Health Care Rationing in Federal Bill

Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey
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Commentary by Betsy McCaughey

Feb. 9 (Bloomberg) – Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

New Penalties

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

Elderly Hardest Hit

Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.

Hidden Provisions

If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.

The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).

Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”

More Scrutiny Needed

On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.

The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.

Hi Folks

Sadly Pres. Obama has few choices. The last 20 or so Presidents and the lazy congress with all the sheep in this country. Have led us the brink world wide ruin. I for one don’t think we the rest of 21 century to debate what best. I think if things don’t work out we can change them.

Thanks
Bob O’Brien

[QUOTE=bobeleanor;17184]Hi Folks

Sadly Pres. Obama has few choices. The last 20 or so Presidents and the lazy congress with all the sheep in this country. Have led us the brink world wide ruin. I for one don’t think we the rest of 21 century to debate what best. I think if things don’t work out we can change them.

Thanks
Bob O’Brien[/QUOTE]

Yes, he does have a choice, a free market health system. The arrogance of these people who believe they know what is best for you. Sound familiar from somewhere?

We’ve had a “free market” healthcare system for decades in the US, NDXUFan12, and it’s led to some of the worst healthcare outcomes in the world–at the highest cost. Here’s a link to the World Health Organization’s rating of healthcare systems (Hint: the U.S. is #37) http://www.photius.com/rankings/healthranks.html. Please don’t be fooled by people who claim “we have the best healthcare system in the world.” It’s simply not true.

The U.S. does a good job with acute, high profile illnesses or injuries, like:
– High tech prosthetics
– Separating conjoined twins
– Finding the source of infectious outbreaks quickly

But we do a very poor job with chronic disease–including kidney disease. Care is poorly coordinated, treatment differs from one part of the country to another, basic things are missed… The Dialysis Outcomes and Practice Patterns Study (DOPPS) has looked at more than 22,000 people on in-center HD in the US, Europe, Japan, Canada, and Australia/New Zealand. The researchers reported that survival on in-center HD in the US was worse than any other country studied, even accounting for differences in the age, gender, race, other illnesses, etc. (http://www.ncbi.nlm.nih.gov/pubmed/15486869?ordinalpos=49&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum.

If an unregulated “free market” worked–in any sense–the US would not have needed to institute the Food and Drug Administration in 1906 to protect consumers from patent medicines containing large amounts of alcohol, opiates, or outright poisons (http://www.hagley.org/library/exhibits/patentmed/history/history.html or from foods like milk adulterated with lead paint. (Today’s counterpart is China and melamine poisoning pet food and milk).

A “free market” health system would probably not include Medicare payment for dialysis. People who have good health coverage could afford treatment, and most everyone else could just die. That’s what happened in the early 1960s in this country, with the “Life and Death Committees” saving a few people. (http://www.voiceexpeditions.com/index.php?id=287.

Tom Daschle is out, and the new administration has been focused elsewhere. There is certainly time to have input into whatever plan they come up with. But I do think there are some important, and tough, questions we should be asking ourselves, like:

– Is it appropriate to give everyone with kidney failure dialysis indefinitely? Comatose people with multiple illnesses who are being transferred to and from a nursing home three times a week? People with other terminal illnesses, like Alzheimers? (I got a call about this!). How about people who don’t even want dialysis, but whose families want them to have it?

– How do we assure that taxpayers are getting value for our dollars, and not just enriching a doctor or a clinic who is looking upon each patient as a “revenue stream” and not paying any attention to their quality of life? Can we give everyone every treatment?

The questions of who gets to live (with costly treatments) at whose expense, and for how long, are extremely uncomfortable. Everyone’s priorities differ. Right now, we have a system where 50% of bankruptcies are due to medical costs–often in insured people–and that was before the economic meltdown. We are de facto rationing by limiting access to care by people who don’t have health coverage. This has pretty much been a dismal failure. Frankly, I’m having a hard time seeing how any other system could be worse.

[QUOTE=Dori Schatell;17186]We’ve had a “free market” healthcare system for decades in the US, NDXUFan12, and it’s led to some of the worst healthcare outcomes in the world–at the highest cost. Here’s a link to the World Health Organization’s rating of healthcare systems (Hint: the U.S. is #37) http://www.photius.com/rankings/healthranks.html. Please don’t be fooled by people who claim “we have the best healthcare system in the world.” It’s simply not true.

The U.S. does a good job with acute, high profile illnesses or injuries, like:
– High tech prosthetics
– Separating conjoined twins
– Finding the source of infectious outbreaks quickly

But we do a very poor job with chronic disease–including kidney disease. Care is poorly coordinated, treatment differs from one part of the country to another, basic things are missed… The Dialysis Outcomes and Practice Patterns Study (DOPPS) has looked at more than 22,000 people on in-center HD in the US, Europe, Japan, Canada, and Australia/New Zealand. The researchers reported that survival on in-center HD in the US was worse than any other country studied, even accounting for differences in the age, gender, race, other illnesses, etc. (http://www.ncbi.nlm.nih.gov/pubmed/15486869?ordinalpos=49&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum.

If an unregulated “free market” worked–in any sense–the US would not have needed to institute the Food and Drug Administration in 1906 to protect consumers from patent medicines containing large amounts of alcohol, opiates, or outright poisons (http://www.hagley.org/library/exhibits/patentmed/history/history.html or from foods like milk adulterated with lead paint. (Today’s counterpart is China and melamine poisoning pet food and milk).

