Looking Out For Her Constituents

Cathy McMorris Rodgers posted this on her Facebook timeline yesterday. Surprisingly, the majority of the comments are calling her out on her hypocrisy.

 

So what's the deal here? Medicare Advantage Plans are still Medicare but they're offered by private companies. These companies must follow the Medicare reimbursement rules, but they can charge different out-of-pocket expenses and they can set different rules for obtaining services like specifying which doctor or facility you can go to. (Remember how our congresswoman was so concerned with the government telling you where to go for health care? Not so much when it's a private company doing the same thing.) Medicare beneficiaries are not required to use Medicare Advantage, but they can if they choose to. And they can choose which plan they want. The term of each plan is one year. There's a ton of information about Medicare Advantage that eligible persons need to research before they make a choice.

One part of the Affordable Care Act contained a reduction in subsidies to Medicare Advantage. Remember the $700 billion Medicare talking point? The reduction is in payments to private companies. Medicare Advantage subsidies are a huge part of their profit line. From a Kaiser News article:

At UnitedHealth Group, one insurance giant, Medicare Advantage plans account for a fourth of all profits, said Ana Gupte, an industry analyst for Leerink Partners. Another, Humana, owes two-thirds of its profit to Medicare Advantage, she said.

So you can see why the insurance companies are against lowering the subsidies. 

Beautiful Takedown

I apologize for the autoplay.

Republican Health Care Reform Bill

At long last. Three and a-half years after the passage of the Patient Protection and Affordable Care Act, after focusing all this time on only repealing the Patient Protection and Affordable Care Act, just in time for the upcoming manufactured debt limit crisis and following the summertime anti-Obamacare emphasis patrol, the Republican Study Committee has proposed a bill called The American Health Care Reform Act.

The first step of the bill--repeal the Patient Protection and Affordable Care Act in its entirety.

"...the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted."

Just yank the rug right out from under everybody. Second, increase access to portable, affordable health insurance through tax breaks.

Except as otherwise expressly provided, whenever in this title an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Internal Revenue Code of 1986.

Individuals could claim a deduction of $7,500 against their income and payroll taxes, regardless of the cost of the insurance and families could deduct $20,000. Of course, that doesn't do you much good unless your income well over that.

Next up, it improves access to insurance for vulnerable Americans by removing a couple of eligibility requirements, providing $5 million to states to establish a qualified risk pool, and verifying that only citizens and nationals of the United States are eligible.

Fourth, it says it encourages a more competitive health care market. It's confusing. The insurance policy issuer designates one state as the primary state for a particular policy and the health care laws of that state govern the policy. They can change the primary state designation when the policy is renewed. Other states where that policy is offered are considered secondary states, but the laws of the primary state governing that policy trump the laws of the secondary states. Essentially, any single state, district, or territory could pass laws governing health insurance that are favorable to insurance companies. Those companies could designate that state, district, or territory as a primary state. All other states where that policy is offered become secondary states whose laws become toothless with respect to those policies because they are now governed by the laws of the primary state. Imagine your state's Insurance Commissioner telling you, "Sorry, I can't help you. For your policy you'll have to contact the Insurance Commissioner in Alabama."

Fifth, it reforms medical liability law. You get three years to file a lawsuit. The amount of damages for actual economic losses is unlimited.

Economic damages are defined as "...objectively verifiable monetary losses incurred as a result of the provision of, use of, or payment for (or failure to provide, use, or pay for) health care services or medical products, such as past and future medical expenses, loss of past and future earnings, cost of obtaining domestic services, loss of employment, and loss of business or employment opportunities."

Noneconomic losses are limited to $250,000.

Noneconomic damages are defined as "...damages for physical and emotional pain, suffering, inconvenience, physical impairment, mental anguish, disfigurement, loss of enjoyment of life, loss of society and companionship, loss of consortium (other than loss of domestic service), hedonic damages, injury to reputation, and all other nonpecuniary losses of any kind or nature."

