Why Ebola petrifies us: One reason is healthcare’s unobtainable expectations.

Ebolacare givers practice safe procedures

Ebola caregivers practice safe procedures

Petrified & Angry

We are petrified of Ebola. It is a deadly disease, but we are much more scared of this today than we were of Polio, and Tuberculosis years ago. Why?

In the 1940s and 50s, modern medicine was a bit less advanced than we are today.  We had many more diseases to be afraid of.  Polio was an epidemic. Outcomes from Polio were not particularly good. Tuberculosis (TB) was a significant issue as well.  People with TB were quarantined.

Travel in that period was not as easy and ubiquitous as it is today yet, we routinely restricted affected people’s movements. In some cases we incarcerated them in sanitariums to protect the public at large. Despite these actions and the lack of effective treatment for these, and many other, diseases, people were no where near as panicked then as we see them today with the current Ebola crisis.

People who grew up in this era will tell you that most Americans accepted the dangers these microbes presented as a regular part of life. Sure, they were afraid of the diseases but they recognized that they had little control over potential infection. If they became infected they understood that HealthCare did not have cures. While there may have been many things to help ease the symptoms, odds were usually not very good that they would see their symptoms eliminated.

Americans accepted the potential negative outcome to themselves as individuals as coming from the hands of fate. They were not panicked about any particular disease, and they were seldom angry or recriminating of healthcare, doctors or medicine in general because there were few effective treatments for anything.

Today, we no longer recognize that much of what happens is not really preventable. We do not recognize that fate still has a lot to do with our outcome from an illness. Somehow we have come to a place where we feel that HealthCare can shelter us and protect us from every microbe, every disease, and every potentially negative health issue. When it fails to do so, we then become angry and recriminating of government, doctors, healthcare and medicine as having failed us. I believe this is one reason we are so anxious about the Ebola issue we face today.

How did we get to this place? And, is it a fair expectation to think that government should be able to protect us from disease, that doctors should be able to cure us of anything that happens, and that healthcare should be able to provide these services easily for everyone with little cost to us as individuals?

Current Debate

The debate over the Affordable Care Act, aka Obamacare, has gone beyond partisan rhetoric into the truly absurd and potentially dangerous. Our recent reactions to the current outbreak of Ebola are a prime example of the danger that can happen when our expectations of what healthcare can deliver far outstrip what medicine can truly deliver.

How we arrived here

Much of what we believe about healthcare and the practice of medicine is wrong. We have ingrained so many myths into the discussion of healthcare so tightly that what we say is often disconnected from what we mean. We speak of single payer systems, and cures for diseases. We routinely confuse popular beliefs and historical methods with scientifically backed best practice. We misunderstand the true extent of medicines capabilities and ignore the cost of their increasing side effects. We conflate our heath needs with our health wants and ascribe equal weight and priority to both. We have so disconnected ourselves as consumers of care that we do not understand the real effect of the care we receive. When it seems to work, more often than not it’s a result of our body’s natural ability to heal not what modern medicine can reliably deliver.

The Plague of Myths

  • We believe we have a healthcare system
  • We believe that we already have, or are near to having, cures for everything
  • We believe what is good for us as individuals is good for the human species
  • When it comes to healthcare we think that what we want is the same as what we need
  • We believe healthcare is safe and effective most of the time

Do we have a healthcare system?

No, what we have is at best a collection of self-predatory practices and methods that promulgate massive increases in costs, erosion of effective checks and balances, little accountability, and exponential unintended consequences to patients, providers, facilitators and program sponsors.

Is healthcare effective?

We believe we have cures for everything. We believe that doctors know what they are doing and provide safe, effective, care most of the time. The truth is doctors do an amazing job, the things they have learned have helped extend life from 45 years old, at the time my grandfather was born, in the 1800s, to over 78 years old today. But, what we expect from healthcare providers is a far cry from what the science of medicine can actually deliver – We simply expect too much. Much to our collective dismay, Medicine in the 21st century is still much more art than science. Look at the stats.

  • 2003, Drs. McGlynn et.al. reported that doctors get their diagnosis wrong about one-half of the time.
  • 2008, Dr. Norman Scarborough reported that multiple autopsy studies revealed frequent clinical errors and misdiagnoses with error rates as high as 47%
  • 2008, CBO director Peter Orszag reported to congress that more than $700 billion of $2.9 trillion spent on healthcare did nothing to improve outcomes and in many cases produced harm
  • Sanjaya Kumar in 2011 found only 20% of clinical practice treatments doctors deliver to patients are backed up by solid controlled trial evidence of effectiveness.
  • Multiple Studies show that medications are only chemically active in about 68% of the population, sometimes startlingly less.

In summary, half the time the diagnosis is wrong, the treatment provided is seldom backed by scientific best practice, when medications are provided many times they have no effect. Even when treatments do work, the system is fraught with safety issues. Often, the diseases healthcare needs to treat are seldom seen in most hospitals or, as is the case with Ebola, have never been treated here before.

Is healthcare safe?

The Institute of Health Improvement reported (2007), that about 40,000 times per day there is an incident of medically induced harm – about 15 million cases per year. There are about 4,600 incidences per day of Hospital Acquired Infections. (CDC 2007). Institute of Medicine report (2006) showed that medication errors account for about 1.5 million patients harmed each year. About 12,000 heart-attack patients are mistakenly discharged from hospital emergency departments each year. (Wachter and Shojania 2004) Firefighters lose their life in their job at the rate of about 4 deaths per 100,000 in that occupation. Loggers have an occupational death rate of 102 per 100,000. Commercial fishermen die at the rate of 200 per 100,000, the Deadliest Catch rate. Surprisingly, 265 people per 100,000 die as a result of seeking healthcare each year.

Why we feel the government is lying.

We have come so far in our false expectation of healthcare that when it does not work we are left believing it is someone’s, or everyone’s, fault. We seek to blame all connected. We believe the government has not provided what we believe is not only our right but, what we also believe is an expected level of care and outcome.  If reality does not equate to our belief we expect reality to be adjusted, not our faulty beliefs. We believe government, and healthcare workers are to blame and we believe they are not telling us the truth when their words do not match the myth we hold dear. The people in the government then feel a significant need to color the pure truth, because they are concerned over the negative reaction and potential panic.  It becomes much easier for them to say things like, “Ebola likely will never come here”, or “If Ebola does come here, we are prepared.”  They know these statements are not true but, they simply cannot bring themselves to say the pure truth.  Healthcare professionals have so long carried the unrealistic burden of omniscience and infallibility that to even hint they do not know something destroys their own confidence in their ability to treat.

Summary

While there are a number of other myths, these are a few of the significant ones. Healthcare’s just not as safe or effective as we expect. Little wonder why the current Ebola outbreak is causing so much concern or why most Americans believe the government is neither effectively able to deal with it nor tell us the truth about it. We need to move beyond the political rhetoric over Obamacare and fundamentally fix our healthcare system now.

Breast Cancer and Enviornmental Causes: Links not as clear as we’ve hoped.

The latest research is finding that real links between environmental causes, genetics and occurrence of Breast Cancer continue to be elusive. Perhaps, it’s for a reason. Are we thinking of cancer in the wrong way?

Published in Aquila Style (click to read original article)

Published in Aquila Style
(click to read original article)

October is National Breast Cancer Awareness Month.

The above graphic is from an interesting article titled, Suprises in Hunt for Environmental Links to Breast Cancer, published by , 6:30 pm Monday, 11th November 2013 on http://www.aquila-style.com. The article is about one of the latest studies trying to find a definitive link to breast cancers’ origins. Many studies have tried to find links to environmental and genetic causes. So far the research has not been definitive to say the least. We do know that genetic mutations are present in many cancers, but we also know that they are sometimes not there in some – where we expect them, and are there in many – where do not see the cancer develop.

