The RetrieverTraining.Net Forums The Retriever Academy
Total Retriever Training with Mike Lardy
Hawkeye Media Gunners Up Tritronics Outdoor Media
Page 1 of 3 123 LastLast
Results 1 to 10 of 28

Thread: Obama-Care based on inaccuracies

  1. #1
    Senior Member TXduckdog's Avatar
    Join Date
    Oct 2007
    Location
    Republic of Texas
    Posts
    632

    Default Obama-Care based on inaccuracies

    Here's an enlightening op-ed in this mornings Wall Street Journal. The highlights are mine. This is the first really good analysis of the current healthcare legislation that I've seen. It's not done by politicians or radio show hosts but by very accomplished doctors.


    In recent town-hall meetings, President Barack Obama has called for a national debate on health-care reform based on facts. It is fact that more than 40 million Americans lack coverage and spiraling costs are a burden on individuals, families and our economy. There is broad consensus that these problems must be addressed. But the public is skeptical that their current clinical care is substandard and that no government bureaucrat will come between them and their doctor. Americans have good reason for their doubts—key assertions about gaps in care are flawed and reform proposals to oversee care could sharply shift decisions away from patients and their physicians.
    Consider these myths and mantras of the current debate:

    Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not. Yet it was presented as fact to the Senate Health and Finance Committees, which are writing reform bills, in March 2009 by the Agency for Healthcare Research and Quality (the federal body that sets priorities to improve the nation's health care).

    The statistic comes from a flawed study published in 2003 by the Rand Corporation. That study was supposed to be based on telephone interviews with 13,000 Americans in 12 metropolitan areas followed up by a review of each person's medical records and then matched against 439 indicators of quality health practices. But two-thirds of the people contacted declined to participate, making the study biased, by Rand's own admission. To make matters worse, Rand had incomplete medical records on many of those who participated and could not accurately document the care that these patients received.

    For example, Rand found that only 15% of the patients had received a flu vaccine based on available medical records. But when asked directly, 85% of the patients said that they had been vaccinated. Most importantly, there were no data that indicated whether following the best practices defined by Rand's experts made any difference in the health of the patients.

    In March 2007, a team of Harvard researchers published a study in the New England Journal of Medicine that looked at nearly 10,000 patients at community health centers and assessed whether implementing similar quality measures would improve the health of patients with three costly disorders: diabetes, asthma and hypertension. It found that there was no improvement in any of these three maladies.

    Dr. Rodney Hayward, a respected health-services professor at the University of Michigan, wrote about this negative result, "It sounds terrible when we hear that 50 percent of recommended care is not received, but much of the care recommended by subspecialty groups is of a modest or unproven value, and mandating adherence to these recommendations is not necessarily in the best interest of patients or society."

    The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate. Yet the head of the National Committee for Quality Assurance, a powerful organization influencing both the government and private insurers in defining quality of care, has stated this as fact.

    The World Health Organization ranks the U.S. No. 1 among all countries in "responsiveness." Responsiveness has two components: respect for persons (including dignity, confidentiality and autonomy of individuals and families to make decisions about their own care), and client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). This is what Americans rightly understand as quality care and worry will be lost in the upheaval of reform. Our country's composite score fell to 37 primarily because we lack universal coverage and care is a financial burden for many citizens.

    We need to implement "best practices." Mr. Obama and his advisers believe in implementing "best practices" that physicians and hospitals should follow. A federal commission would identify these practices.

    On June 24, 2009, the president appeared on "Good Morning America" with Diane Sawyer. When Ms. Sawyer asked whether "best practices" would be implemented by "encouragement" or "by law," the president did not answer directly. He said that he was confident doctors "want to engage in best practices" and "patients are going to insist on it." The president also said there should be financial incentives to "allow doctors to do the right thing."

    Data from clinical studies provide averages from populations and may not apply to individual patients. Clinical studies routinely exclude patients with more than one medical condition and often the elderly or people on multiple medications. Conclusions about what works and what doesn't work change much too quickly for policy makers to dictate clinical practice.

    An analysis from the Ottawa Health Research Institute published in the Annals of Internal Medicine in 2007 reveals how long it takes for conclusions derived from clinical studies about drugs, devices and procedures to become outdated. Within one year, 15 of 100 recommendations based on the "best evidence" had to be significantly reversed; within two years, 23 were reversed, and at 5 1/2 years, half were contradicted. Americans have witnessed these reversals firsthand as firm "expert" recommendations about the benefits of estrogen replacement therapy for postmenopausal women, low fat diets for obesity, and tight control of blood sugar were overturned.