A jury won't be informed of the $250,000 noneconomic loss limit. If a jury awards more for noneconomic losses then the award will be reduced to $250,000.

Punitive damages are allowed only "...if it is proven by clear and convincing evidence that such person acted with malicious intent to injure the claimant, or that such person deliberately failed to avoid unnecessary injury that such person knew the claimant was substantially certain to suffer."

If there are no compensatory damages then there shall be no punitive damages. But here's the kicker.

The amount of punitive damages, if awarded, in a health care lawsuit may be as much as $250,000 or as much as two times the amount of economic damages awarded, which ever is greater. The jury shall not be informed of this limitation.

Plus, there are no punitive damages for medical products and devices that comply with FDA standards.

Last of all, the bill says it respects human life by not requiring any health plan to provide coverage of or access to abortion services. Separate policies that do offer coverage may be offered, but back in the tax break section it states that the costs are tax deductible only if the pregnancy resulted from an act of rape or incest, the woman's life is endangered by the pregnancy, or it's for treatment of infection, injury, disease, etc., caused by or exacerbated by an abortion.

I'm just not feeling the love here.

Marijuana Dispensary Raids Protest

Chants of "DEA. Go away!" and others of similar vein rang out outside the Federal courthouse for much of the day today as a small but boisterous group protested the recent raids on the medical marijuana dispensaries. A couple of SPD patrol cars stopped by for a few minutes. Lots of passing cars honked horns in support. Heck, even Harpman Hatter showed up and played.

No need to rehash everything on this because even if state law was explicitly clear, it is trumped by federal law which lists marijuana as a Schedule I drug. And drugs are bad. M'kay?


Here, according to the Controlled Substances Act, are the characteristics of a Schedule I drug:

* The drug or other substance has a high potential for abuse.
* The drug or other substance has no currently accepted medical use in treatment in the United States.
* There is a lack of accepted safety for use of the drug or other substance under medical supervision.


State law on medical marijuana dispensaries continues to remain ambiguous, in part thanks to Governor Gregoire's partial veto of S.B. 5073 (PDF). One would think that it wouldn't matter anyway, but I beg to differ. If enough states legally establish medical marijuana and there's enough evidence for its medical use, then it would make it easier for it to be moved to Schedule II where morphine resides and where alcohol should be. (I'm not against drinking alcohol, but I've seen what abuse can do. It has a high potential for abuse and can lead to severe physical dependence.) I think Schedule III would be a better fit for marijuana, but I also think that if we can be trusted to purchase, consume and even make (to some extent) alcohol, then we should do the same for marijuana. While it's true anyone can abuse any drug, marijuana is not nearly the demon alcohol is.


And if you're concerned that marijuana is a gateway drug leading to abuse of more dangerous and addictive drugs, take a moment to consider that even milk can be a gateway drug.

Quit Wasting My Oxygen

Sometimes I stumble across the strangest things. The late Konstantin Buteyko, a former Soviet-era doctor, developed the Buteyko method to treat asthma and apparently with some success according to a patient who went to the US clinic that opened last year.

While treating asthma has been the primary use of the method, Dr Buteyko apparently believed he could cure just about any disease.

In 1952, Konstantin Buteyko found out that people often consume five to ten times more air than their bodies require. An extensive amount of air creates an insufficiency of carbon dioxide in the lungs and bloodstream, which badly impacts metabolism and the immune system gradually rendering them dysfunctional. Carbon dioxide deficit also affects respiratory gas exchange and diminishes the amount of oxygen carried by the blood to the brain, heart and kidneys. This situation can cause asthma, allergies, high blood pressure, anxiety, depression, cardiological problems, growth of tumors, etc. - after a life-long research, Dr. Buteyko came to the conclusion that about 150 out of all known diseases are the result of hyperventilation. Ironically, those 150 diseases are the most widespread.