A “free market” health system would probably not include Medicare payment for dialysis. People who have good health coverage could afford treatment, and most everyone else could just die. That’s what happened in the early 1960s in this country, with the “Life and Death Committees” saving a few people. (http://www.voiceexpeditions.com/index.php?id=287.

Tom Daschle is out, and the new administration has been focused elsewhere. There is certainly time to have input into whatever plan they come up with. But I do think there are some important, and tough, questions we should be asking ourselves, like:

– Is it appropriate to give everyone with kidney failure dialysis indefinitely? Comatose people with multiple illnesses who are being transferred to and from a nursing home three times a week? People with other terminal illnesses, like Alzheimers? (I got a call about this!). How about people who don’t even want dialysis, but whose families want them to have it?

– How do we assure that taxpayers are getting value for our dollars, and not just enriching a doctor or a clinic who is looking upon each patient as a “revenue stream” and not paying any attention to their quality of life? Can we give everyone every treatment?

The questions of who gets to live (with costly treatments) at whose expense, and for how long, are extremely uncomfortable. Everyone’s priorities differ. Right now, we have a system where 50% of bankruptcies are due to medical costs–often in insured people–and that was before the economic meltdown. We are de facto rationing by limiting access to care by people who don’t have health coverage. This has pretty much been a dismal failure. Frankly, I’m having a hard time seeing how any other system could be worse.[/QUOTE]

Stanford Economist Thomas Sowell:

If you ask most people about the cost of medical care, they may tell you how much they have to pay per visit to their doctor’s office or the monthly bill for their prescription drugs. But these are not the costs of medical care. These are the prices paid.

The difference between prices and costs is not just a fine distinction made by economists. Prices are what pay for costs — and if they do not pay enough to cover the costs, then centuries of history in countries around the world show that the supply is going to decline in quantity or quality, or both. In the case of medical care, the supply is a matter of life and death.

The average medical student graduates with a debt of more than $100,000. The cost per doctor of running an office is more than $100 an hour. The average cost of developing a new pharmaceutical drug is $800 million. These are among the costs of medical care.

When politicians talk about “bringing down the cost of medical care,” they are not talking about reducing any of these costs by one cent. They are talking about forcing prices down through one scheme or another.

All the existing efforts to control the rising expenses of medical care — whether by government, insurance companies, or health maintenance organizations — are about holding down the amount of money they have to pay out, not about reducing any of the real costs.

Many of the same politicians who are gung ho for imposing price controls on prescription drugs, or for importing Canadian price controls by importing American medicines from Canada, have not the slightest interest in stopping frivolous lawsuits against doctors, hospitals, or drug companies — which are huge costs.

Price control zealots likewise seldom have any interest in reducing the amount of federal requirements for getting a drug approved for sale to the public — a process that can easily drag on for a decade or more, costing millions of dollars, and also costing the lives of those who die while waiting for the drug to be approved by bureaucrats at the Food and Drug Administration.

For political purposes, what “bringing down the cost of medical care” means is some quick fix that will win votes at the next election, regardless of what the repercussions are thereafter.

What are those repercussions?

If the bureaucratic hassles that doctors have to go through make their huge investment in time and money going to medical school not seem worthwhile, some can retire early and some can take jobs no longer involving treating patients. Either way, the supply of medical care can begin to decline, even in the short run.

In the long run, medical school may no longer look like such a good investment to many in the younger generation. Britain, which has had government-run medical care for more than half a century, has to import doctors from the Third World, where medical school standards are lower.

So long as there are warm bodies with “M.D.” after their names, there is no decline in supply, as far as politicians are concerned. Only the patients will find out, the hard way, what declining quality means.

No law passed by more than 500 members of Congress is going to be simple or even consistent. There are already 125,000 pages of Medicare regulations. “Universal health care” can only mean more.

I saw a vivid example of what bureaucratic medical care meant back in 1959, when I had a summer job at the headquarters of the U.S. Public Health Service in Washington. Around 5 o’clock one afternoon, a man had a heart attack on the street near our office.

He was taken to the nurse’s room and asked if he was a federal employee. If he was, he could be sent to the large, modern medical facility there in the Public Health Service headquarters. But he was not a government employee, so an ambulance was summoned from a local hospital.

By the time this ambulance made its way through miles of downtown Washington rush-hour traffic, the man was dead. He died waiting for a doctor, in a building full of doctors. That is what bureaucracy means.

Making a government-run medical care system mandatory — “universal” is the pretty word for mandatory — means that we will all have no choice but to be caught up in that bureaucratic maze.

Unregistered, you make a good point about costs vs. prices. But one example of bureaucracy from 1959 (50 years ago!) makes a good story, but doesn’t really add much reality. For liability reasons, most hospitals used to only accept emergencies through the ER, preferably via ambulance. The policy of the (public) hospital that I worked my way through school at in the early 80s had the same policy–sometimes with a similar result. Today, with defibrillators in many public buildings, this may have changed.

What I didn’t see was a better solution. Got any ideas?

Hi Folks

To Unregistered, & NDXUFan12

I might give you more due if you you signed in with real names. And if you just gave us the link to the story , gave us your thinking on the subject.

