prestige of physicians; thereby, reducing their power. How? Lump physicians together with everyone else in medicine from nurses and technicians then include outright charlatans such as chiropractors.(1) Instead of physicians practicing medicine, medical doctors would be merely one category of “providers” among many delivering “healthcare”. The strategy succeeded.

Ask yourself the following, three questions: 1)What comprises “healthcare”? In Webster’s New Collegiate Dictionary (1977), the term, healthcare or health care, doesn’t appear even. Whence came it?  2) How does “healthcare” differ from medicine?  3) Does the distinction matter?

1) As the term denotes, “healthcare” refers to caring for one’s health. It’s amorphous, is largely a personal responsibility, and  includes everything from washing your hair to brushing your teeth to cutting your toenails. Accordingly, a “healthcare-provider” includes anyone or everyone who promotes himself or herself as rendering advice, assistance, or instruction in the care of one’s own health. Simply put, “healthcare” is not medicine.

2) In contrast, medicine is the healing art based upon science the mission of which is the relief of suffering caused by disease and trauma. Its practitioners are known as physicians; those whom they diagnose and treat are known as patients. Traditionally but not currently, physicians must have gained a Doctor of Medicine and be licensed as such in the state in which they practice. Traditionally, para-medical personnel included nurses, technicians, and certain classes of therapists. Medicine was among the learned professions. At its best, for its practitioners it was to be more a calling than a business . . . something akin to the priesthood. The sole obligation of the physician was to the patient not to a third-party such as the government or a “healthcare plan” or even society as a whole. Communication between physician and patient was to be sacred and kept confidential except in cases of malpractice litigation.

3) The distinction is not mere semantics. If not coined by them, the term, healthcare, was seized by politicians, bureaucrats, and profiteers to concoct a deliberately confusing, inconsistent system of medical delivery that they themselves could control for their own respective, pecuniary benefits. The consequence has been that, instead of becoming scientifically-based and scientifically-driven, the medical system has become politically-motivated and politically-manipulated with money and power as the controlling variables. The nightmare of ObamaCare represents Gerry’s dream come true. It brings with it a new host of euphemisms guaranteed to confuse. As I described in the non-fictional Healthcare Reform D.O.A. (now out-of-print; 1994)* and more recently in the fictional/non-fictional Inescapable Consequences (2009), there is a better way.

So, in any discussion of medical services, let us force the politicians and bureaucrats to define their terms. Let us remember always . . . words can kill; and, in this case, you, the patients, are the victims.

* Nominated for two national awards by The American Risk & Insurance Association.

1.  Theoretically, the underlying principles of chiropractic are nonsensical. Operationally, chiropractors injure 30% of their customers, on average (See, for example, Hurwitz, EL, et al: “Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study.” Spine 30:1477, 2005.). Worse, some of these injuries are fatal; chiropractic “manipulation” has been documented to cause death from dissection of the vertebral artery (See, for example, Chen, WL, et al: “Vertebral artery dissection and cerebellar infarction following chiropractic manipulation”. Emergency Medicine Journal 23: e1, 2006.). Re-labeled “chiropractic physicians”, these “healthcare providers” receive the same governmentally-mandated prestige as genuine medical doctors.