In order to overcome those diseases and develop health, Dr. Buteyko recommended reducing air consumption. It sounds like an easy solution; however, in actuality, this task was too difficult for most of his patients because they did not apply awareness towards their breathing. Then Dr. Buteyko developed a series of breathing exercises, which, if performed with diligence, have a miraculous power: they eliminate symptoms and restore well-being to the body, mind and spirit. From one healed person to another, the Buteyko Method spread all over the world, often saving lives of those who were sentenced to death by their health conditions.

And even more surprising was his claim during an interview that his method could cure AIDS.

“There are rumours that you can treat AIDS.”

"Normalization of breathing can defeat even AIDS.

“Why did you not announce that to the whole world? That would be an international sensation and could lead to recognition.”

“We do not advertise that because AIDS is the punishment for human promiscuity. If people now find out that AIDS can be defeated, epidemic of wrongdoing and perversion will be catastrophic.”

Hmm, no condom? Then breathe through your nose, baby. You won't catch an STD and your baby will be crazy healthy.

Ludmilla Buteyko, current patent holder of the Buteyko method which cured her asthma and cancer--she was clinically dead three times--and has kept her disease free for 40 years, warns us to beware of untrained and unlicensed imitators, some of whom have ethics that are not up to standards.

Um, yeah, that's what I thought, too.

I Wonder What Else Is In the Fine Print

Every year I guess the amount to put in my flexible spending account for the health care costs I'm pretty sure will take place in the coming year. This is a great tax savings benefit in that the money that goes into this account is deducted from my salary and I don't pay taxes on it. The downside is that if my guess is too high then I lose whatever money I haven't used by the end date. If my guess is too low then I pay for it using money that is not tax free.

One expense category covered by the flex spending is over the counter drugs. It's not a lot compared to everything else, but acetaminophen, ibuprofen, nonprescription allergy meds, etc., can add up over the year. It turns out that might go away because both the House and Senate version of the health care reform bill remove it.

Both bills restrict individuals with these [flexible spending accounts and health savings accounts] pre-tax accounts to buying a “medicine or drug only if such medicine or drug is a prescribed” one. And ironically, this tax that will raise health care costs substantially by creating incentives for the use of more expensive prescription drugs even when OTC drugs are just as safe and effective.

I will let Congresswoman McMorris Rodgers and Senators Murray and Cantwell know where I stand on that.

I'm Only Posting This Because I Was Told To

I broke out in itchy bumps yesterday after dinner and Kathy diagnosed it as an allergic reaction. I ran through everything I ate yesterday and the only thing that was out of the ordinary was some cookies made by one of the ladies at work. I had eaten these cookies on other occasions so I was doubtful they were the cause. A dose of Benadryl set things right.

When I got to work this morning, I decided to try some of the cookies and see what happened. Nothing. At lunch I went for a run and then I ate the pasta I had leftover from the night before. Not long after that I broke out again. Fortunately, a coworker had a dose of Benadryl on hand so I didn't have to tolerate the itching. Now the pasta and sauce was suspect in my book.

I told Kathy about my experiment and she was flabbergasted. "You ate the cookies on purpose to see if you would have an allergic reaction?"

"Uh-huh."

"And you did this without taking any Benadryl with you?"

"Uh-huh."

"Do you know that the allergic reaction normally gets worse each time you're exposed to the allergen?"

"Uh-uh."

"Do you know this was quite likely a delayed reaction from the cookies?"

"Uh-uh."

"Do you think it's smart to endanger your health by experimenting with something you're allergic to?"

"Uh-uh."

And with a look that said she would not take no for an answer, "You're putting this on your blog, right?"

"Uh-huh."

What Exactly Is The Public Option?

Robert Greenwald is a film maker who has made many documentaries, one of which resulted in testifying before Congress. I like his style of digging deep into the subject matter at hand.

Here's a Brave New Films short of former Labor Secretary Robert Reich explaining what a public option for health care coverage really means for working people. Notice that when he mentions those trying to scare the public, they show one Fox network talking head after another. I wonder why that is. I suppose that if I watched them I would know.

