Thursday, June 8, 2017

Busting up myths about U.S. healthcare

Book Review by Dave Racer

Building any kind of enterprise on the foundation of a false assumption is not only fool-hearty, it is expensive and can be dangerous. Greg Scandlen, in his must-read new book, Myth Busters: Why Health Reform Always Goes Awry, proves this in his first chapter.

I have read dozens of books on health care – reform, practice, theory, finance – and most have been helpful. I’ve written and/or edited 18 books about healthcare myself. Here’s my confession: I wish I had consulted Greg Scandlen on “Roemer’s Law” early on.

In 1959, Milton Roemer, MD, published a study that changed the dialogue about the delivery of and payment for healthcare. Roemer, who had advocated for a single-payer healthcare system for America during the 1950s, claimed to have “…found a correlation between the number of hospital beds per person and the rate of hospital days used per person,” as Scandlen reports it.

Roemer’s Law, succinctly states “A built bed is a filled bed.” The unproven idea assumes that people are eager to enter hospitals. Based on my own experience, I can attest to the fallacy of this myth.

Still today, healthcare reformers have bought into the idea that the supply of medical and hospital care has to be limited and/or controlled by third parties and governments. If not, they warn, doctors will prescribe as much care as possible to line their own pockets. Hospitals will overbuild and somehow go out and recruit patients to fill their beds. Scandlen destroys this myth showing that hospital occupancy rates declined “from 77 percent to 67 percent” during 1970-2000. And while anecdotal “evidence” may exist about doctors here and there over-prescribing out of personal greed, this does not call for a government takeover of healthcare.

The myth perpetrated by Roemer’s Law continues to be foundational for federal and state government control over our personal healthcare. It has led to strict regulation of the patient-physician relationship so much so that today, physicians are not free to practice as they believe best for patients, and patients have no clue about the cost of their healthcare.

Third-party payers and government bureaucrats have insinuated themselves into the financial transaction between patients and their physicians, hospitals, pharmacies, and medical device suppliers. Patients have almost no incentive to save money or shop for healthcare value when someone else pays their bills. Meanwhile, patients have to pay the price fostered by another myth, that insurance companies are fighting to reduce the price of care.

“You may have noticed in this sorry saga that all of it was pushed by academics and politicians, and all of it was imposed upon hospitals, doctors, employers, and insurance companies. Who is missing? The patient/consumer/employee/taxpayer,” [emphasis added] Scandlen writes.

In this great book, Scandlen destroys the arguments supporting 30 predominant myths, each of which contributes to the high cost of healthcare. This book needed to be in the hands of lawmakers and regulators decades ago, but I’m glad it’s available today. I recommend it to anyone, especially politicians and academics, that believes we ought to get the facts right before setting on the laws and regulations that govern our individual healthcare.

Scandlen, Greg. Myth Busters: Why Health Reform Always Goes Awry. First Printing. Pennsylvania: CreateSpace Independent Publishing Platform, 2017. 160 Pages. Paperback.

Saturday, May 13, 2017

Purposely injuring yourself to get drugs

In the new book, Passion for Patients (, Dr. Lee Beecher and I included a few stories about patients with whom he and/or I had come in contact – true stories, but without identifying the person. This is one of those true stories. I hope it shocks you.

Before you read this, ask yourself what you know about an addict’s desperation. How far would a person go to get drugs to feed his or her habit? I am sure you will agree, after reading this, that addiction is an evil curse that thoroughly destroys lives – and unless you know an addict, you might never believe how it drives such negative behavior.

Lynn, a middle-aged single female, presented to the Emergency Department with serious burns on her leg. The burns extended from her right knee down to her ankle and had spread across the width of her calf. Lynn expressed extreme pain – at least a 10, she said.

The medical intervention was clear enough. Reducing the pain, of course, resulted in an opioid prescription which the staff administered, and it included two powerful painkillers for each administration of medicine. The staff did not notice that Lynn only swallowed one of the pills, and hid the other in her blankets. She gave those hidden pills to her partner who visited her constantly during her hospitalization.