    Even when experts examine the same data, they can come to different conclusions. For example, millions of Americans have elevated cholesterol levels and no heart disease. Guidelines developed in the U.S. about whom to treat with cholesterol-lowering drugs are much more aggressive than guidelines in the European Union or the United Kingdom, even though experts here and abroad are extrapolating from the same scientific studies. An illuminating publication from researchers in Munich, Germany, published in March 2003 in the Journal of General Internal Medicine showed that of 100 consecutive patients seen in their clinic with high cholesterol, 52% would be treated with a statin drug in the U.S. based on our guidelines while only 26% would be prescribed statins in Germany and 35% in the U.K. So, different experts define "best practice" differently. Many prominent American cardiologists and specialists in preventive medicine believe the U.S. guidelines lead to overtreatment and the Europeans are more sensible. After hearing of this controversy, some patients will still want to take the drug and some will not.

    This is how doctors and patients make shared decisions—by considering expert guidelines, weighing why other experts may disagree with the guidelines, and then customizing the therapy to the individual. With respect to "best practices," prudent doctors think, not just follow, and informed patients consider and then choose, not just comply.

    No government bureaucrat will come between you and your doctor. The president has repeatedly stated this in town-hall meetings. But his proposal to provide financial incentives to "allow doctors to do the right thing" could undermine this promise. If doctors and hospitals are rewarded for complying with government mandated treatment measures or penalized if they do not comply, clearly federal bureaucrats are directing health decisions.

    Further, at the AMA convention in June 2009, the president proposed linking protection for physicians from malpractice lawsuits if they strictly adhered to government-sponsored treatment guidelines. We need tort reform, but this is misconceived and again clearly inserts the bureaucrat directly into clinical decision making. If doctors are legally protected when they follow government mandates, the converse is that doctors risk lawsuits if they deviate from federal guidelines—even if they believe the government mandate is not in the patient's best interest. With this kind of legislation, physicians might well pressure the patient to comply with treatments even if the therapy clashes with the individual's values and preferences.

    The devil is in the regulations. Federal legislation is written with general principles and imperatives. The current House bill H.R. 3200 in title IV, part D has very broad language about identifying and implementing best practices in the delivery of health care. It rightly sets initial priorities around measures to protect patient safety. But the bill does not set limits on what "best practices" federal officials can implement. If it becomes law, bureaucrats could well write regulations mandating treatment measures that violate patient autonomy.

    Private insurers are already doing this, and both physicians and patients are chafing at their arbitrary intervention. As Congress works to extend coverage and contain costs, any legislation must clearly codify the promise to preserve for Americans the principle of control over their health-care decisions.

    Dr. Groopman, a staff writer for the New Yorker, and Dr. Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.
    Train the dog, the ribbons will take care of themselves.

  2. #2
    Senior Member Buzz's Avatar
    Join Date
    Apr 2005
    Location
    Brookings, South Dakota
    Posts
    6,782

    Default

    Nice to read something that doesn't refer to Nazis, Hitler, death panels, and unplugging granny for a change.

    I have concerns about government developing guidelines for best practices, but I am as much or more concerned about every individual private insurer doing the same. I have been trying to get to the bottom of some health issues since around the first of the year. My doctor feels that if not for the insurance company BC/BS meddling in the doctor's decisions about what tests and what to try, we would be in a better position today. If you bring it up, he gets very vocal about it.
    "For everyone to whom much is given, of him shall much be required." -- Luke 12:48

    Raven - Moneybird's Black Magic Marker***
    (Esprit's Power Play x Trumarc's Lean Cuisine)
    Mick - Moneybird's Jumpin' Jack Flash***
    (Clubmead's Road Warrior x Oakdale Whitewater Devil Dog)
    Peerless - Moneybird's Sole Survivor
    (Two River's Lucky Willie x Moneybird's Black Magic Marker)

  3. #3
    Senior Member TXduckdog's Avatar
    Join Date
    Oct 2007
    Location
    Republic of Texas
    Posts
    632

    Default

    I'm right there with you Buzz on the issue of private insurers.

    It may be simplistic, but I think it's really health insurance reform that is needed more than anything else. But how best to do that and still maintain freemarket enterprise? Or, is that even possible?

    Jeff, I know you had some thoughts on this issue a while back. Care to re-iterate?
    Train the dog, the ribbons will take care of themselves.

  4. #4
    Senior Member YardleyLabs's Avatar
    Join Date
    Dec 2006
    Location
    Yardley, PA
    Posts
    6,639

    Default

    Quote Originally Posted by TXduckdog View Post
    I'm right there with you Buzz on the issue of private insurers.

    It may be simplistic, but I think it's really health insurance reform that is needed more than anything else. But how best to do that and still maintain freemarket enterprise? Or, is that even possible?

