Stanley Feld M.D.,FACP,MACE
President Obama has tried to keep the bad news about Obamacare from us. The bad news concerning errors in design and execution are being recognized daily. The administration has not published the demographic figures of those who enrolled in Obamacare yet.
It is going to be impossible for the administration to keep Obamacare implementation errors out of the news. Even the traditional media, big Obamacare fans, are starting to realize the huge defects in Obamacare and the hardships it is about to bring.
The defects are becoming obvious because they are affecting the majority of the working middle class signed up through the health insurance exchanges.
Bureaucracy has created evaluation of care panels. While the panel members, most of them clinicians, agreed that a study could be impressive in its implementation and results, they have concluded that some studies were not good enough to recommend a new coverage policy to the CMS.
The members of the committees are usually not the most expert in the field they are evaluating. Thus, access to care through government coverage is denied when it should not be.
I previously gave the example of Medicare’s discussion to not pay for lung cancer screening even though the U.S. Preventive Services Task Force made the following recommendation based on their review.
"Smoking-related lung cancer kills about 130,000 Americans each year. The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease. The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented."
The USPSTF is not the ultimate authority in my view, but even using it as the ultimate authority Medicare ignores its recommendation because of the cost burden.
The Affordable Care Act (Obamacare) has touted Preventive Services.
What is the meaning of Preventative Services?
I guess it is to prevent diseases from occurring.
I believe if we could prevent obesity, stop cigarette smoking and alcoholism we could prevent a lot of diseases from occurring.
However, patients are the only ones' who can only prevent these diseases from occurring.
If we could genetically type diseases and alter those genes we could prevent the disease from occurring. This would relieve individuals of their own responsibilities.
The government defines Preventive Services as identifying disease by screening for disease in people who have no signs or symptoms of disease.
The idea of screening patients for diseases is to make the diagnosis early enough in a disease process so that when treated early patients can be cured.
In other words, a 40 year- old woman can have a free screening mammogram.
If the same woman notices a breast lump by self-examination and goes to her doctor to have it evaluated, she’ll pay for a diagnostic mammogram.
The mammogram can be as much as $300. With a high deductible Health Insurance Exchange plan she would pay out of her pocket because of the high deductible.
It means that a woman with no breast lump and at lower risk for cancer has incentive to be tested because it is free while the woman with a lump at higher risk of cancer faces financial disincentive to get a mammogram.
Isn’t that a little crazy? That’s the problem with giving patients things for free under different circumstances.
“Subsequent interventions are an integral part of all screening. Were I a mammographer, I’d happily argue that additional mammographic views, ultrasounds, M.R.I.s and breast biopsies are all part of screening.”
This decision should not be made by the by a committee of non-experts. Individual patients should make these decisions after discussion with their physicians.
This is a defect in the bureaucratic definition of Preventative Services. Should the government provide the entire work up free?
A crazier example is a 50 year old undergoing a screening for colon cancer.
If a patient had a fecal test for occult blood for screening for colon cancer and it was positive, the patient would have to have a colonoscopy. Occult blood screening is inaccurate. It is cheap and free. It has a lot of false positives.
If the patient had an initial colonoscopy for screening it would also be free according to the Obamacare rules.
If during a colonoscopy a polyp were found the screening test would be reclassified as a diagnostic test. If it were a diagnostic test patients would have to pay for it. It would be an out of pocket expense for the patient on Obamacare making over $50,000 a year.
The outcry caused the government to change the rule. The polyp biopsy would be part of the colonoscopy and still be free to the patient. Do not forget someone is paying for it.
Medical decisions should not be made by government rules. Patients should make the medical decisions for themselves with the advice of their physicians.
If patients had control of their health care dollars with the ideal medical savings account they would become true consumers of healthcare.
Patients would become responsible for making the decision on when to screen and what diagnosis to screen for and how often to screen for disease.
Patients would have to have the information to make those decisions. With the state of the information available and their physicians’ help responsible patients can make those judgments.
Patients have to drive the healthcare system. The government should be concentrating on setting up systems to teach patient how to be educated purchasers of healthcare.
The confusion created by confusing and ever-changing rules puts an emotional and a financial burden on all stakeholders.
Some use the argument that patients are not smart enough to be responsible for they health and healthcare dollars. It is their reason for totally free healthcare for all.
I believe this is disrespectful to our intelligence and our ability to learn to survive.
Paul Krugman a devoted liberal/progressive has shown little respect for the average Americans’ intelligence.
In my view Paul Krugman has been wrong about almost everything. He writes articles of opinion for the New York Times that are not based on any facts.
In 2011 he wrote an article “The VA Is A Huge Policy Success Story’
Paul Krugman wrote; “The V.H.A. is a huge policy success story, which offers important lessons for future health reform.”
And yes, this is “socialized medicine”. But it works — and suggests what it will take to solve the troubles of U.S. health care more broadly.
Where is Paul Krugman’s evidence? The VA healthcare system didn’t work in 2011 and it doesn’t work today. The VA produces nice reports that do not have anything to do with reality.
There is much to write about the recent VA problems. I promise to get to these problems shortly.
The lessons to be learned from the VA’s problems are these problems a precursor to the Obamacare problems.
I fear this is what the American public is going to be facing as the Obama administration tries to implement Obamacare.
Obamacare is a terrible business model. America cannot afford this business model that is destined to failure.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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