No Crying Towel Needed Here

Today's Spokesman Review presents an opinion piece by Dr Robert Golden concerning Medicare and what a contrast to Dr Condron's piece last week.

I am a urologist, providing medical and surgical care to my patients with diseases of the urinary tract. Over 75 percent of my patients are on Medicare.

Medicare allows me the freedom to provide quality health care with the interests of my patients as first priority. Medicare is a single-payer, government-sponsored health insurance plan and yet imposes no restrictions or arbitrary rules between my patients and me. The health care decisions are only between my patients, their loved ones and me. Yes, there are guidelines for best practice, which I honor and embrace.

But he does take a poke at the insurance industry.

That nearly 50 million citizens in our country are uninsured is a travesty and, frankly, embarrassing. Every year, more than $400 billion of private health insurance money (paid for by subscribers of the insurance company like you and me) go to profits, marketing, executives, buildings, etc. The president of United Health Care makes $102,000 an hour. Of the money flowing into for-profit private insurance, only 65 percent is used for actual health care services. This is in contrast to Medicare, where more than 95 percent is directly used to provide health services to our seniors.

And while he comes across as a bit altruistic, I don't think that's a bad thing.

These issues are complex – financially and ethically. Standing by and listening to the verbiage by the profit-seeking, fear-mongering insurance and pharmaceutical industries is no longer an option for me. What makes this country great is our willingness to sacrifice our excesses for the general greatness of the whole.

Personally, I became a medical doctor to serve with compassion and love – to relieve pain and suffering. At the end of the day, I do not ruminate about money. Rather, I hope I’ve contributed to my patients’ journey toward a greater understanding of the wonder and blessings of life.

A Sense Of Entitlement

Dr. Donald F. Condon wrote an opinion piece which was printed in yesterday's Spokesman Review. He leads off with this:

"The primary problem with Medicare is simply this: Medicare doesn’t pay. Reimbursement for care is 35 to 50 cents on the dollar of charges submitted. This doesn’t cover overhead. It costs more to provide care for a Medicare patient than the reimbursement schedule pays.

Medicare constitutes 20 percent of my schedule, but since Medicare patients are, generally speaking, more complex, it often requires 30 percent of my time.

Medicare payments represent 5 percent of my income, so that means 25 percent of my day I am working for free. This busyness does not mean business is good. My practice population is aging and matriculating into Medicare coverage, threatening the viability of my practice."

He then continues on stating how bad Medicare is and supporting each declaration with what sounds like weak, selective support.

"Medicare is irresponsible and not held accountable: About two years ago Medicare prematurely launched a new computer program that was not ready to handle its own billing requirements. The consequence to my practice was that over $60,000 in charges was not paid for over six months."

Having been on both ends of the "computer program" spectrum--development and implementation--for 20 years, I have never seen a new "computer program" go in flawlessly.

Medicare interferes with the doctor-patient relationship: Medicare instructs patients to report physicians they feel may be overbilling. This is an unfair burden on the patient.

I'm sorry, but I just can't wrap my brain around that. If you tell a patient to report when a doctor is cheating the system you are interfering with their doctor-patient relationship? Do you mean the part where they're supposed to trust their doctor?

"I know of no other industry that is as mistreated as the health care industry. Government and military contract winners expect a profit, sometimes even large profits. Only the health care industry, charged with the health of the nation, is expected to subsidize the government."

So it's all about the money? Well, maybe not.

"Most of the physicians I know are generous and serving; that is why they are in health care."

What a wonderful sentiment. But at the beginning he said,

"I have worked with Medicare for 30 years, feeling I was doing my part. If ever there was such an obligation, it was paid back years ago."

So it must be all about the money.

"The Medicare system has taken advantage of the generosity of the physician for far too long. The current administration claims that physicians are paid too much and proposes to pay even less."

Is it unreasonable for him to expect what he thinks he is owed since he has obviously paid his dues?