Lynn suffered third degree burns. She self-reported that she had taken a pot of boiling water from the stove and the handle twisted. The boiling water hit her leg and caused the burns.

Upon discharge from the burn unit two days later, the hospital gave Lynn a script for 80 opioid painkillers. By the time she had arrived home, her partner had already bartered away 24 of them to obtain her own stash of mind-altering drugs. A day later, Lynn’s leg began blistering and needed to be regularly scraped.

In terrible pain, Lynn returned to the burn unit, was readmitted for two more days, and over time, secured a second script for opioids. She had to continue to scrape the blisters on the burned area for several weeks.

Months after the incident, Lynn confessed that the “accident” of pouring boiling water on her leg was no accident. Her partner had done it on purpose, solely so that the two could obtain opioids – paid by Medicaid.

The United States has an opioid epidemic that delivers death, destruction, and terrible suffering. In 2013, the Center for Disease Control reported that more than 47,000 deaths in the U.S. were attributed to drug overdose. CDC and medical professionals say we are experiencing an “opioid epidemic.” The rate of drug overdose deaths in 2015 in the U.S. has spiked 2.5 times since 1999, to 16.3 deaths per 100,000 people.

Lynn knew that when her partner poured boiling water on her leg it would painful, but to those two, nothing was more important than getting more drugs. Nothing.

The tragedy of addiction is written out each day by individuals whose choices destroy their lives and create incredible suffering for those who love them.

I’m betting you know someone, or are someone, who has experienced, or is still experiencing the pain of addiction.  

Friday, May 5, 2017

Avoid winning the lottery - you will lose your free healthcare

An amazing 6% of the pages of the new House-passed “healthcare” reform bill (some 175 lines) is devoted to disqualifying individuals from Medicaid who win lotteries, provided that the amounts they win exceed [lots of conditions] and it’s not meant to penalize others who are eligible in the same household.

Medicaid is a state and federal program intended to provide healthcare services to low-income individuals. But if you win the lottery, so goes the GOP House’s reasoning, you should be able to buy your own health insurance. I expect you agree with that, right?

But this exposes one of the greatest flaws of the now-dying Affordable Care Act of 2010. The ACA opened up enrollment for millions of individuals into taxpayer-paid coverage under Medicaid regardless of how much money that person has, houses owned, cars in the garage, or boats on the lake. Conceivably, under the ACA, a Medicaid recipient can have millions in assets and still receive taxpayer-paid healthcare.

The ACA had many flaws, but to me, this is among the most egregious. Why should taxpayers have to pick up the medical bills of people who have tens of thousands, or more, in assets, while working people have to not only ante up for insurance premiums, but also to pay higher taxes to provide free coverage to rich people?

It appears that if HR 1628 (the bill the Federal House of Representatives passed on May 4) were to move forward as is, those Medicaid enrollees with high valued assets will still qualify for taxpayer-paid healthcare coverage – and that is wrong. Of course, these individuals will have to quit buying lottery tickets, or they might lose their coverage.

CONSTITUTIONAL FOOTNOTE: What no one seems to want to challenge is the fact that there is no explicit enumerated power in the United States Constitution that gives the federal government any authority to write legislation that deals with individual healthcare. But who cares about the Constitution anymore.

Tuesday, April 4, 2017

How to force Congress to pass healthcare reform quickly

The Affordable Healthcare Act of 2010 - aka ObamaCare - specifically required members of Congress and their staff to buy health insurance the same way as all us mere mortals (Chapter 1312). But Congress and President Obama played dirty.

If Congress Members and their staff had to play by the same rules as we do, they may have forced ObamaCare changes before Obama left office. That would have been fun to watch.

So here's how to get Congress to act now, quickly, in haste, to reform ObamaCare. President Trump should immediately rescind the regulation that changed the intent of Chapter 1312 of ObamaCare.

Here's what I'm talking about.

While millions of Americans struggled with health insurance premium spikes of 150 percent or more since the ACA launched, members of Congress and their staffers received a sweat deal. You don't have to trust me on this. Read the most recent version of the final Office of Management and Budget rule by clicking here. Dated January 13, 2017, this is what it says.

If you are a member of Congress or an employee of a member of Congress, and your member of Congress certifies that you work for him or her, and choose to be enrolled as if you are working for a small employer, then you get a juicy benefit. This is it. You get to choose a Gold level health plan (how many of you can afford a Gold plan) from the Washington DC insurance exchange and we the taxpayers will subsidize up to 75 percent of your premium.

I would agree with you if you believe government employees should have access to health insurance. But not in contradiction to the law -specifically ObamaCare.

Here is what the OMB said about the language of the law.
  • "...the Act included clear and unambiguous language providing that all Members of Congress and congressional staff employed by the official office of a Member of Congress be subject to the terms of Section 1312 regardless of their dates of employment. Thus, the final rule implements Section 1312 of the Affordable Care Act as written." (Federal Register, Vol. 78, No. 191, page 60653)
OMB then went on to say that although the law is clear about it, we believe these good people fall under a different section of the law. OMB therefore determined that in their view, a Congress Member, along with his or her staff members, could be considered the same as employees of a small business and therefore, have access to the Small Business Health Options Program (SHOP).

Congress created SHOP to benefit very small employers, not Congressional office employees. And SHOP enrollees are assumed to be employed in the same state as their employer, not spread all across the county.

Now don't get me wrong. I have sympathy for the thousands of great employees working for members of Congress, and it's okay with me that they get a health benefit from employment. But it is not okay with me that President Obama's OMB ignored the law and stretched it beyond belief to tamp down anger among the very members of Congress who passed the law in the first place!

So, contact President Trump's office and tell him that the very next rule he needs to roll back is the one that shielded Congress Members and their staffers from the real world of health insurance, like the rest of us. If Pres. Trump threatens to do this, it will get Congress to the table in a hurry to reform ObamaCare now.

Friday, March 31, 2017

Is our form of government working?

Many of us are angry at the rancor, tension, and disruption we see in our governments - state and federal. Some, who don't quite grasp how this is supposed to work, wish "we could all just get along" and get something done.

The reality is that We the People, by the hands of our Founding Fathers, gave us a system of government purposefully besieged by checks and balances. Congress checks the President and the Federal Courts. The President checks Congress and the federal Courts. The Federal Courts check the President and the Congress. And We the People check them all.

Then there are 50 state governments that check the federal government - the federal government checks the state governments. And in each state, the same system of checks and balances exists.

We the People are the ultimate check on all of these government offices.

It is not supposed to be easy, and if it were easy, we would be in trouble.

What we don't like is the foolish, costly, dangerous game of gotcha politics that predominates our government offices - most especially. Frankly, when Democrats oppose things just because Republicans propose them, or vice versa, it does us no good, and instead, does great harm.

The Senate's upcoming deliberations and vote to confirm Judge Neil Gorsuch as a Justice of the Supreme Court is a perfect example of destructive, partisan politics - and has nothing to do with checks and balances. Nearly unanimously, SCOTUS-watchers rate Judge Gorsuch as a superior choice, highly and wholly qualified to be a Supreme Court Justice. Yet, Democrats feel obligated to create a false narrative to justify their opposition to him - threatening a filibuster to stop the nomination.  

Senator Chuck Schumer, D-New York, the Democrat Minority Ruler, needs to grow up, step up, and vote - down if he wishes. My two senators, Amy Klobuchar and Al Franken, plan to vote against Judge Gorsuch for reasons that defy reality - but Minnesota voters will express their level of agreement with their vote soon enough.

For our republican system of government to work, we need aggressive and persistent checks and balances by all branches of government. But we also need grown-ups in office who view policy and personalities through the eyes of justice and equity, and I don't see much of that going around just now.

Friday, February 26, 2016

Politics as theatrics (and please, give us a grown up for a candidate)

The Wall Street Journal ran an op-ed today about the rancor of Roman politics. The author focused on the tactics of the extraordinary orator, Cicero, and the theater of politics centuries before Christ, and millenniums before Trump/Sanders, et. al. The author posited that nothing has changed in that regard, except in the modern era our social media is instant and ubiquitous, whereas theirs was tempered by the slow slog of their times. 

No doubt, those Roman citizens were more preoccupied with finding their next meal unlike us worrying whether "Trump has a healthcare plan" or "Sanders' spending is realistic" or what else Hillary has hidden from us.

So about the GOP presidential debates: Take Trump out (please) of last night's Houston debate on CNN, and the entire dynamic changes. The debates would still be sharp, intense, but for certain, more intellectual and less childish. A Tumpless debate would still feature worthy verbal combat, but it might help sort out winners from whiners. 

Unless Trump triumphs (which to me is worse than Saddam Hussain rising from the dead) and wins the nomination, I believe the GOP/Democrat campaign debates next fall will be more civil, but even more intense, intended to draw political blood from the contestants. I don’t think it’s hard to imagine what Ted Cruz or Marco Rubio would be saying about Mrs. Clinton. And she already has her playbook at hand on whomever emerges from the GOP field.

A lot is at stake in this election - maybe even the survival of liberty in the United States, and civil order in the world. I teach my American Government students that those artificial lines in the sand we call state borders are nothing more than that – lines in the sand. The U.S. could “Balkanize” overnight. You might want to start planning where you would move, but I'm pretty sure I’d end up in the Republic of Texas.

There is great and grave danger in the world. This, too, is predictable. Prophets told us about it millenniums ago. Whom we pick for President of the United States in 2016 may see a rebirth of freedom, or the acceleration of grave trouble.

Our challenge is to see through the theater and understand the character of the actors, and from that, predict what they will do to preserve liberty.

Tuesday, December 24, 2013

A Subarachnoid Hemorrhage for Christmas

December 24, 2012, on my treadmill, about 8:10 AM. Rosanne upstairs, sleeping in. The pressure started at the base of my neck, pushed up the outside of my head, and pinched off my ears - that's how it felt to me. "What was that!" I thought, stepping off the treadmill.

Then the headache. Wow. Never had anything like that before.

December 24, 2013, on my treadmill, about 8:10 AM. Rosanne upstairs, sleeping. How ironic. Are we people of habit? I chuckled. And wondered.

Don Gehrig, MD, told Rosanne to take me to the Emergency Room, where I was to tell the nurse, "My doctor believes I'm having a brain bleed, and I need a CT Scan right away." We followed his instructions. A few hours later, I woke up in ICU at St. Joseph's Hospital in St. Paul, Minnesota. After 11 days, they removed the spinal tap, and my final four days in the hospital were far more comfortable.

It's obvious I recovered or you wouldn't be reading this. But why write it?

While experiencing the health care experience at St. Joseph's in what the hospital called the aneurysm center of the United States - or was it the world? - I realized something: The work I had been doing since 2005 held great value. Protecting the world's best health care system (speaking here in a broad sense) is an important mission. Making sure others could receive the incredible care I experienced is a noble and important pursuit.

All that surrounded me at St. Joe's was not, however, just the product of an isolated system to provide health services. Not by a long shot.

At least four critical elements built this marvelous care system:
The relatively free market-based economy of the United States, and the riches that economy has generated making investment in health care possible.
People. Smart and motivated people, gifted to care for others and willing to pay the price to master themselves and the human condition that demands their help.
Science. Scientists. The never-ending pursuit of knowledge and the application thereof.
The Creator. God created science and order. He created human life, and all life. He created freedom. He set me free.

Many memories flood over me this Christmas Eve, relative to my brain bleed. Three remain constant:
So many friends who visited and cared.
Family who gathered around me (not the Christmas tree).

And lest you wonder, I told the neurological psychologist who tested me this past July that somehow, I think my brain is working better now than ever. But for sure, I do not recommend a subarachnoid hemorraghe as a cure for a tired old brain.

God be praised.