For every story you copy and paste the other side can do the same. Dori post was right. We here in American can & do somethings right if not great. The Nxstage is a result of the thinking here,

But something had to give, all sides(or most) in the medical world has issues with the current system. Up in till I enter dialysis I understood we had issues in the medical world, but if you two are on dialysis are you happy with the way the dialysis is running? I have to tell you dialysis is nothing more that the Dr, Nurse demanding control over your life. And the Dr ,Nurse , keeping the dialysis consumer in the dark.

As to the plan working or not only time will time. I don’t think the country will become a vast waste land. Too much money to lose

Thanks
Bob O’Brien

I

This is NDXUFan12. I tried to sign in on the site, last night. For some reason, it would not let me sign in. I was making my point thru Stanford Economist Thomas Sowell. If we look in the past, before Medicare, a gall bladder operation cost a grand total of $170.00. After Medicare was passed in 1965, the cost of the gall bladder operation rose to $3,000.00. Business will charge what the market will bear. With a third-party payer system, whether it is the Government and private insurance, has seen the cost of medical care skyrocket. Why? Regulation has caused the cost of an office visit or hospital visit to climb beyond the average income of the American family. In basic economic terms, regulation equals cost. To regulate, we must incur the costs of the regulation, paying salaries and benefits to the regulators, it is very expensive. For example, when you walk in to the average physician’s office or any physician’s office, what do you see? The first thing you will see in the office is office personnel or people pushing paper. These individuals are pushing paper to comply with Government(Medicaid or Medicare) or private insurance regulations. The physician’s group has to pay a salary and an extensive array of benefits to these individuals to push the paper. If we eliminate these regulations, this will decrease the cost of an office visit from $100.00 to $20.00.

Which is more compassionate, an office visit of $100.00 or $20.00?

When you go to the grocery store, I am sure that the vast majority of individuals know what the price range is for the various goods that they will purchase at the store, right? Now, when most people go the physician’s office, they have no idea what the office visit will cost the insurance company. Yes, they know about the price paid, not the total price. We need to make individuals more cost aware than what has been allowed in the past. I do not understand why we cannot be cost aware in every single field, except health care. Individuals need to start researching about what treatments might or might not be effective for them. There is serious disagreement among hard scientists and hard medical people about Cholesterol, weight, blood pressure as reliable medical measures of health. The BMI index has never been proven as a reliable measure of an individual’s health. I will post a YouTube video of Nephrologist Jerome Kassirer, the Former Editor of the New England Journal of Medicine. My primary care physician was a student of Dr. Kassirer in medical school, he said that as a physician, Dr. Kassirer is “awesome.” The drug companies are trying to tout Epogen as a treatment for diabetes, Dr. Kassirer said that theory is alot of nonsense.

I agree, the treatment in the dialysis field is lousy. I have never met so many control freaks in my entire life. Think about this, the XCR-6 machine, the HD+ machine are being researched because there is a potential to make a major profit, along with the Wearable, Artificial Kidney. Now, which would you rather have, the companies making a profit and a new way of doing dialysis or a kidney belt or do you want to sit in a dialysis clinic for 4 hours a treatment, 3 days per week? Do want a control freak standing over you, do not eat this, do not eat that, do not drink, even though you are a diabetic and you are thirsty as HELL? I think that these people really need a taste of their own medicine. I take my medicine when I eat and I eat what I want, they can go jump off a bridge. I have lived on both sides of the care fence and I think it is high time that these people learn what it is like to walk in our shoes.

I have alot more to say about the economics of medicine and dialysis, what do you think so far?

Dr. Jerome Kassirer:

SURGERY FOR WEIGHT LOSS: COMPARISON OF RISK AND BENEFIT
by Paul Ernsberger, Ph.D.

"Well, the gold standard in medicine is the controlled clinical trial. We don’t go subjecting 100,000 people to a surgical procedure without doing a controlled clinical trial or dozens of clinical trials, and then looking at the results. Do you know how many clinical trials have been published on weight-loss surgery or gastric bypass? Zero. None of them have compared it to clinical conservative treatment and found it to be superior for life expectancy or for anything else other than, you know, risk factors. A number of trials have been started, and the final results have never been reported. We have to ask, you know, why haven’t we seen the final results? I think it’s because it’s bad news. "

(Paul Ernsberger on Donahue, 2002)

from Obesity & Health (renamed Healthy Weight Journal)
March-April 1991, pp. 24-25

As the eve of the 1991 NIH consensus conference on weight-loss surgery approaches, let us look back at the last NIH conference on this topic in December 1978. The panel gave its approval to intestinal bypass surgery, even though this operation was already coming under criticism for the long-term side-effects that it caused. As a result of recommendations by the consensus panel, intestinal bypass was accepted for health insurance coverage, which made possible tens of thousands of these operations. The legacy of the NIH panel’s endorsement of intestinal bypass surgery is perhaps a hundred thousand patients worldwide, the majority of whom have suffered severe complications. Of the survivors, most now have had the operation undone. One can only hope that the legacy of this latest panel is more benign.