There Must Be An Explanation

An article in the Wichita Eagle describes what a miracle it is that a young man survived a severe skull fracture and the resulting swelling of his brain.

[A Vatican investigator] will investigate on behalf of the church in Rome whether 20-year-old Chase Kear's survival qualifies as a miracle; whether he survived a severe head injury last year in part because his family and hundreds of friends successfully prayed thousands of prayers to the soul of Father Emil Kapaun, a U.S. Army chaplain from Pilsen, Kan., who died a hero in the Korean War.

When something occurs that's beyond our capability to explain--and mostly when it's a good outcome--we curiously try to attribute that to a higher power. If the outcome is bad then the higher power chose not to intercede. Years of constantly improving medical intervention has limited those miraculous survivors to fewer and fewer extreme cases. Two hundred years ago a woman surviving giving birth by Ceasarian section--an extreme last resort--would have been miraculous. Now it's common place--and not such a last resort--in the modern world.

Had the young man not survived, would his family have questioned whether their fellow parishioners prayed hard enough to be successful? Probably not. More than likely it would have been "God's will" and not the fact that the trauma caused his brain to swell enough to kill him.

Something Jenny McCarthy Won't Read

From the Public Library of Science we have an article by Liza Gross

Struck by how the idea of a vaccine–autism link continued to gain cultural currency even as science dismissed it, [Sharon] Kaufman took a 26-month hiatus from her life's work on aging and longevity to investigate the forces fueling this growing divide between scientists and citizens. She wanted to understand how parents thought about risk and experts, how these attitudes shaped parents' decisions about vaccination, and what the vaccine wars might teach us about the long-term erosion of public trust in science.

...

Despite overwhelming evidence that vaccines don't cause autism, one in four Americans still think they do. Not surprisingly, the first half of 2008 saw the largest US outbreak of measles—one of the first infectious diseases to reappear after vaccination rates drop—since 2000, when the native disease was declared eliminated. Mumps and whooping cough (pertussis) have also made a comeback.

But Enquiring Minds Are Dying To Know

In spite of the relatively few cases of H1N1 flu in the country, I get the feeling from the eternal breaking news swine flu coverage that we're all about to die a grisly death.

We might want to pause and reflect on the roughly 36,000 people who die every year in the United States--from common influenza.

Why aren't you always wearing a mask?

Hard To Draw A Line

There was a guest editorial in today's Spokesman Review about the implementation of Initiative 1000 which legalized physician-assisted suicide in Washington state. I realize this is an emotional issue for many and you can tell it is so for the author. There is one part I have to question.

Now, instead of trusting God to determine the natural course of one’s life, and turning to focusing on better compassionate care for those who have to deal with the challenges of end-of-life issues, Washingtonians can now play God and ask the state to assist them to die earlier than their natural course of life. It is a Faustian bargain I believe voters will come to regret, as folks soon realize the state and insurance companies can and will more and more determine who lives and who dies, with economic issues overriding ethical concerns.

Why is it that when we extend the course of a person's life through research, medication and treatment the argument that we're not trusting God never comes up? Why can we not trust God and allow someone to die without treating them for cancer? When there's a Do Not Resuscitate order on a person are we not not trusting God as well?

Indeed, if we're supposed to trust God, why treat people for any medical need at all? Hmm, that's criminal negligence or worse.

So, yeah, these are things I wonder about.

Washington's Death With Dignity Act

The Bellinghamd Herald has an excellent article about this law which takes effect on March 5. I like that they include links to the FAQ and the rules created by the state. I wish more news organizations (and bloggers) did the same.

As with many topics, this is a difficult issue to discuss with lots of people. I long for the day when I can speak with someone about issues like this without them getting upset and emotional. And when I can, too.

It'll be interesting to see the use of this as compared to Oregon's law.

Methods Of Think Control

The emergency contraceptive known as Plan B is back in the news again. Back in 2006, the state Board of Pharmacy took up rules under which a pharmacist could cite "conscientious, moral or religious reasons" in refusing to fill prescriptions for Plan B. Many people opposed the rule and in 2007 the board issued rules saying that pharmacists had to fill all lawfully prescribed drugs and devices. Later that year a US District Judge granted an injunction staying the rule for pharmacists who claimed it forced them to violate their religious beliefs. The Ninth Circuit Court of Appeals refused to lift the injunction and is scheduled to hear the case this coming April. We're sure to hear about that once they make their decision.

I was curious as to how Plan B works and found this excellent explanation. (Be warned that Paul Myers, associate professor of biology at the University of Minnesota, Morris, does not hold back while expressing what he thinks.) You could boil it down to one sentence. Plan B doesn't help if one is already pregnant, and it doesn't affect any implanted zygotes.

The FDA confirms this...

Plan B works like other birth control pills to prevent pregnancy. Plan B acts primarily by stopping the release of an egg from the ovary (ovulation).

... but then adds the "mays".

It may prevent the union of sperm and egg (fertilization). If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work. (emphasis added)

And the "mays" is what people with "conscientious, moral or religious reasons" are keying on, especially the second "may". It doesn't matter that many fertilized eggs do not attach to the womb anyway. Or that something like 20 per cent of all pregnancies end in miscarriage and most of those during the first two weeks. It'll be interesting to see if the FDA under the new administration changes that language.

Given all that the question for me is not, should pharmacists be allowed the option of not dispensing Plan B out of conscience or personal belief? The question is, should a pharmacist be allowed to practice if her beliefs about a particular medication defy or deny the science of that medication?

When you think about it, that's their argument. Unlike RU486 which does end a pregnancy, Plan B does not. But they believe differently.

While I'm On The Subject Of Bloodsucking Companies

Pharmaceuticals irk me. Easy fixes for erectile dysfunction, toenail fungus, bladder control, restless legs, high cholesterol, high blood pressure, allergies, hair restoration, depression, arthritis, gastroesophageal reflux disease, premenstrual disphoric disorder, osteoporosis and more are spewed from our television sets in a plethora of ads that try to show us just how happy and better we can be if we ignore the side effects they talk about at the end.

Marcia Angell is a former Editor in Chief of The New England Journal of Medicine. She has an article on the New York Review of Books discussing the trustworthiness of pharmaceutical companies. A noteworthy excerpt:

The problems I've discussed are not limited to psychiatry, although they reach their most florid form there. Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.

As for reading the article, you have a four hour time limit starting now.

What's It All About?

The Bush administration granted sweeping new protections to health workers who refuse to provide care that violates their personal beliefs. You can read about it here and here. The best quote:

"This is a huge victory for religious freedom and the First Amendment," said Tony Perkins, president of the Family Research Council.

Nope, it's not about medical care.

Imagine an attorney telling you she cannot represent you because of her religious beliefs. Imagine a waiter telling you he cannot serve you because of his religious beliefs. Imagine a bus driver telling you she cannot let you on the bus because of her religious beliefs. Sounds ridiculous, doesn't it? And yet nurses, doctors, pharmacists, and just about any other medical professional can refuse to provide certain types of care and medication because of their religious beliefs.

I'm all for freedom of religion. By all means choose whatever religion you want or none at all. But why should that freedom allowing a person to worship as they please also permit them to deny legal treatment, services, or medication for someone else regardless of their religion?

One Pill Makes You Larger And One Pill Makes You Small

It bothers me when we medicate healthy people in an attempt to make them more healthy or to counteract the effects of poor diet or lack of exercise. A recent international study study of 17,800 men and women with normal cholesterol levels found Crestor cut deaths from heart attacks and strokes. The patients in the trial, funded by AstraZeneca, the maker of Crestor, had cholesterol levels below those usually indicating a need for treatment and had no other signs of heart disease. It appears that whatever AstraZeneca spent on studying a drug they make and control was well worth the expense. And that's what it's all about.

I'm suspicious. When has a drug company published a study that showed their product didn't work?