“We have still got 80 percent that has got to be environmental,” said Reinlib, who is part of the Breast Cancer and the Environment Research Program (BCERP) program that has received some $70 million in funds from the US government since 2003.

The above quote from the article seems to indicate that there is clear evidence that the causes simply have to be environmental because we have ruled out that family history is the main indicator. Yet, this may be a false premise as well.  Just because a white jelly bean is not vanilla flavored, does not mean it must therefore be coconut flavored. It can be any flavor at all or have none! Most of the research into environmental, family history and genetic mutation indicators have shown relatively slight correlation to the actual development of breast cancers.  These indicators may statistically increase the chances a few percent but they do not provide definitive guidance that one will, or will not, get cancer.

Recently, some researchers are starting to discuss cancer, less as a disease — even though the outcome is devastating on the individuals and the family — but more of a naturally occurring process — perhaps necessary in the species. Perhaps this same process that sometimes evidences as cancer, is a natural part of the core engine that drives natural selection to improve the species. Changing how we think about and classify cancer may have more of an effect on how we learn to adapt to it than “cure it” as time goes on.

We have found many genetic markers in the past decade or so that we felt were the main drivers of disease, like the BRACA genes for breast cancer, only to find that they turned out to not be specific. BRACAs were considered a key indicator specifically for breast cancer but recently has been shown to exist for prostate — not much of a surprise as prostate and breast tissues are histologically very similar — lung and now many other cancers as well. BRACAs are more likely broad based cancer markers as time will likely tell.  Most genetic markers are likely relatively nonspecific. In fact, our genes may be good blueprints for building the body and its systems but may not be the control point for what happens with these things when they are built.

Further, genetic markers themselves have been know to not be definitive for the occurrence of a cancer. You can have the markers and not get the cancer, and you can sometimes have the cancer and not have the markers. Some other researchers now believe there is a different biochemical system at work. Undiscovered, this other system has been dubbed epi-genetic — meaning above the gene. Numerous studies over the past 15 years have indicated the presence of some other control point. Don’t forget that it took many decades for actual chemistry of DNA to be identified and proven; even though we understood the theory of its presence for many years.

It is likely in the years to come we will find more answers to these new questions and new theories will fundamentally change how we think of cancer and reset our expectations on its treatment and occurrence.

Please remember all those who have died due to this horrible disease!

Why the Middle Class is Still Getting Crushed: Lets look back!

It is now crystal clear that the middle class are being destroyed. Politician’s explanations are based on pure biased rhetoric. The real reason is much simpler. It is the mechanics of how we are trying to fix the economy.

This is a reprint of an earlier Article, originally published September of 2013, on some of the reasons the middle class in America are declining. At the end of the article will be links to a couple other articles relating to this issue.

man_question_mark DemoCare demolishes America’s Middle Class

The Affordable Care Act is often called ObamaCare but I think from now on it should be called “DemoCare” because it’s going to demolish care in America and along with that demolish America’s Middle Class.

There are quite a lot of things about the way this law works that make it undesirable.  Mostly, the causes are not in the debate that we hear so much about nor are they in the parade of facts that we are about to be inundated with over the next 90 days from those selling the benefits or arguing against them.  Like most debates the truth in the rhetoric is somewhere between the extremes. There are many flaws, there are some benefits but there are massive amounts of unintended consequences. This is why, I do not call for its repeal.  I call for amendment and alteration.

DemoCare demolishes  America's Middle Class

DemoCare demolishes America’s Middle Class

I agree with the provisions that prohibit refusal or cancellation of insurance because of disease state. I also agree with the concept of a base level insurance policy that is offered as a minimum by all insurers.  I agree with some of the provisions that help provide, monitor and manage our national safety net for the helpless. If you want to see more of what I think refer to my latest book, The History and Evolution of Healthcare in America.

What is disappointing, is the use of facts in a manner that obscures the real effects of the law, in once respect, and the ignorance of the problems in the underlying mechanisms, unintended consequences, and damage to needed mechanisms and industries in other respects.

Since the law was created to lure Americans into a system, to hook them to increased dependence and then force the failure of the for-profit system leaving only the option of a federal single payer system, that the legislators pushing the law failed to achieve, the construction of the law itself will demolish our care systems, hence the new name DemoCare, on many levels.

Let’s look at one or two of these many levels. You can go to my Blog to see many more: http://tloker.wordpress.com.

Personal Healthcare costs will drastically increase

Much is being made about the low cost of care and how the premium costs are actually declining now and will continue to do so in the future—this is simply not true! At the time of the law’s passage the average cost of a policy for a family of four was about $8,000.00 per year.  Today it is over $13,300. You will notice that the stats on lower cost plans are calculated from the policy costs of this year, mid-2013, compared to the lowest levels of the estimated policy costs in the new exchanges, fall of 2013. Well, if you have suffered significant cost raises since 2009 and you only look at the last few months the initial policy premium may appear lower, but if you’ve been paying the bills for your family of four they are anything but lower.  Secondly, many of the premium costs shown in articles include eligible subsidies for those who are eligible. They are simply false comparisons. Health care costs, and premium costs have gone up a lot since 2009.

Now let’s look at the overall costs, beyond just the premiums, and what it means to Americans.

You can purchase the lowest cost plans and they come with a deductible limit of about $6,500.00 per year meaning you will spend that money before any insurance coverage kicks in.  You will pay a premium of between $150 and $300.00 for a Bronze level plan depending on your state.  You can’t get a subsidy if you buy the cheapest plan, Bronze, you have to buy the more expensive silver or gold. We’ll take about the subsidies in the next section. So when you really look at the numbers there is one more number that is important… How much do people actually spend on care in a year?  Answer is about $8,500.00 per year. (I’m using rounded numbers to make the math easy) So to be clear, to be painfully obvious, you will pay on average about $8,500 per year on care. If you buy the cheapest policy (the one that’s such a great deal everyone should have at least one) you will pay out of your own pocket about $6500.00 before the insurance covers anything, and you will pay somewhere between $1750 and $3600 per year for premium payment—and remember you can’t get a subsidy for the cheapest plan!  What a deal! I think you should all sign up right away. Sure, for some who have chronic illnesses this still could still be a good deal but this is not the majority of America.

So why is the law also Demolishing the Middle Class?

Let’s start with some simple definitions just to make it easy to divide people. We need to be able to discuss clearly who are Poor, who are Rich and who the middle-class are.

  1. Poor are people who do not earn enough to live, not simply survive, without some subsidy.
  2. Rich are people who have more earnings, and assets than they need to live and can invest some of the excess earning or assets to hedge against loss of buying power.
  3. Middle Class are people who have either not enough to invest to hedge against the loss of buying power or make too much to get a subsidy.

Under DemoCare, and many other federal and state programs, you can get some subsidy is you earn less than 400% of poverty level. So why it that the federal poverty level has not been is revised to a higher number and now we just multiple it—two three or four times? For a family of four this comes to about $89,000 per year in income.  As a side note, this represents about 60- 70% of the US population by the way and even without DemoCare over half of the nation gets about one half of their annual income directly or indirectly from a federal subsidy already. So for the purposes of this discussion. Poor are anyone who earns less than $89,000. And, on Monday if you earn less than $89,000 there is a federal subsidy for you. Welcome to the Poor club of America where all of your dreams can come true!

If you are Rich, this means you have excess assets or income—income that you don’t need to keep living in your home, put your kids through school and keep food on the table. Today, on average, this number is about $175,000 per year.  I think this is a high number but for this discussion let’s go with it. If you’re Rich, you can invest some of this excess money into savings accounts or the stock & bond markets (the prime vehicles of choice today) and you can earn interest or receive gains. In effect, while you believe these are really gains, what they have been mostly is keeping you somewhere between earning slightly less than the rate of buying power reductions or significantly more, depending on how much “extra” you really invested.

So, if you are in the Middle class you don’t get a subsidy and you can’t keep ahead of the loss of buying power! Oh yea, I forgot to ask, “Where is the loss of buying power coming from?” Well, in a large part it’s coming from the federal programs providing subsidies to an increasing number of American citizens.

Since 1972, when we only had about $500 billion of currency in circulation, we have been printing money with no real basis in tangible value.  We had to do this because we were spending a lot more money, between federal subsidy programs, wars, and trade deficits, than our economy could generate.  So we changed over, and over, how we calculated the amount of currency that was OK to have. As of today we have somewhere around $17 Trillion of currency in circulation. During the same time we have continued to have a trade deficit (cumulative since 1972 about $12 Trillion) and we have continued to increase what we spend for war and subsidies. So at the same time we also have a U.S. Debt of about $16 Trillion.  Don’t try to balance the numbers as they just don’t balance.  Maybe this is why the government hasn’t passed a budget since Lincoln! 

So why is DemoCare killing the Middle Class?

If you are Poor, as your ability to purchase what you need has been eclipsed by the loss of buying power due to printing money with no basis to an increase in real value, the government has simply printed more money to cover the subsidies.  So the Poor get protected against, inflation, deflation, cross-flation, stagnation, whatever term you want to apply. In reality, as they had to buy less to pay, the government has printed more money to give to help them pay for what they can’t afford. Since we purchase from other nations more than we actually produce, a lot of the new money spent has flowed out of the U.S. and we have lost even more buying power, requiring new money – a vicious, viscous, cycle! The Poor disproportionately capture the new printed money to make them “whole.”

Now, if your one of the Rich, because, you can invest some of your “extra,” you have been able to disproportionately capture a bit of the new money as it has entered the market. You can borrow it, and pay interest on it allowing the printing of more new money, you can invest it in stocks and bonds, where the high yields have been because this is how a lot of the large dollar amounts of new money have entered to economy, or you could invest some of it in creating new businesses and get tax breaks, which require the government to make up the loss of revenue by – say it with me – printing more new money. So the Rich can hedge against the loss of buying power. Now, who in the economy can do neither?  Who are getting crushed? Who is it that is losing this game really badly and will lose even worse on October 1st? Yes! You are correct! You paid attention and got the correct answer! The Middle Class. They are getting disproportionately screwed.

One last thing to ask yourself. Who is it that the government constantly tells to borrow more and buy more?  The exact part of the population that has no ability to do either! The Middle Class!  And as the government has tried to help the Middle Class they have simply converted a huge section of the population from Middle Class to Poor government subsidy dependent citizens.

As DemoCare continues to implement and we swell the current 50% of subsidy dependents to 60-70% government dependents, the Middle Class will be further demolished. Ultimately we will end up just where the rhetoric claims the problem is today.  There will be little to no Middle Class. There will be Rich and there will be Poor.  And there will be such a break in numbers between the two groups that likely we will have a societal catastrophe. This will not be the fault of some conspiracy of Rich people trying to hurt the Poor for their own gain!  This makes for great debate, great argument, and is a good tool to get people to join a side.  It will be because, we have allowed the evolution of a financial, and economic system that is just one big unintended consequence!

So welcome to DemoCare, jump right in the waters going to be just fine!

More Reading if your interested:

QE3 will crush the middle class: What appears as good news may not be after all Sept. 2012

President Obama Describes Role for the Middle Class Aug. 2012

Middle Class Myth: Let’s Try This Again Jan. 2012

You may also want to check out Health Reform 2.0.

Report Reveals Employed Physicians Losing Money for Employers

http://www.physiciansfoundation.org/uploads/default/2014_Physicians_Foundation_Biennial_Physician_Survey_Report.pdf

The Physicians Foundation has once again published their excellent report, 2014 Survey of America’s Physicians Practice Patterns and Perspectives. The Foundation once again contracted with Merritt Hawkins – a subsidiary of AMN Healthcare – to conduct the survey. For those of us who like these kinds of reports, this one carries some of the interesting trends and data from their 2012 report forward, and adds a number of pertinent and timely new questions to the mix. The 2014 report is chocked full of interesting information, trends, data points and facts about how physicians are responding and adapting to the Affordable Care Act. Over the coming days we will be assimilating more of this information and relating it to other trends, reports and raw data. Keep checking back as we do so to stay abreast of this new information as it is digested, analyzed and evaluated.

As so often happens, one small entry grabbed our attention as it is highly indicative of a trend-line that is becoming of significant concern to us and many others. The foundation reports that for 2012 the median LOSS for an employed physician – meaning a doctor that is an employee of a hospital or group practice, a significant and growing trend – was $176,463. To be clear organizations that had doctors working as employees had a median loss of over $175,000 per physician, per year, on the services they performed.

The median loss for employing a physician in 2012 was $176,463, which causes some observers to question the long-term financial sustainability of the physician employed model. (Making Physicians Pay Off, Modern Healthcare. February 22, 2014)

This is a shocking revelation in that we are led to believe that physician owned private practices, either small group or individual, while seeing small to modest gains in overall income last year are losing money. This trend to unprofitability in individual practices is supported both in other reporting and in some of the empirical data from the Physicians Foundation’s report.

The trend to aggregation of independent practices, by hospitals and large groups, has been driven by the belief that, generally, the economies of scale gains of aggregation will deliver consistent return to profitability during this time of declining margin in healthcare. Simply put it is based on the concept that, “We can make it up in volume!” Any retailer will tell you the failing of such an idea. Circuit City and many others have learned these lessons and can offer chapter and verse examples. If those physicians that have already aggregated and sold out their practices are still losing in excess of $175,000 per year, what does this portend for independent practice physicians today?

Looking at various other more consumer based models, tells us that it is not often aggregating volume that will return profitability in a declining margin industry; it is through the management of the mix and margin of services offered that is the key to sustainable performance. Sure, increased volume can bring economies of scale, but simply increasing the volume of negative margin services can have disastrous effects on a business or industry if you can’t also reduce the number of losing operations you must perform to a minimum and replace the time saved with higher margin services. The next question will be how do we re-educate patients and physicians and rebuild our healthcare system to actually yield better results?

This and other questions are exactly the kinds of issues Health Reform 2.0 was created to address. Stay tuned for more tidbits from this Physicians Foundation report.

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Doctors NOT taking insurance may actually be a good thing for healthcare!

man_question_mark

Questioning Our Preconception of HealthCare

In an Aug. 23, 2014 Reuter’s article called, “‘I don’t take insurance’ not always a doctor deal breaker,” author Beth Pinker, explains how this typically plays out for a person seeking care.

As more and more people realize the extent of the funds they will need to spend before they gain access to insurance coverage — the average deductible is now $5000 — Physicians are waking up the fact that insurance and government reimbursements are too low for their “business” of medicine to survive. Recent numbers indicate that 40 to 50% — in some cases more — have already decided to opt out of insurance and move to so called concierge, i.e. retail, medicine.

The attraction for the physician is faster payment, and in most cases, a higher margin on the services performed. One of the big drivers is the total size of the pot of deductibles that will need to be spent for full insurance to kick in for the insured.

Some argue that the average deductible is not really $5000, that it is closer to $3000 per year. Still, with over 186 million insurance policies in the U.S. this lower estimate yields a total available market — called TAM by marketers —  of $500 billion that must be spent before insurance coverage kicks in. Any marketer will tell you, this makes desired value-based deductible retail healthcare one of the largest market opportunities out there.

It is not surprising that many doctors have already moved to some form of a retail model. Even physicians that feel they need to keep one foot in the reimbursement based model are exploring ways to augment this with more direct pay services. Companies like https://pokitdok.com/ are helping physicians pave their way into a more sustainable healthcare service model. Many more are working with doctors to help them begin to manage their margin and mix of patients and find incremental revenues from historically unavailable sources.

Most physicians would be well served to take a look at these alternate revenue models and the evidence clearly shows most already have.In the long run, this is a good and necessary step. It portends the start of what likely will finally become an effective and efficient healthcare system.

For some, this may seem counter-intuitive but it is really the step that must be taken.  In the end, it will help set up a good basis for the additional evolutionary steps to design an effective and efficient system. A system that can provide assurance we have the resources to “Help the Helpless” while providing value-based choice for those who can afford more.  Most importantly, this will help provide a basis to integrate and manage the two economies through a common administrative system eliminating duplication of services, waste and fraud while bridging those in crisis together with all available resources necessary to treat their complete needs and provide comprehensive and fully coordinated care. By now, we all know this improves patient outcomes and lowers costs.

If your interested to learn more about why this is really a good trend and how such a system might look, you can go to http://healthreform2dot0.org/

 

When Mammograms Lie: An article by Sharon Kirkey published on Canada.Com

When Mammograms Lie: How cancer can sneak past our greatest screening techniques

Just because the results of your mammogram are negative, doesn’t mean you don’t have cancer

By Sharon Kirkey, Postmedia News May 23, 2014 (CLICK THE LINK TO READ THE ARTICLE)

“Four months after her mammogram came back “normal,” Susan Quinn-Mullins discovered the lump herself, a smooth, hard mass on her left breast the size of a big marble. An ultrasound revealed a tumour nestled deep in dense breast tissue. It was stage 3 — aggressive, invasive breast cancer that was spreading to the surrounding lymph nodes…”

Breast Density Types

Breast Density Types

This interesting article not only chronicles the story of people who initially relied on mammography to check the health of their breasts but also serves as an incitement over the undue reliance on this as the sole modality. It also brings in some contra posing views on the debate over dense breast notification laws.

Breast Cancer is the number two killer of women in America, lung cancer is number one at the moment. The issue of dense breast related problems in imaging has been long known but for the most part hidden. It is a sordid tale in some ways. For years women have been told get a mammogram and you will reduce your chances of dying from breast cancer because, with mammography, we can detect the cancer early, smaller than you can palpate, feel with your fingers, the tumor. What has not been discussed is that we can further reduce your chance of dying from breast cancer because, for about half of all women, by adding additional screening techniques we can detect the cancer earlier than it can be seen on the mammogram. What has also not been discussed is that, for about half of all women, their breast biology so compromises the appearance of the mammogram that, without additional screening techniques, the probability of performing unnecessary follow-up diagnostic activities on benign structures is greatly increased.

Age Specific Breast IncidenceStartling Statistics

  1. Contrary to claims by many in the medical community, mammography is not the only method of early detection which has demonstrated a reduction of mortality from breast cancer. The same studies that many cite to support this position demonstrate that, finding cancers smaller, and before they have spread to the lymph nodes, significantly reduces mortality – regardless of the method used to detect those small early cancers.
  2. “While mammogram detects 98% of cancers in women with fatty – non dense – breasts, it finds only 48% in women with densest breasts.” (AreYouDense.com) This translates in to at least 100,000 invasive cancers in the US each year which could have been discovered at a meaningful earlier stage than that at which they were actually discovered.
  3. Even when the cancer is discovered in women with dense breasts, the clinical evidence suggests that it could have been found at about half the size (less than 1cm vs almost 2cm) and, more often, before it spread to the lymph nodes (less than 10% of the time vs 15% to 20% of the time), had an additional screening tool (ultrasound) been added to the mammogram.[i], [ii]
  4. Women with dense breasts whose cancers are found with mammography alone are 2.5 times more likely to die from that disease than women whose cancers are found with mammography and an additional screening method (30% 20 year mortality for cancers discovered at 15-19mm vs 12% 20 year mortality for cancers discovered at less than 10mm)
  5. 70% to 80% of cancers occur in women without major known risk factors[iii],[iv],[v] Most breast cancer risk analyses do not consider breast density, despite the fact that density is one of the strongest predictors developing breast cancer (Nancy has this stat).
  6. In addition to being a major predictor for developing breast cancer, “Breast Density is one of the strongest predictors of the failure of mammography screening to detect cancer” (AreYouDense.com)
  7. “Approximately 75 percent of women in their 40s have dense breasts. This percentage typically decreases with age – but half of all women aged 40 and older have dense breasts.” (Dense Breast Tissue Should Not Be Ignored, By David C. Weintritt, MD, FACS, Director Breast Care Institute Mount Vernon Hospital, Wednesday, October 24, 2012
  8. Dr Louise Eriksson and her colleagues from the Karolinska Institutet (Stockholm, Sweden) found that women with denser breasts had nearly double the risk of their cancer recurring, either in the same breast or in the surrounding lymph nodes, than women with less dense breasts. They warn that doctors should take breast density into account when making decisions about treatment and follow-up for these women. … “We found that if you have a PD at diagnosis of 25% or more, you have an almost two-fold increased risk of local recurrence in the breast and surrounding lymph nodes than women with a PD of less than 25%.” (The European CanCer Organisation (ECCO))
  9. In 2011, approximately 39,520 women were expected to die from breast cancer. Only lung cancer accounts for more cancer deaths in women. Page 6 of this report shows that the incidence rates for breast cancer have continued to increase but death rates have declined.(Breast Cancer Facts & Figures 2011-2012)
  10. Recent studies indicate that it is not just a family history of breast cancer but perhaps a history of ovarian and prostate cancer may also contribute to increase risk in women. (Susan G. Komen.Org)

Tumor Size at time of DiscoveryDisturbing Trend

Despite study after study indicating there are significant risks to women with dense breast tissue, and the fact that a significant number of women have dense breast tissues – 50% of the population on average – there are those who are seemingly working hard to obscure these facts. Perhaps it is simply they do not want to “panic” women but some people believe there is more afoot than just simple concern for women’s anxiety.

One question needs to be asked, “If this has been known for quite some time, why were women not informed?” Radiologists have known for decades that it was exceedingly difficult, in some cases close to impossible, to detect cancers in women with dense breast tissues. Yet few, if any, radiologists informed women of the significant deterioration in the ability to perform effective early diagnosis for these women. Interesting, because the argument for regular screening mammography has been for women to benefit from early detection. But how beneficial has it been if over 50% of those getting regularly screened were dense, and it was not possible, by relying on mammography alone, to find half of the cancers at an early stage in this population?

Over the past 10 years the movement to force notification to women who have dense breasts has been building. Advocacy groups like, Are Your Dense have been arguing publicly for this need. Yet, something so common sense and simple has taken quite a while for actions to begin to happen. It seemed so simple to approach state legislatures with information about how dense breast tissues are obscuring cancers and increasing the cancer risk and mortality of these women. One would have thought this was an easy decision! Just pass a law to require notification for these women! Simple, right? Evidently not. It has taken over 7 years for 16 states to pass such legislation. Why? In many of these states the law requires notification but ion only a few does it go beyond notification and require alternate screening methods to be disclosed and in even fewer do the states require insurers to pay for the additional screening methods.

Why is this so difficult? Why is it that some organizations have grasped the isolated studies that report breast density has no effect on outcomes when so many other studies point to effectiveness? Why do medical groups, such as those represented by www.breastdensity.info, present information which is factually untrue (“small studies (with screening ultrasound) have shown a modest increase in sensitivity”, when, in fact many, large, studies have shown a dramatic, and statistically significant, increase in sensitivity). Why do so many states listen to those physician groups who argue that the other screening methods do not provide significant value? Why do so many breast centers avoid whole breast ultrasound, the most cost effective secondary method, arguing that it has high false positive rates – it doesn’t, that it adds to the cost – it does by about $110.00, or that it significantly interrupts their workflow and decreases the number of screens that they can do in a day – some systems do this but other systems simply do not. Some cite the high cost of supplementary screening, referring to the use of MRI – a valuable and very capable, and expense diagnostic system – which is clearly not necessary for secondary screening, or the high labor costs associated with ultrasound screening. While MRI devices cost millions to purchase and maintain, effective automated screening ultrasound system reduces labor effort and start as low as $85,000 – for the BreastMapper system from Tractus Corporation, to about $300,000 for other automated screening ultrasound systems (such as the U-Systems be GE).

Governmental Dirty Secrets

While it may be slightly exaggerated to classify these as “dirty secrets,” many states have resisted the call to approve their dense breast notification bills because of legitimate concern over the rise in Medicaid costs due to the increase in early diagnosis and treatment of these breast cancers that otherwise today remains hidden. Logic dictates that earlier detection leads to lower cost of treatment. The cost of providing ultrasound screening to the 15 million women with dense breasts who receive mammograms each year is $1.8 billion, and yields a reduction of just $9,000 in treatment costs for the 200,000 women who are diagnosed with invasive breast cancer each year. This is what much of the literature and reporting indicates. But, for many states, struggling with already tight budgets—further strained due to the extensions under the Affordable Care Act – the costs are seen as significantly problematic. Screening costs are immediate, savings from screening are projected. It is true that the federal government will provide states with subsidies for increases in cost under the expansion rules in the ACA. Yet, this is limited to only the increase in costs associated with those patients that fall into the increased eligibility area, not regular patients that are now signing up due to the increased awareness. Nor is it true for those patients whose costs are increasing due to better diagnosis. California’s governor, Jerry Brown, vetoed his states dense breast bill for three years, only approving it in the last legislative session. As stated, many states have simply enacted a limited law that only requires physicians to provide their patients with a letter stating they have dense breasts – that’s it!

“Dear Ms. Smith, we have the results of your mammogram. It was normal. By the way you have dense breasts!”

The above quote, it a bit of hyperbole but not far from the truth in how many women are being informed of the problem with having dense breasts. First, the report did not tell the woman that she did not have cancer – it reported that her breasts were “normal”. Most patients interpret this to mean that they did not have cancer. They typically do not interpret it to mean that their breasts are “normal” for dense-breasted women and that “normally” the doctor couldn’t find a cancer on that mammogram if their life, much less the life of the patient, depended upon it. I have a lifelong friend, a nurse in Maryland, who after receiving her bi-annual mammogram received a notification that she had dense breasts. No, notice of what this meant to the ability of the mammogram to detect cancer in her breasts, no notice as to what option she may have to get a secondary effective screen for her dense breasts, not even a statement that she should seek a secondary screen! This is what is considered in many of these 16 states as effective notification. I think NOT!

What Should You Do?

First, if your state does not have a dense breast bill and you get a mammogram, ask the radiologist if you have dense breasts. If you do, ask, or perhaps demand is a better word, to have an automated screening ultrasound done! I mean, why not? We are told to demand this drug or that drug form numerous TV commercials that then proceed to tell us of all the dire side effects we can suffer from taking the medication. Why can’t we demand to have an automated screening ultrasound to detect cancer when the potential side effect of the screen is nothing more than 10 to 20 minutes of additional time? Don’t tell me there is the risk of a false positive! There may be! But which do you think is better? A false positive that can then be cleared up by an MRI, or a biopsy, or finding out a few years later that you have a stage 3 or 4 cancer that was undetected due to your dense breasts?

Second, if your state doesn’t have a dense breast notification bill find your local group(s) and get active to demand they address this issue. Check out www.areyoudense.com to find out more. If your state has a law but the law does not require anything more than the kind of notice in the quote above, go raise a little hell! It should at least require some notification of what dense breasts mean in terms of the efficacy of the diagnosis and what options are available to you to get further testing.

Third, after you have achieved these first two objectives, work to get your state insurance commissioner to mandate that automated screening ultrasound – for dense breasted women be approved and reimbursed by insurance companies offering coverage within your state. It is long past time for this issue to get resolved. I have seen a number of people devastated by breast cancer. My mother, mothers in law (more than one), friends, family, and neighbors. While mammography has been a very effective tool over the past so years at reducing deaths from breast cancer, it is now known that it is not as effective as we thought it was, or were led to believe. Let’s change this and get to the next plateau in the reduction of unnecessary death from this horrible disease.

Finally, do not wait for insurance reimbursement to get this, potentially life-saving, procedure. When it pays, insurance reimburses $100 to $150 for whole breast ultrasound. If you are denied coverage find a way to get $150. That is just five cups of coffee per month.

 

 

 

 

 

 


 

[i] Weigert, et al; “The Connecticut Experiment: The Role of Ultrasound in the Screening of Women With Dense Breasts”, The Breast Journal, Volume 18 Number 6, 2012 517–522

[ii] Bae, et al; “Breast cancer screening with US: Reasons for non-detection”, Radiol (2014) Vol 217:No 2, 369-377

[iii]      Colditz GA, Willett WC, Hunter DJ et al (1993) Family history, age, and risk of breast cancer. Prospective data from the Nurses’ Health Study. JAMA 270:338–343

[iv]      Gail MH, Brinton LA, Byar DP et al (1989) Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81:1879– 86

[v]       Seidman H, Stellman SD, Mushinski MH (1982) A different perspective on breast cancer risk factors: some implications of the non-attributable risk. CA Cancer J Clin 32:301–313

Figure 1: American Cancer Society Surveillance Research
Figure 2: Stephen W. Duffy, MSc, CStat,* Laszlo Tabar, MD, Bedrich Vitak, MD, and Jand Warwick, PhD, “Tumor Size and Breast Cancer Detection: What Might Be the Effect of a Less Sensitive Screening Tool Than Mammography?”, The Breast Journal, Volume 12 Suppl. 1, 2006 S91–S95

 

Healthcare Reform 2.0 – Better Solutions Summary

Thomas W. Loker:

We have put together a summary of the Healthcare Reform 2.0 solutions. Please take a look and remember we are soliciting feedbalck and comments now. This will change.

Originally posted on Health Reform 2.0:

The ACA – ObamaCare is failing, and will surely fail, but not for the populist reasons being discussed so readily today!

Overview – Why We Still Need More Reform

We now expect significantly more from our country’s healthcare system – and by extension its governmental structures: federal, states and commonwealths – than we did at its founding. We no longer value the role of Benjamin Franklin’s style of “compromise though tolerance as we once did. Everything we now attempt to do becomes locked in an all-or-nothing outcome based approach. The latest healthcare legislation, and more recent proposals, can be seen as the culmination of this dysfunctional approach.

For a variety of historical reasons, all seemingly reasonable and appropriate at the time, we have adopted a series of modifications, often in the form of rules and laws, to try to affect corrections to one part, or another, of this non-system. All…

View original 2,843 more words

John C. Goodman: Obamacare – A Costly Failed Experiment

Originally posted on Health Reform 2.0:

[testimonial author="John C. Goodman March 21, 2014 The Wall Street Journal]With Sunday marking the fourth anniversary of the Affordable Care Act being signed into law, it’s worth revisiting the initial purpose of the president’s signature legislation: Universal coverage was the main goal. Four years later, not even the White House pretends that this goal will be realized. Most of those who were uninsured before the law was passed will remain uninsured, according to the Congressional Budget Office…

…So four years into this failed experiment, what are the alternatives? Getting rid of the mandates, letting people choose their own insurance benefits, and giving everyone the same universal tax credit for health insurance would be a good start. More easily accessible health savings accounts for people in high-deductible plans is another good idea.[/testimonial]

Mr Goodman starts and ends his excellent article, A Costly Failed Experiment, with a clear and concise summary…

View original 954 more words

Health Reform 2.0 Site Launches

Aside

HealthReform20 site picFor some time, we have been working on taking the years of work and effort of understanding the issues that have plagued our healthcare system and why none of the legislation or proposals, so far, have been able to deliver on their promises.  When I was researching my last book, The History and Evolution of Healthcare in America, I came to the conclusion that many of the problems were rooted in most of our past decisions and fixes. What we now think of as a system is mechanically incapable of performing as one. Most of the things we believe about our healthcare system, and to a large part, the practice of medicine lives more in the land of myth and fantasy than reality.

I have written extensively about most of the issues and I have chronicled many of the deficiencies in the Affordable Care Act, aka ObamaCare. In the past few months I have been working with an increasing number of individuals, on both sides of the aisle, to find a more pragmatic — less partisan solution.

As a result of many of these meetings, speeches and various other activities we began to develop a white paper, recently published here. Initially, I thought this effort would produce some higher level recommendations and my role would be very limited. This has not been the case.  The more we have discussed the core principals, the more buy-in we have received on the general concepts.

This broad level interest has resulted in a commitment to provide a more focused location for interaction to see if we can’t cut through some of the rhetoric and get traction on fixing the fundamental issues that have plagued our healthcare market.  I don’t know if we will make any difference whatsoever, or if we can even get enough people to read and comment to make a difference at all.  I do know that we can try.

We have created a location called Health Reform 2.0 linked above to the graphic.  If you want to tell someone about it and what we are trying to do, here is the URL spelled out: http://healthreform2dot0.org. (that’s “two” dot “zero”)

We have pushed all of the earlier material that appeared on this site to this new location and we encourage you not just to visit the site but to also read the materials, and most importantly, lend your voice to the solutions by posting comments.  We will continue to cross post the articles on this site as they get published.

Thank you for your support on Healthcare: Crisis in America and I hope you will subscribe to this new site as well.

 

Sincerely;
Tom Loker

Article 4 – The Plague of Myths – Myth 3: We Can, and We Should, Live Forever!

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

This is the fourth of a series of articles that are being published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!

We all want to live longer

It is clearly an historical ideal to live longer. We all, for the most part, desire not to die anytime soon. I am sure that for most of us it is a completely natural instinct to continue to live. We often find it morally abhorrent to want to die prematurely – like from suicide. It would be completely counter intuitive from what we know about the survival instinct, and the laws of natural selection to decide to become premature feedstock for the organisms that prey on us. Our individual desire to survive is primitive and persistent for most of our lives. And it is safe to say we have been built this way! Continue reading

Article 3 – The Plague of Myths – Myth 2: Healthcare, It’s Good for What Ails You!

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the third of a series of articles that will be published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

Do our expectations of Healthcare match reality?

We have a large number of myths that govern our beliefs about our current Healthcare system – or non-system to be more accurate.  One of the larger set of myths that drive our perceptions of both the positives and negatives of our healthcare system are our beliefs and expectations as to what we should get from healthcare and the underlying medicine.  We believe, that modern medicine has cures for almost anything we face.  We believe that the continual research and discovery that has occupied much of the past 164 years has led to a firm and almost complete understanding of the science of disease, injury, and treatment.  We believe that there is little difference in cost between the things we need for survival and the things that we want to improve our lives.  We believe that the current methods of treatment and the discoveries we have made over the past 80 years are making us a stronger more robust species.  We believe that the doctor is typically the best and most qualified person to deliver the care we need. And we believe that in most cases going to the doctor is safe and leads to improvements in our health. These are just a few of the myths and misconceptions we have about the current state of medicine and what we should expect from our healthcare system. Continue reading

Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the second of a series of articles that will be published over the coming days and weeks. The series of articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Articles:

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

The Plague of Myths

There are many myths that pervade our beliefs and therefore underlying assumption about our so called healthcare system. We believe that;

  • We have a healthcare system,
  • We believe that we already have, or are very near to having, cures for almost everything,
  • We believe what is good for us as individuals is good for the human species,
  • When it comes to healthcare we think that what we want is the same as what we need,
  • We either believe only government should have the role of providing care or we believe that government should have no role at all,
  • We believe that America can afford it – whatever it is,
  • We believe that Employer Sponsored Insurance has been a good thing,
  • We believe Co-Pays and Deductibles have helped lower costs and reduce consumption, and
  • We believe many, many others myths as well.
  • We also believe that American Healthcare costs too much! Continue reading

Article 1: Introduction to the Real Healthcare System

We don't really have a healthcare system and its killing any reform.

We don’t really have a healthcare system and its killing any reform.

“This is the first of a series of articles that will be published over the coming days and weeks. The series articles will define the problems, at a higher level, that we have in what we call our healthcare system, why they are important and how they have conspired to foil our various attempts to “fix” healthcare. Each article will encapsulate one, or more, related issues, describe the problem and its effect today, how it historically developed and describe the framework of the solution(s). The final article will summarize the solutions and describe their intrinsic benefits.
(If you would like a more detailed read you may go directly to the draft Whitepaper titled, HEALTHCARE REFORM 2.0: Beyond the Partisan Divide Lies Pragmatic Solutions currently version 1.1)”

List of Published Articles

  1. Introduction to Healthcare reform: What’s next
  2. Article 1 – Introduction to the Real HealthCare System
  3. Article 2 – The Plague of Myths: Myth 1 Healthcare Costs Too Much
  4. Article 3 – The Plague of Myths: Myth 2 Healthcare, It’s Good for What Ails You!
  5. Article 4 – The Plague of Myths: Myth 3 We Can, and We Should, Live Forever!

 We don’t have a system

When it comes to America’s, so called, Healthcare System, one of the biggest reasons that most of the attempts to “fix” our healthcare system have consistently yielded more unintended consequences than benefits is that we treat the symptoms of the disease not the disease itself. We have a number of misconceptions about our healthcare system and the first and foremost is that we believe that it is, in fact, a system.  It’s not!  It never has been.  What we think of as our healthcare system is really nothing more than a disjointed, tangled collection of practices, methods, procedures, policies, laws and guidelines that have been developed over the past 200 plus years.  Most of this collection of things were developed for the furtherance of one failing group or another.  Most were promulgated to preserve the business of individual practitioners – doctors, physicians, pharmacists, hospitals, pharmaceutical manufacturers, insurers, nurses, therapists, program sponsors, etc. With rare exception, many of this collection of things were not focused on the needs of the patient. Continue reading

What’s next for our Healthcare System: Leading to real fixes or total collapse?

A new approach is needed

It is now crystal clear that the methods, some would say madness, that we have promulgated over the past 200 years to define the mechanisms we needed in order to provide healthcare to Americans have worked both spectacularly, and miserably, depending on your perspective and measures.  America’s healthcare system has become a collection of practices, methods, and mechanisms that neither integrate nor properly manage the efficient, effective and appropriate level of care that citizens need nor does it provide an appropriate method to deliver the care we want.

How we got to this point

Tolerance-RealCompromiseDuring the same 200 years, our overall understanding of America and our expectations of services have materially shifted.  We now expect significantly more from our country – and by extension its governmental structures: federal, states and commonwealths – than we did at its founding. We no longer value the role of tolerance in compromise as we once did. This has led to a frozen governmental structure where we are trapped between two ideological extremes. Everything we now attempt to do becomes locked in an all or nothing outcome based approach. The latest healthcare legislation, and more recent proposals, can be seen as the culmination of this dysfunctional approach.

For a variety of historical reasons, all seemingly reasonable and appropriate at the time, we have adopted a series of changes, often in the form of rules and laws, to try to affect corrections to one part of this non-system or another.  All of these approaches, in the parlance of medicine, have affected the symptoms of the disease but they have not cured the underlying fundamental problems.

We must identify and agree on the fundamental problems

In order to correctly define an effective, cost efficient, and appropriate healthcare system for all Americans, we must first address the fundamental issues, disconnects, and problems of our historical non-system.  In order to begin to actually address the needed fundamental fixes – therefore deal with the disease not the symptoms – we need to first identify and agree on what the fundamental problems are.

Clearly, America is caught in this crossroads. Since we are now trapped between two ideological positions. It is because neither party can find ground for compromise because we have lost the art of tolerance that I often say, “The only thing that we, as Americans, tolerate today is intolerance!” The principal of tolerance was a key characteristic that made America the leader of the free world it became.

A series of articles

What follows over the next few days to weeks will be a series of articles in which we will lay out a set of principles, that encapsulate solutions for the issues and goals that have been laid out by both sides of this debate repeatedly over the past seven years, beginning with the authors first encounter with a major Senate bill in 2007, and as identified in the authors reading of every formative bill from each committee whose work ultimately contributed to, or argued against, the final legislation for better or worse since then.

For those of you that would like to cut to the chase and read the more academic whitepaper it is available here: HealthCare Reform – Beyond Partisan Divide Ver 1

There is a solution

The solution will require quite a bit of work, much debate and a healthy dose of tolerance. In the end, we believe we can find compromise that will yield a much Continue reading

Internet Scams: Thank God for the internet!

You just gotta love the people who sit around and think these things up! Over the past two days, I received two e-mails, the first (copied as sent below as Letter 1), was a very official looking letter from Mr. Edward Meyers who was polite enough to inform me that no less than the Government Accountability Office (GAO) of United States Government and also the International Monetary Fund (IMF) had instructed he, Mr. Edward Meyers, working on their behalf, to immediately within 72 banking hours – wow this must have been very important – to transfer to me the sum of US$45 Million. Nice!

—————————————————————————————————————

LETTER 1

From The Desk Of Mr Edward Meyers
Phone: +1 530 540 5419
Dear valued Customer,

My Name is Mr Edward Meyers, A citizen of the United States,52 years Old. I reside in Hobbs, New Mexico,My residential address is as follows;1320 Linam Street, Hobbs, NM 88242, USA,i work in the remittance department with Bank Of America in collaboration with Gulf General Investment here in New Mexico, United States Of America.

Am contacting you concerning your overdue payment of US$45 Million which have been endorsed for onward transfer to your destination depending on your choice to receive your full payment,you have the legal rite to indicate by return email, the preferable method to receive your payment within 72 Banking hours.

Bank Of America will be willing to receive your full  contact details in your next email,so as to furnish you with the necessary steps to deliver your funds within 72 Banking hours.

Considering the latest payment instruction we received few days ago from THE UNITED STATES GOVERNMENT ACCOUNTABILITY OFFICE(GAO) AND ALSO FROM INTERNATIONAL MONETARY FUND(IMF),You will not be required to pay for any money transfer charges until your funds are delivered to your bank account,but you must present valid and verifiable details of your payment to my office prior to the final release of your payment so as to indicate and assure that you are the rightful beneficiary to the funds in our custody.

Do not hesitate to call me on  my contact phone numbers given below for more details or send an email.

I will be expecting to hear from you urgently

Sincerely yours,

Mr Edward Meyers
For Bank Of America,
NM, USA.
Direct phone: +1 530 540 5419

(I have highlighted the errors in the letters in red)

—————————————————————————————————————-

Of course I thought, finally, the government is going to reimburse me my share of the profits from the car companies for those bail out loans Continue reading

To David Brooks: Its not just leaders its their point of origin

The Leadership Revival By David Brooks Article

The Leadership Revival
By David Brooks Article (click to read the original article)

I like David Brooks! He is one of the pre-eminent writers in this era and along with Charles Krauthammer one I try to read on a regular basis. Always thoughtful and cogent, his observations typically are well worth reading, educational and stimulating. Continue reading

4 Straight Years of Slowing Health Care Costs: Really?

man_question_mark

U.S. Marks 4 Straight Years of Slowing Health Costs(click to read the article) so blasts the headline from ABC News today, January 7, 2013. Like so much of the debate over Healthcare reform, many that read the article will walk away believing that things relating to healthcare costs are really improving—along with the economy. After all the article proudly says that the percentage that healthcare costs make upon of the Gross Domestic Product (GDP) has declined for the fourth straight year. This must be a good thing—one would think! But, like so much of the reporting Continue reading

HIV/AIDS: The face has changed but disease still wreaking havoc

The Gift of the Human Hand

The Ryan White Care Act—the prime funding source for HIV/AIDS treatment assistance—is due to sunset this year.  The strongest advocate for RWCA, Senator Ted Kennedy, not long before his death fought a hard fight to update the law.  The fight to update the law was unsuccessful due to a highly Continue reading

Half Full or Half Empty: Another Happy New Year!

It is often said, “A picture is worth a thousand words!” Perhaps, unlike no other time of the year this is best considered at the birth of another new year! We seem to go on each year, new resolutions in hand, gradually returning to our prior ways. Sometimes we may keep one of our new hard-one habits for a bit longer than normal, but for the most part we revert to who we were before—continuing to creep along at our own petty pace from day to day, with our sound and fury intact signifying nothing. Still, it is good to wonder and consider. It is, in retrospect, likely something we should all do more often than we do. At a minimum, maybe we should complete this one simple exercise each year whether we need to or not. Whether we are people who routinely see the glass half full, or half empty—in the end we will find gratification.

With this in mind I offer the following video. I hope it helps you in your own consideration find a ponderous start to your new year!.

From those of us at the Health Care: Crisis in America blog and www.loker.com

Happy New Year to you and yours and thank you for being a loyal reader in 2013 and for your consistent referrals to others to help in their considerations. You have helped this blog and twitter find more than 9,000 regular readers!

Value Based Insurance: it sounds so – “valuable”

Value based insurance, sounds so - valuable!

Value based insurance, sounds so – valuable!

Value Base Insurance Coverage, it sounds so — valuable. But is it really valuable? Is Value Based Insurance Coverage (VBIC) what you really want — what you may need? Well, perhaps, that simply remains to be seen. As we move through the implementation of the Affordable Care Act, ObamaCare, VBIC will become the next big thing we need to pay close attention to. You can be sure that soon this item will be getting quite a bit of ink as the potential ramifications become apparent.

Like so many things in life, the reality of this “value” based system may be fraught with unintended consequences for the individual and massive values and benefits for Continue reading

The ACA Exchange Poster Child – Covered California: Works for some, not for others

CoveredCaCalifornia, has long had the reputation as being one of the most progressive, or liberal, states in the nation. Often in a neck and neck battle with New York over who gives more free-stuff to its people at any given time, California long ago adopted the philosophy that what is good for some should also be good for all. The concept of income redistribution though higher taxes is not a new one for California residents.  Yet this state, nicknamed “the Golden State,” and home to Hollywood, Biotech, Oil and Silicon Valley fortunes often confounds because there are also strong anti-tax forces that from time to time rise up and limits California’s spending power through measures like Proposition 13. Continue reading

Obamacare Insurance Cancellation: Welcome to the #ObamaNation

Welcome to the ObamaNation where we know better than you!

Welcome to the ObamaNation where we know better than you!

The cancellation letters people are now receiving for their earlier choice based plans– you know the ones that President Obama said they could keep, PERIOD–out of courtesy and perfect declaration should open with this line,

“Welcome to the #ObamaNation where we know better than you!”

Those of us who have warned of these effects under the law, and a number of other predictable negative outcomes that are only beginning to show up, have been called fear mongers, and haters. The shouted counter argument becomes a diatribe of how this law is going to be so great. How it will provide insurance for so much less cost. How it will lower the cost to the nation and the individuals. How you will get whatever you want and have to pay almost nothing for it! Continue reading

Jay Carney’s recent statement may be quite revealing!

Recently, Gov’t spokesman, Jay Carney, said he could not answer questions about the exchange sites because, in his own words, “I’m not a computer expert and I don’t build websites!” But, he is the spokesman for the #ObamaNation, i.e. the Federal government.  So in this capacity as speaking for the Government or the president’s administration, he is admitting that they are not computer experts and they don’t build websites! Then why on earth did they take on the challenge to try to build this one.
I understand that they hired subcontractors to build its parts. But unlike most projects, they did not hire a contractor to manage the project, to take the pieces and integrate them into a cohesive final system.  This is the way virtually every other project the government does is handled.
 
Carney is correct, the government has no experience in computer engineering, architecture, design and development. They do not build websites! They spend most of their IT assets maintaining ever aging mainframes systems that cost huge amounts to keep running and are difficult, if not impossible, to interconnect with newer more efficient systems. So why did they try to take on such a role in this case?
 
Is it possible, that they simply did not want any third party to find out how the site would be used? Is there some “secret systems built into this massive infrastructure that the government doesn’t want people to know about? Is there some hidden data system slurping our information as some people have surmised? These would be something that any outside contractor would need to know about in order to build the system and have it work.  It could also explain why a system that should at most have 10s of millions of lines of code has 500 million.  Could it be that like the NSA’s recent incursions into the lives of American Citizens, there is a much bigger, “Big Data” game afoot that the #ObamaNation does not want Americans to find out?  Why else would a government, who admittedly is not computer programmers and does not build web sites decide to take on such a task in the first place.  Every part of their reputations were riding on the success of these sites. And clearly money was no object. There has to be a much bigger reason they did not want to bring in real experts to do the job!  Maybe the American People need to have someone come in and audit the code and find out just what else may have been afoot here!
 
Hey I’m just asking!!!

The ACA Exchange Connundrum

Aside

I have a friend, lets say she is in her 50s, a single mom and has been out of work for quite a while. She created her own business through hard work but has been unable to purchase insurance for a while.  She has one adult child that lives at home with her. I believe that she deserves affordable insurance and that she has a right to coverage regardless of her disease state.  From time to time, she gets frustrated with my positions on ObamaCare thinking that I am advocating for its repeal and that even the changes I speak of will harm her ability to get affordable insurance. This is not the case, but I can understand how she feels and why she feels this way. It is my friend and many others like her that need the very sections of ObamaCare that I think should stay in place and this is why I do not support a blanket repeal.

She is a very good person, intelligent and industrious. She is a strong supporter of ObamaCare. When Covered California, opened yesterday I went to the site to see what the new deal will be for people like my friend. It took two attempts to get into the site, although it was not a long wait, perhaps 20 seconds. My friend will be able to get insurance, as the law promises, and because of her circumstances she will be able to get subsidies as well. In fact according to the site (which provides estimates only) she has options under the Bronze plan that after subsidies she will be paying just $1.00 per month.  Yes, you read that correctly $1.00 per month for the premium. But she will also have a deductible of about $2500. before she gets to coverage. Some items are exempted from the deductible so in some cases she doesn’t have to pay anything.

I have not spoken to her but I would bet that she will think this is a good deal at this point. Depending on how the actual deductible plays out in her circumstances, she may or may not find this is a good deal 6 months from now. While this is a good deal for her, is this a good deal for most? Or the better question is this a good deal for America inclusively?  And, it is here that there is a rub. While the government is simply printing money out of thin air to pay for the bills, this new money still comes out of our pocket by reducing the real value of the dollar. And as we age, we disproportionately cost rise more and more for the care we need. From birth to age 70 we cost about $100,000 for care, and from 70 to 75, we cost about $500,000 for care.  The same curve happens from birth to 50.  So at mid 50s we cost significantly more than someone who is in late 20s early 30s. As a result those later life spiraling costs get disproportionately allocated to the younger insured. And the actuarials are not static numbers. Due to many factors they continue to rise and they will rise exponentially under the current rules. This is not due to greed, corporate profits, or expensive technology, it is due to simple mathematics. As we live longer that curve of costs goes ever higher. And under the current law the costs, are neither constrained nor controllable. They simply get reallocated.

I am truly very happy that my friend is able to get coverage, but I am also very concerned that we are hiding the overall cost and stacking increasingly unsustainable burdens on these future generations. The math is clear, even if we just don’t want to see it.  We not only are placing the rising cost burden on the young whose own costs will get exponentially higher as we continue to extend their lives beyond our own,  but we will also present them with a huge moral burden as well for while this generation will not create the death panels as promulgated buy the extreme edge of the republican party, the will have to made a determination of at what age quality of life care is suspended for elderly under government programs and their parents and grandparents own savings or additional private policies pick up the costs. Otherwise the cost for them in their early lives will be increasingly unpayable and the nations economy will collapse under the cost..

ObamaCare becomes DemoCare: Demolishes Middle Class!

DemoCare demolishes  America's Middle Class

DemoCare demolishes America’s Middle Class

The Affordable Care Act is often called ObamaCare but I think from now on it should be called “DemoCare” because it’s going to demolish care in America and along with that demolish America’s Middle Class.

There are quite a lot of things about the way this law works that make it undesirable.  Mostly, the causes are not in the debate that we hear so much about nor are they in the parade of facts that we are about to be inundated with over the next 90 days from those selling the benefits or arguing against them.  Like most debates the truth in the rhetoric is somewhere between the extremes. Continue reading

Dan Brown’s Inferno: A Coming Global Crisis?

Light summer reading

    Population Graph from "Inferno" by Dan Brown

Population Graph from “Inferno” by Dan Brown

In his latest book, Inferno, author Dan Brown explores a world where past symbols and artifacts from Dante Alighieri’s Italy, and his famous work The Divine Comedy, become the vehicle to unravel a diabolical and deadly plot of a modern day bio-terrorist. I originally grabbed this book because we were coming to the close of summer and I just finished working on a series of articles about the current issues of our healthcare system that will be appearing later this fall. Frankly, I was looking for a diversion from the complicated world of healthcare reform and Obamacare. I wanted a respite, a brief mindless romp in Dan Brown’s always entertaining world. Having read much of his prior work, I was confident that Mr. Brown would not let me down.

I found this work characteristically suspenseful, interesting, thought provoking and fun to read till I got to the following section which, in the story, lays the groundwork for the epic conflict between the antagonist, Bertrand Zobrist , a world renowned biochemist and leading geneticist and the protagonist, Elizabeth Sinskey, M.D. Continue reading

Orange Countey Register says, “Women’s deaths from painkillers ‘an epidemic'”: But, its nothing new!

Screenshot (4)To read the original article click here!

The rising rate of addiction for women in America seems at first blush a historically startling event. But its not! America has had a long, long history of dancing with the devils of hard drug addictions.

While the article calls these rates historically the highest, they factually are not. In the late 1800s and early 1900s, the addiction rate to cocaine, Continue reading

President Trumpets Obamacare Rebates as Deadline Approaches: Beware of Greeks Bearing Gifts!

President Trumpets Obamacare Rebates as Deadline Approaches - Time Swampland

President Trumpets Obamacare Rebates as Deadline Approaches – Time Swampland

Nought from the Greeks towards me hath sped well. So now I find that ancient proverb true, Foes’ gifts are no gifts: profit bring they none.” So observed the great philosopher and teacher Sophocles about 430 BCE.  Today we loosely translate this as, “Beware of Greeks bearing gifts!

No quote could be more apropos in regard to the supposed $500 million in insurance rebates being sent to 8 million Americans under #Obamacare. Like most ponzi schemes, at first blush this appears to be a great deal for America and Americans. Continue reading

States make ‘disturbing cuts’ to unemployment benefits: Ya’ll want it fixed? Just ask a redneck!

Unemployment BenefitsAn interesting article caught my attention this morning titled, States make ‘disturbing cuts’ to unemployment benefits, authored by Jake Grovum, Pew/Stateline Staff Writer. You can read the article by clicking the link of the photo above from the article.

The irony of this article, is that the continued stretching of unemployment benefits have, in the words on some economists, perpetuated unemployment. How can this be? people ask!

On the one hand, some people (how many I do not know — likely not the majority) just do not really seek work once they get on unemployment Continue reading