The panel members face a difficult task in evaluating the risks of the various surgical treatments for obesity. Nearly very surgical operation originates in a laboratory, where it is refined by extensive tests in animals. For example, coronary bypass surgery was the product of years of experimentation on dogs in which repeated measurements and detailed autopsies revealed potential complications and allowed surgeons to perfect the operation. In contrast, only three animal tests have ever been reported or gastric bypass or gastroplasty. In one test of gastric bypass in rats, many abnormalities were found at autopsy, including damage to the stomach, liver and pancreas from fibrosis (American Journal of Clinical Nutrition 40:293-302, 1984). We don’t know whether these progressive abnormalities happen in human patients, because autopsy results have never been reported. Because of a lack of animal testing, the panelists will lack information on the biological effects of these operations.

Another difficulty the panelists will face is the bewildering variety of operations. As many as two dozen basic types of both gastroplasty and gastric bypass are in current use, along with several modifications of the original intestinal bypass. If we then consider variations on the basic methods, it can almost be said that no two surgeons do exactly the same procedure. The different types of operations differ in their safety and effectiveness. Operations such as gastric bypass that impair the absorption and processing of nutrients produce the greatest weight loss, and are most likely to produce lasting weight loss. With gastroplasty, weight regain is more common. After the most effective operation of this type, the vertical banded gastroplasty, 76% of patients failed to maintain weight loss after 30 months of follow-up (Surgery 98:700-707, 1985). In another study, 69% had fair-to-poor results in maintaining weight loss after 23 months and 22% suffered from obstruction of the narrow outlet from the stomach pouch (Mayo Clinic Proceedings 61:287-291, 1986). Weight regain after gastroplasty is usually the result of gradual stretching and enlargement of the stomach pouch or the narrow outlet from it. Because the stomach is almost infinitely expandable and adapts to increased pressure by growing larger, the operation is doomed to be eventually undone by natural adaptive processes of the patients’ body. Although gastric bypass is more effective in maintaining loss of weight, there are more long-term complications, particularly nutritional deficiencies including anemia, pernicious anemia, osteoporosis, and neurological damage. These same complications were described 30 years ago as the long-term result of stomach surgery for ulcers. Consequently, these operations were long ago abandoned for treatment of ulcer.

The stomach is not simply passive sac for storing ingested food, but plays a complex role in the processing of nutrients. Surgical procedures which interfere with the normal operation of the stomach inevitably cause multiple problems. Unfortunately, no controlled trials have ever been run which include physical examination of the patients for possible side effects by independent doctors not associated with the surgeon. In a rare instance of independent examination of bariatric surgery patient, a team of neurologists examined 500 patients who had received either gastric bypass or gastroplasty and found neurological complications (nerve or brain damage) in 5% of them (Neurology 37:196-200, 1987). The patients were usually examined within a year after surgery, so the incidence of long-term neurological deterioration could be much higher than 5%. Possible damage to organs other than brain and nervous system has not been put under rigorous independent evaluation.

Once a surgical technique has been developed in the animal laboratory, normally the next step is to run controlled clinical trials comparing long-term outcomes for patients and an untreated control group. Coronary bypass was tested in this way and it was proven that heart patients undergoing surgery lived longer than comparable patients getting only non-surgical treatment. No controlled clinical trials have ever been run for weight-loss surgery, except for one Danish trial of gastric bypass that showed that patients undergoing surgery experienced more health problems than comparable patients who were put on very-low-calorie diets (New England Journal of Medicine 310:352-356, 1984; Danish Medical Bulletin 37:359-370, 1990). Gastric bypass or gastroplasty does result in improved levels of blood pressure. cholesterol, and blood sugar. These reduced risk factors might translate into long-term disease prevention over the patients’ lifespan if (and only if) their reduced weight can be maintained for life.

Do the benefits of weight loss exceed the risks of major surgery and the side-effects of tampering with the digestive system? In considering this question, the consensus panel must first ask whether weight loss is permanent. If a patient loses 100 pounds only to gain it back five years later, then her risk factors will return to dangerous levels. Because of the harmful effects of losing and regaining weight (the “yo-yo syndrome”), some risk factors, especially blood pressure, may be worse after regain of weight than they were at the start. When the risks of surgery and long-term complications are taken into account, then it become apparent that the net outcome for the patient who regains weight is highly negative. The typical patient receiving these operations is a woman in her 30’s. To be certain of reducing her risk for heart disease later in life, weight loss must be assured for at least 10 years and preferably 20.

The consensus panel must also consider the benefit side of the risk-benefit equation. In order to evaluate the benefits of weight loss in extremely obese persons, let us start with the assumption that the poor health suffered by fat people can be completely reversed by weight loss. This may not be a valid assumption, especially because it is now dear that many fat people are burdened by a genetic defect that allows runaway weight gain. This same genetic defect may also lead to diabetes, high blood pressure and heart disease. Currently we do not know whether the health problems of the obese are directly caused by the fatty deposits themselves or whether they result from defective genetic machinery. If the latter is true, then weight loss will not completely erase the excess risk associated with obesity, because weight loss will not change a person’s genetic makeup. Setting this argument aside, let us consider the actual risk faced by extremely obese persons. The median life expectancy from age 25 as a function of body mass index is shown in the illustration above (see original article). These data were taken from the world’s largest epidemiological study, which tracked 1.8 million Norwegians for 10 years (Acta Medica Scandinavica Supplementum 679:1-56, 1984). Let us consider the lifespan of women, since 90-95% of all patients undergoing weight-loss surgery are female. Women who are neither underweight nor overweight have a life expectancy of about 79 years. Morbid obesity begins at a body mass index of 35. Women with a body mass index of 40 and above are shown at the far right. Their life expectancy is reduced by 5 years, which is equivalent in risk to light cigarette smoking. However, even these extremely obese women still have a longer life expectancy that normal-weight men. Several conclusions can be made from this graph: first, the typical “morbidly obese” woman in her 30’s considering weight-loss surgery faces another four decades of life, which means that weight loss maintenance and surgical complications must be evaluated over the very long term. Second, given that the maximum benefit from weight-loss is a 5-year prolongation of life, the risks from surgery must be kept very low. Third, surgery should clearly be reserved for the most obese patients (body mass index over 40) and the ongoing trend for surgeons to make exceptions to the “100-pound rule” and operate on thinner patients must be deplored.

The challenge awaiting the NIH consensus panel is formidable. They will lack a base of knowledge of the biological effects and the medical consequences of these operations, especially over the long term. The vast array of variations of these operations complicates any evaluation. Operations that are more effective are also less safe; none of the surgical procedures seem to be both safe and effective. Risks and benefits must be compared over the remaining 40 years of life expectancy of the patient, but for many procedures patients are tracked for two years or less, and many times only weight loss is recorded without independent evaluations of the patients’ overall health. Hopefully the 1991 panel will not repeat the mistakes of the 1978 panel, which failed to confront the epidemic of complications from intestinal bypass.

Paul Ernsberger, Ph.D.
Associate Professor of Medicine, Pharmacology and Neuroscience
Case Western Reserve School of Medicine
10900 Euclid Avenue
Cleveland, OH 44106-4982
pre@po.cwru.edu

[QUOTE=bobeleanor;17196]Hi Folks

To Unregistered, & NDXUFan12

I might give you more due if you you signed in with real names. And if you just gave us the link to the story , gave us your thinking on the subject.

For every story you copy and paste the other side can do the same. Dori post was right. We here in American can & do somethings right if not great. The Nxstage is a result of the thinking here,

But something had to give, all sides(or most) in the medical world has issues with the current system. Up in till I enter dialysis I understood we had issues in the medical world, but if you two are on dialysis are you happy with the way the dialysis is running? I have to tell you dialysis is nothing more that the Dr, Nurse demanding control over your life. And the Dr ,Nurse , keeping the dialysis consumer in the dark.

As to the plan working or not only time will time. I don’t think the country will become a vast waste land. Too much money to lose

Thanks
Bob O’Brien

I[/QUOTE]

So, tell me, what right does Chairman Obama or Thomas Daschle have to tell you what treatment is right for you???

Mark Moulliet

[QUOTE=bobeleanor;17196]Hi Folks

To Unregistered, & NDXUFan12

I might give you more due if you you signed in with real names. And if you just gave us the link to the story , gave us your thinking on the subject.

For every story you copy and paste the other side can do the same. Dori post was right. We here in American can & do somethings right if not great. The Nxstage is a result of the thinking here,

But something had to give, all sides(or most) in the medical world has issues with the current system. Up in till I enter dialysis I understood we had issues in the medical world, but if you two are on dialysis are you happy with the way the dialysis is running? I have to tell you dialysis is nothing more that the Dr, Nurse demanding control over your life. And the Dr ,Nurse , keeping the dialysis consumer in the dark.

As to the plan working or not only time will time. I don’t think the country will become a vast waste land. Too much money to lose

Thanks
Bob O’Brien

I[/QUOTE]

This is NDXUFan12. I tried to sign in on the site, last night. For some reason, it would not let me sign in. I was making my point thru Stanford Economist Thomas Sowell. If we look in the past, before Medicare, a gall bladder operation cost a grand total of $170.00. After Medicare was passed in 1965, the cost of the gall bladder operation rose to $3,000.00. Business will charge what the market will bear. With a third-party payer system, whether it is the Government and private insurance, has seen the cost of medical care skyrocket. Why? Regulation has caused the cost of an office visit or hospital visit to climb beyond the average income of the American family. In basic economic terms, regulation equals cost. To regulate, we must incur the costs of the regulation, paying salaries and benefits to the regulators, it is very expensive. For example, when you walk in to the average physician’s office or any physician’s office, what do you see? The first thing you will see in the office is office personnel or people pushing paper. These individuals are pushing paper to comply with Government(Medicaid or Medicare) or private insurance regulations. The physician’s group has to pay a salary and an extensive array of benefits to these individuals to push the paper. If we eliminate these regulations, this will decrease the cost of an office visit from $100.00 to $20.00.

Which is more compassionate, an office visit of $100.00 or $20.00?

When you go to the grocery store, I am sure that the vast majority of individuals know what the price range is for the various goods that they will purchase at the store, right? Now, when most people go the physician’s office, they have no idea what the office visit will cost the insurance company. Yes, they know about the price paid, not the total price. We need to make individuals more cost aware than what has been allowed in the past. I do not understand why we cannot be cost aware in every single field, except health care. Individuals need to start researching about what treatments might or might not be effective for them. There is serious disagreement among hard scientists and hard medical people about Cholesterol, weight, blood pressure as reliable medical measures of health. The BMI index has never been proven as a reliable measure of an individual’s health. I will post a YouTube video of Nephrologist Jerome Kassirer, the Former Editor of the New England Journal of Medicine. My primary care physician was a student of Dr. Kassirer in medical school, he said that as a physician, Dr. Kassirer is “awesome.” The drug companies are trying to tout Epogen as a treatment for diabetes, Dr. Kassirer said that theory is alot of nonsense.

I agree, the treatment in the dialysis field is lousy. I have never met so many control freaks in my entire life. Think about this, the XCR-6 machine, the HD+ machine are being researched because there is a potential to make a major profit, along with the Wearable, Artificial Kidney. Now, which would you rather have, the companies making a profit and a new way of doing dialysis or a kidney belt or do you want to sit in a dialysis clinic for 4 hours a treatment, 3 days per week? Do want a control freak standing over you, do not eat this, do not eat that, do not drink, even though you are a diabetic and you are thirsty as HELL? I think that these people really need a taste of their own medicine. I take my medicine when I eat and I eat what I want, they can go jump off a bridge. I have lived on both sides of the care fence and I think it is high time that these people learn what it is like to walk in our shoes.

I have alot more to say about the economics of medicine and dialysis, what do you think so far?

Generally I have learned to not trust or give any weight to Republican talking points. Ever. With that being doubly true when it comes to healthcare reform. This is not an exception. The goal is not to constructively find the best way to reform healthcare. The Republican goal is to simply stop all healthcare reform in its tracks. I think that is not in the interest of this country and is frankly despicable.

Misinformation On Health Information Technology

      Posted by [James O'Rourke](http://jimorourke.wordpress.com/2008/02/) on February 11, 2009

Late last month, the House passed an economic recovery package containing $20 billion for health information technology, which would require the Department of Health and Human Services to develop standards by 2010 for a nationwide system to exchange health data electronically. The version of the recovery package passed by the Senate yesterday contains slightly less funding for health information technology (”health IT”). But as Congress moves to reconcile the two stimulus packages, conservatives have begun attacking the health IT provisions, falsely claiming that they would lead to the government “telling the doctors what they can’t and cannot treat, and on whom they can and cannot treat.” The conservative misinformation campaign began on Monday with a Bloomberg “commentary” by Hudson Institute fellow Betsy McCaughey, which claimed that the legislation will have the government “monitor treatments” in order to “‘guide’ your doctor’s decisions.” McCaughey’s imaginative misreading was quickly trumpeted by Rush Limbaugh and the Drudge Report, eventually ending up on Fox News, where McCaughey’s opinion column was described as ”a report.” In one of the many Fox segments focused on the column, hosts Megyn Kelly and Bill Hemmer blindsided Sens. Arlen Specter (R-PA) and Jon Tester (D-MT) with McCaughey’s false interpretation, causing them to promise that they would “get this provision clarified.” On his radio show yesterday, Limbaugh credited himself for injecting the false story into the stimulus debate, saying that he “detailed it and now it’s all over mainstream media.”

McCAUGHEY GETS THE FACTS WRONG:
In her commentary, McCaughey writes, “One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.” But the fact is, this isn’t a new bureaucracy. The National Coordinator of Health Information Technology already exists. Established by President Bush in 2004, the office “provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation” of “health information technology.” Far from empowering the Office to “monitor doctors” or requiring private physicians to abide by treatment protocols, the new language tasks the National Coordinator with “providing appropriate information” so that doctors can make better informed decisions. As Media Matters noted, the language in the House bill, on which McCaughey based her column, does not establish authority to “monitor treatments” or restrict what “your doctor is doing” with regard to patient care. Instead, it addresses establishing an electronic records system so that doctors can have complete, accurate information about their patients. The Wonk Room’s Igor Volsky pointed out that “this provision is intended to move the country towards adopting money-saving health technology (like electronic medical records), reduce costly duplicate services and medical errors, and create jobs.”

HEALTH I.T. BELONGS IN RECOVERY PACKAGE:
Projected to create over 200,000 jobs, the funding for health information technology in the recovery package is both an important stimulus and a down-payment on broader health care reform. Speaking in Ft. Myers, FL, yesterday, President Obama said that investment in health IT was “an example of using a crisis and converting it into an opportunity.” ”We are going to computerize our health care system, institute health IT,” said Obama. “That creates jobs right now for people to convert from a paper system to a computer system, but it also pays a long-term dividend by making the health care system more efficient.” Currently, fewer than 25 percent of hospitals, and fewer than 20 percent of doctor’s offices, employ health information technology systems. Researchers have found that implementing health IT would result in a mean annual savings of $40 billion over a 15-year period by improving health outcomes through care management, increasing efficiency, and reducing medical errors. Investing in health would also help primary care physicians — who often bear the burnt of tech implementation without seeing immediate benefits — afford the infrastructure for expansion. The Congressional Budget Office has estimated that one-third of $2 trillion spent annually on health care in America may be unnecessary due to inefficiencies in the system such as excessive paperwork. Investments in infrastructure like health IT will help improve the quality of America’s health care.

MCCAUGHEY’S POISONING HEALTH REFORM AGAIN:
Responding to her Bloomberg commentary, the New Republic’s health care writer Jonathan Cohn noted that “Elizabeth McCaughey is up to her old tricks again.” “Not content to have poisoned one major health care debate, she seems determined to poison this one, too,” wrote Cohn. In 1994, McCaughey published a “viciously inaccurate” article on the Clinton health care plan in the New Republic, which is credited with having “completely distorted the debate on the biggest public policy issue of 1994.” McCaughey’s article claimed that there would be “no exit” from the Clinton plan, and individuals would be prevented from “going outside the system to buy basic health coverage” that they preferred. But, as the Atlantic’s James Fallows pointed out after the Clinton plan was defeated, McCaughey ignored “the first provision of the bill,” which clearly said: “Nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services.” Just like in 1994, McCaughey’s latest Bloomberg commentary provides page numbers from the legislation to give her claims the aura of credibility. But just as in 1994, McCaughey’s assertions are not supported by the language of the bill she cites.

Dr. Jerome Kassirer

[quote=NDXUFan12;17203]Dr. Jerome Kassirer

Dr. Kassier is in favor of taking the market out of medicine, that is the direction President Obama is going. Here is Dr. Kassier’s thinking from 2 weeks ago rather than 2 years ago:

Jerome P. Kassirer, professor, Tufts University School of Medicine, editor-in-chief emeritus, New England Journal of Medicine

[ol]
[li] Devise a [health-care] plan that covers all Americans. It is the only way to gain control over excessive spending.[/li][li] Don’t falter in your resolve to reform the system when opponents from the pharmaceutical industry, the health insurance industry and the high-income specialists try to oppose reform. (They will do so.)[/li][li] Don’t expect too much from automation of medical records. There is too much variation from one electronic medical record to another, and computers still haven’t learned to talk to one another efficiently.[/li][li] Fix primary care. It will require more than adjusting incomes of internists and family doctors.[/li][li] Comparative effectiveness assessment is much harder than most people believe, and it is a political hot potato. Don’t rush into it without caution.[/li][/ol]

[quote=NDXUFan12;17203]Dr. Jerome Kassirer

This video is not worth 30 minutes unless you are a Highlander or some other kind of immortal. This sort of bias has been well documented in a much more compelling way by Merrill Goozner in his book about EPO The $800 Million Pill or if you don’t have time to read a book, you only have a half hour you want to spend thinking about the corrupting influence of money in medicine, spend that thirty minutes reading Merrill’s blog, Gooznews.

[QUOTE=Bill Peckham;17202]Generally I have learned to not trust or give any weight to Republican talking points. Ever. With that being doubly true when it cones to healthcare reform. This is not an exception. The goal is not to constructively find the best way to reform healthcare. The Republican goal is to simply stop all healthcare reform in its tracks. I think that is not in the interests of this country and is frankly despicable.

Misinformation On Health Information Technology

      Posted by [James O'Rourke](http://jimorourke.wordpress.com/2008/02/) on February 11, 2009

Late last month, the House passed an economic recovery package containing $20 billion for health information technology, which would require the Department of Health and Human Services to develop standards by 2010 for a nationwide system to exchange health data electronically. The version of the recovery package passed by the Senate yesterday contains slightly less funding for health information technology (”health IT”). But as Congress moves to reconcile the two stimulus packages, conservatives have begun attacking the health IT provisions, falsely claiming that they would lead to the government “telling the doctors what they can’t and cannot treat, and on whom they can and cannot treat.” The conservative misinformation campaign began on Monday with a Bloomberg “commentary” by Hudson Institute fellow Betsy McCaughey, which claimed that the legislation will have the government “monitor treatments” in order to “‘guide’ your doctor’s decisions.” McCaughey’s imaginative misreading was quickly trumpeted by Rush Limbaugh and the Drudge Report, eventually ending up on Fox News, where McCaughey’s opinion column was described as ”a report.” In one of the many Fox segments focused on the column, hosts Megyn Kelly and Bill Hemmer blindsided Sens. Arlen Specter (R-PA) and Jon Tester (D-MT) with McCaughey’s false interpretation, causing them to promise that they would “get this provision clarified.” On his radio show yesterday, Limbaugh credited himself for injecting the false story into the stimulus debate, saying that he “detailed it and now it’s all over mainstream media.”

McCAUGHEY GETS THE FACTS WRONG:
In her commentary, McCaughey writes, “One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.” But the fact is, this isn’t a new bureaucracy. The National Coordinator of Health Information Technology already exists. Established by President Bush in 2004, the office “provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation” of “health information technology.” Far from empowering the Office to “monitor doctors” or requiring private physicians to abide by treatment protocols, the new language tasks the National Coordinator with “providing appropriate information” so that doctors can make better informed decisions. As Media Matters noted, the language in the House bill, on which McCaughey based her column, does not establish authority to “monitor treatments” or restrict what “your doctor is doing” with regard to patient care. Instead, it addresses establishing an electronic records system so that doctors can have complete, accurate information about their patients. The Wonk Room’s Igor Volsky pointed out that “this provision is intended to move the country towards adopting money-saving health technology (like electronic medical records), reduce costly duplicate services and medical errors, and create jobs.”

HEALTH I.T. BELONGS IN RECOVERY PACKAGE:
Projected to create over 200,000 jobs, the funding for health information technology in the recovery package is both an important stimulus and a down-payment on broader health care reform. Speaking in Ft. Myers, FL, yesterday, President Obama said that investment in health IT was “an example of using a crisis and converting it into an opportunity.” ”We are going to computerize our health care system, institute health IT,” said Obama. “That creates jobs right now for people to convert from a paper system to a computer system, but it also pays a long-term dividend by making the health care system more efficient.” Currently, fewer than 25 percent of hospitals, and fewer than 20 percent of doctor’s offices, employ health information technology systems. Researchers have found that implementing health IT would result in a mean annual savings of $40 billion over a 15-year period by improving health outcomes through care management, increasing efficiency, and reducing medical errors. Investing in health would also help primary care physicians — who often bear the burnt of tech implementation without seeing immediate benefits — afford the infrastructure for expansion. The Congressional Budget Office has estimated that one-third of $2 trillion spent annually on health care in America may be unnecessary due to inefficiencies in the system such as excessive paperwork. Investments in infrastructure like health IT will help improve the quality of America’s health care.

MCCAUGHEY’S POISONING HEALTH REFORM AGAIN:
Responding to her Bloomberg commentary, the New Republic’s health care writer Jonathan Cohn noted that “Elizabeth McCaughey is up to her old tricks again.” “Not content to have poisoned one major health care debate, she seems determined to poison this one, too,” wrote Cohn. In 1994, McCaughey published a “viciously inaccurate” article on the Clinton health care plan in the New Republic, which is credited with having “completely distorted the debate on the biggest public policy issue of 1994.” McCaughey’s article claimed that there would be “no exit” from the Clinton plan, and individuals would be prevented from “going outside the system to buy basic health coverage” that they preferred. But, as the Atlantic’s James Fallows pointed out after the Clinton plan was defeated, McCaughey ignored “the first provision of the bill,” which clearly said: “Nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services.” Just like in 1994, McCaughey’s latest Bloomberg commentary provides page numbers from the legislation to give her claims the aura of credibility. But just as in 1994, McCaughey’s assertions are not supported by the language of the bill she cites.[/QUOTE]

So, the laws of economics do not apply to health care? Regulation does not equal cost, I hope you are able to explain to me how that works in every business sector except health care? I really dislike the government and the private insurance companies being involved in health care. Quite frankly, what are the qualifications of Chairman Obama and Thomas Daschle to run the health care system? Health insurance started in the Second War because employers were prohibited from giving wage increases as a mandate from your friend, FDR. I disbelieve the Democrats on health care, along with just about everything else, because I have seen them in action. I have worked for the government, have you? When the government pays, they want to regulate the individuals involved in the procedure to death. If you want to know why health insurance is so expensive, look at all of the government mandates for health insurance, imposed by your friends, the Democrats. You must cover this, that, and every other thing. Guess what, that jacks up the premiums to kill any affordable level of insurance coverage for the average family.

I think electronic records are a great idea, do not misunderstand. However, I know from experience in working for the government, there are many violations of privacy, look at the example of the I.R.S. Yet, as in Canada, politicians are not forced to live with the problems of their decisions. For example, a friend of mine in Canada needs to wait five months for a surgery involving cataracts. Another friend in Canada was unable to find a physician for father for over a year, he had cancer. However, politicans in Canada would have their medical issues resolved right away in a military or private hospital. Why would a military or private hospital be acceptable for Chairman Obama or Thomas Daschle and not the average citizen, can we say, hypocrisy? If you would like to get into the various hypocrisy of the Democrats, I have a long, long list.

You should pay thousands of dollars in taxes each year, do Thomas Daschle, Charles Rangel, and Timothy Geithner pay what they owe??? If you committed perjury in court, do you believe that you would not be thrown in jail? Bill Clinton committed endless amounts of perjury and he never served a day in jail. If you believe that is a Republican talking point, I have news for you, that was admitted by high priced Democratic attorneys. Do you believe that Ted Kennedy would wait in line for his cancer treatments? The Democrats are the party of “Do as I Say, Not As I Do.”

Mark Moulliet

Seriously. Daschel withdrew his nomination weeks ago and President Obama has talked about why this is important, why it is an economic issue and why each piece is tied to the larger puzzle.

So long as you continue to refer to the President in a way meant to equate to communism you are not being serious or productive. This is not the right forum for partisan polemics and spittle enhanced ranting. Go away.

From 1994:

The Washington Post:

University of Virgina Professor Martha Derthick that said:

“ In many years of studying American social policy, I have never read an official document that seemed so suffused with coercion and political naivete … with its drastic prescriptions for controlling the conduct of state governments, employers, drug manufacturers, doctors, hospitals and you and me."

Now, you know why we do not trust them.

I don’t believe that it’s regulation, per se, that has caused the increase in cost. Rather, it’s management being added onto medicine by insurance companies or managed care organizations. Regulations protect our safety. That’s exactly why I included the example of the Food & Drug Administration–or you could also add the Consumer Product Safety Commission. Without regulations, we’d still have products on the market like killer lawn darts, cribs with strangulatingly-wide slats, toys painted with lead, etc. The company that knowingly released salmonella-contaminated peanut products to the market had to recall them all (and has now filed for bankruptcy). Would you really rather we didn’t have regulations?!

Years ago in the US, doctors saw patients. Their office staff would do the billing, which was a lot less complex than it is today. Now, insurance companies take a huge cut of US healthcare dollars–far more than in other countries. IMHO, insurance is the wrong model for healthcare anyway. It’s meant to be for catastrophic events, not everyday doctor visits.