    Jeff, I know you had some thoughts on this issue a while back. Care to re-iterate?
    I started to reply earlier but my "puppy watch" started turning into puppies and, 12 pups later, I am too exhausted to think. One comment on the newspaper column. The fact that testimony was givn before the Senate doesn't mean the information was assumed to be accurate. A lot of conflicting testimony is normally given in hearings and it tends to be taken with tons of salt. Setting standards/guidelines for care is not easy. However, for certain types of diseases, including hypertension, it is clear that defined protocols would help improve care and outcomes. One approach that Obama has hinted at is, I believe, a dead end. That is payment based on diagnostic related groups or "DRG's". Thos was attempted on an experimental basis under Medicaid waivers in several states and proved to be a complete bust. It sounds good but leads to dramatic provider abuses as some cherry pick their patients to maximize profit and the others are stuck with more complicated cases that cost more to treat.

  5. #5
    Senior Member dnf777's Avatar
    Join Date
    Jun 2009
    Location
    Western Pa
    Posts
    6,161

    Default

    Quote Originally Posted by Buzz View Post
    Nice to read something that doesn't refer to Nazis, Hitler, death panels, and unplugging granny for a change.

    I have concerns about government developing guidelines for best practices, but I am as much or more concerned about every individual private insurer doing the same. I have been trying to get to the bottom of some health issues since around the first of the year. My doctor feels that if not for the insurance company BC/BS meddling in the doctor's decisions about what tests and what to try, we would be in a better position today. If you bring it up, he gets very vocal about it.
    Agree with both your points.
    As of 2007, we comply with the Surgical Care Improvement Project (SCIP) at our hospital. This is not mandated, but rewarded at the hospital level (who makes local policies, and posts public "report cards" for compliance by physicians for care improvement. If you're a doc, you DON'T want patients seeing that you're less compliant with something named "care improvement", right?

    Since we have implemented this program, our own QI outcomes tracking data shows NO improvement in surgical care! Some of the recommendations are out of line with the various specialty colleges' recommendations based on systematic reviews and outcome data.

    This is not to bash the SCIP program, but as is often the case, programs are devised and implemented by people outstepping their expertises, and applied in ways never intended. (ie linking to pay-for-performance) PFP.

    Health care rationing is here. It always has been.
    Best practice measures are here. They always have been. They used to be called "clinical pathways". The difference now is that adminsitrators are applying these old tools in new ways...ie to deny patients' care, and to deny doctor's reimbursement. This has ramped up tremendously in the past 10 years. (not a dig on Bush) Bill Frist and his family were well known for implementing many of these practices....he was NO FRIEND to physicians from his corporate seat!
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

  6. #6
    Senior Member TXduckdog's Avatar
    Join Date
    Oct 2007
    Location
    Republic of Texas
    Posts
    632

    Default

    VERY interesting points, DNF.

    What is the rationale for administrators to deny patient's care and deny doctor's reimbursements?
    Train the dog, the ribbons will take care of themselves.

  7. #7
    Senior Member dnf777's Avatar
    Join Date
    Jun 2009
    Location
    Western Pa
    Posts
    6,161

    Default

    Quote Originally Posted by TXduckdog View Post
    VERY interesting points, DNF.

    What is the rationale for administrators to deny patient's care and deny doctor's reimbursements?
    One thing that was resolved in a class-action lawsuit against United health care was the practice of bundling and downgrading diagnoses. If a patient comes in with a hernia, COPD, non-healing ulcers, and diabetes, and ALL were diagnosed and treated, the insurance company would say, "that's all part of his hernia" and only pay for that. Those claims would not hold up, and as a result, the practice has been somwhat curtailed. If you have skin moles removed out of concern for cancer, and ultimately the path is benign, the company would say it was an unnecessary procedure. Also, they would pay for the first removal, 50% for the second, and 20% for each subsequent procedure. It was like going to the Firestone dealer and saying you'll pay for one tire, half for the next and 20% the the last two!!

    Those are a couple examples, which have been partially addressed. There is a plethora of other excuses for denying care...unecessary tests, procedures, time frames,etc...

    If you are a cancer patient and need a PET scan, most insurance (and MC) will not pay if you happen to be an inpatient in a hospital. Only outpatients.
    Go figure??
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

  8. #8
    Senior Member Gerry Clinchy's Avatar
    Join Date
    Aug 2007
    Location
    Pennsylvania
    Posts
    6,862

    Default

    My doctor feels that if not for the insurance company BC/BS meddling in the doctor's decisions about what tests and what to try, we would be in a better position today. If you bring it up, he gets very vocal about it.
    I would have to think this also happens with Medicare, and would happen with any plan, public or private, that involved a 3rd party payer. Once there would be a govt option, I can't imagine that the govt would wield any less power than the private insurors.

    Medicare is raising its premiums on its prescription drug plan. The net result will be that those who need the expensive meds will, overall, benefit more & pay less $. Those who do not need such meds, will overall pay more, and not gain any increased benefit.

    It is logic, it would appear, that as the govt plan takes on all those pre-existing conditions, they will show the same pattern of continuing to increase premiums to keep the program afloat. In that regard, it will be no different than any other third-payer insurance program. The difference will be that the govt plan will be able to subsidize its deficits with tax money, so will raise premiums less and less quickly than a private insuror. Even with a private insuror, you are looking at the whole situation in microcosm. Those who are healthy subsidize those who are not.

    It also seems logical that there was a need for Medicare because the health care costs of older people will almost always (over the long term) be more expensive than for younger people as age takes its toll on the human body. For a private insuror, the costs become unsustainable. The govt could tax everyone (with no opt out), and then raise the tax as the govt saw fit to fill the needs of insufficient premiums.
    G.Clinchy@gmail.com
    "Know in your heart that all things are possible. We couldn't conceive of a miracle if none ever happened." -Libby Fudim

    ​I don't use the PM feature, so just email me direct at the address shown above.

  9. #9
    Senior Member dnf777's Avatar
    Join Date
    Jun 2009
    Location
    Western Pa
    Posts
    6,161

    Default

    Quote Originally Posted by Gerry Clinchy View Post
    It is logic, it would appear, that as the govt plan takes on all those pre-existing conditions, they will show the same pattern of continuing to increase premiums to keep the program afloat. In that regard, it will be no different than any other third-payer insurance program. .
    That is true. But remember, we all tend to consume more health care dollars as we age. (LIFE is a pre-existing medical condition!) As it is now, we all bring that condition to medicare, as we hit 65. The private insurance companies are no dummies, and have decided "we'll take you premiums and dole out very few precious claim dollars to young, healthy people, but we know that won't last...so when you hit 65, let Uncle Sam pick up the tag....we're done....you're no longer profitable for us"

    the whole concept of insurance, spreading the risk/cost goes out the window. We know "risk" increases with age, and they have concocted the ultimate cherry-picking scenario.

    NO easy answers here. But the current system is unsustainable. In the end, we're probably ALL going to pay more. Whether a little more or a lot more depends on the plan put in place, and obviously, nobody has the answer right now.

    Avoid the Western Diet and live healthier regards,
    Dave
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

  10. #10
    Senior Member Buzz's Avatar
    Join Date
    Apr 2005
    Location
    Brookings, South Dakota
    Posts
    6,782

    Default

    Quote Originally Posted by dnf777 View Post
    That is true. But remember, we all tend to consume more health care dollars as we age. (LIFE is a pre-existing medical condition!) As it is now, we all bring that condition to medicare, as we hit 65. The private insurance companies are no dummies, and have decided "we'll take you premiums and dole out very few precious claim dollars to young, healthy people, but we know that won't last...so when you hit 65, let Uncle Sam pick up the tag....we're done....you're no longer profitable for us"

    Isn't this inevitable in a system that depends upon employers to provide healthcare insurance?
    "For everyone to whom much is given, of him shall much be required." -- Luke 12:48

    Raven - Moneybird's Black Magic Marker***
    (Esprit's Power Play x Trumarc's Lean Cuisine)
    Mick - Moneybird's Jumpin' Jack Flash***
    (Clubmead's Road Warrior x Oakdale Whitewater Devil Dog)
    Peerless - Moneybird's Sole Survivor
    (Two River's Lucky Willie x Moneybird's Black Magic Marker)

Similar Threads

  1. Baucus Care
    By TXduckdog in forum POTUS Place - For those who talk Politics in the Gallery!
    Replies: 41
    Last Post: 09-28-2009, 10:34 PM
  2. We'll get it right with health care.....
    By Ken Archer in forum POTUS Place - For those who talk Politics in the Gallery!
    Replies: 0
    Last Post: 09-11-2009, 04:16 PM
  3. Questions about Obama care
    By Steve Amrein in forum POTUS Place - For those who talk Politics in the Gallery!
    Replies: 8
    Last Post: 08-13-2009, 09:08 AM
  4. So what would you do? (hypotheatrical based on VW's thread)
    By KJB in forum RTF - Retriever Training Forum
    Replies: 53
    Last Post: 05-10-2005, 11:54 AM
  5. Faith-based breeding.
    By Ken Archer in forum RTF - Retriever Training Forum
    Replies: 2
    Last Post: 10-16-2004, 08:47 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •