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Title: Blog by Novelist William S. Frankl, MD

Archive for August, 2009

Maybe We’re Not So Bad: The Hoover Digest Research And Opinion on Public Policy

Saturday, August 15th, 2009

Here’s a Second Opinion

Ten reasons why America’s health care system is in better condition than you might suppose. By Scott W. Atlas.

Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers, and academics beat the drum for a far larger government role in health care. Much of the public assumes that their arguments are sound because the calls for change are so ubiquitous and the topic so complex. Before we turn to government as the solution, however, we should consider some unheralded facts about America’s health care system.

1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

2. Americans have lower cancer mortality rates than Canadians. Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher.

3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.

4. Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate, and colon cancer:
•     Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).
•     Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.
•     More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).
•     Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).

5. Lower-income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report “excellent” health (11.7 percent) compared to Canadian seniors (5.8 percent). Conversely, white, young Canadian adults with below-median incomes are 20 percent more likely than lower-income Americans to describe their health as “fair or poor.”

6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either “fundamental change” or “complete rebuilding.”

8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared with only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).

9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.

10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

Despite serious challenges, such as escalating costs and care for the uninsured, the U.S. health care system compares favorably to those in other developed countries.

How to Destroy Health Care and Much, Much More

Thursday, August 6th, 2009

The push for ” Health Care Reform ” has been temporarily halted, although on July 31st, late in the evening, by a vote of 31-28, the House of Representatives(HR) Bill 3200 was voted out of committee and will be taken up for a vote by the full House in September. This is the bill that the president is touting ( his press secretary, Robert Gibbs, admits Obama hasn’t read the bill!).
Well, folks, you better hold on to your health, your wallet, your privacy, and your freedom, if this bill is signed into law.
With the help of friends, I obtained a copy of the bill, and personally reviewed all 1006 pages. In these pages, one can find rationing for the elderly; invasion of privacy; development of health Centers that will cost billions of unfunded tax dollars; government control of hospitals, residency programs, physician pay and education; control of what drugs will be marketed and paid for, which will stifle innovation; and much much more. Below is an interpretation of the most salient items in the bill and the pages on which they appear.
Happy reading!

Page 22: Mandates audits of all employers that self-insure!

Page 29: Your health care will be rationed!

Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)

Page 42: The “Health Choices Commissioner” will decide health benefits for you. You will have no choice.

Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.

Page 58: Every person will be issued a National ID Healthcard.

Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.

Page 65: Taxpayers will subsidize all union retiree and community organizer health plans ( SEIU, UAW and ACORN ?)

Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.

Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)

Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens

Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.

Page 102: Those eligible for Medicaid will be automatically enrolled. You have no choice in the matter.

Page 124: No company can sue the government for price-fixing. No “judicial review” is permitted against the government monopoly.

Page 126: Employers MUST pay healthcare bills for part-time employees and their families

Page 127: The AMA sold doctors out: the government will set wages!

Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.

Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll

Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll

Page 167: Any individual who does not have acceptable healthcare according to the government) will be taxed 2.5% of income.

Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).

Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.

Page 203: “The tax imposed under this section shall not be treated as tax.” It really says that!

Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected.

Page 241: Doctors: no matter what specialty you have, you’ll all be paid the same.I hope the AMA is happy.

Page 253: Government sets value of doctors’ time, their professional judgment, etc.

Page 265: Government mandates and controls productivity for private healthcare industries.

Page 268: Government regulates rental and purchase of power-driven wheelchairs.

Page 272: Cancer patients: welcome to the wonderful world of rationing!

Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.

Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.

Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!

Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.

Page 321: Hospital expansion hinges on “community” input: in other words, Another payoff for ACORN?

Page 335: Government mandates establishment of outcome-based measures: i.e. rationing.

Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.

Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.

Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone?).

Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens. Assisted suicide, Euthanasia?

Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. This is mandatory. Appears to lock in estate taxes ahead of time.

Page 425: Government provides approved list of end-of-life resources guiding you in death.

Page 427: Government mandates program that orders end-of-life treatment. Government dictates how your life ends.

Page 429: Advance Care Planning Consult will be used to dictate treatment as patient’s health deteriorates. This can include an ORDER for end-of-life plans.

Page 430: Government will decide what level of treatments you may have at end-of-life.

Page 469: Community-based Home Medical Services.( More payoffs for ACORN?).

Page 472: Payments to Community-based organizations.( More payoffs for ACORN?).

Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage?

Page 494: Government will cover mental health services: defining, creating and rationing those services.

Page 502 Center for Comparative Effectiveness Research Established.

Page 503 Government to build registries and data networks from YOUR electronic medical records.

Page 503 Government will get data directly from any department or agency of the U.S., including anybody’s data.

Page 504 The “Center” will collect both published and unpublished data (which means our public and private info).

Page 506 The Center will recommend policies that would allow for public access of data.

Page 508 Establish a Commission to advise the Center on research questions, methods, etc.

Page 518 The Commission will have input from Health Care consumer representatives ( unions, ACORN?)

Page 524 Comparative Effectiveness Research Trust Fund set up. Will need taxes to establish

Page 621 Government will define what quality in health care means. (Government knows quality?)

Page 622 To pay for the Quality Standards, government will transfer money from other government Trust Funds. More taxes.

Page 624 “Quality” measures will be designed to assess outcomes and functional status of patients. “Quality” measures will be designed to profile patients by race, age, gender, place of residence, etc.

Page 628 Government to give “Multi-Stake Holders” pre-rule making input into selection of “Quality” measures.

Page 630-31 The multi-stake holders include unions and groups like ACORN.

Page 632 The Government can implement any “Quality measures” as they see fit.

Page 633-634 The Secretary can issue non-endorsed “Quality Measures” for Physician Services and Dialysis Services.

Page 635-653 Physicians Payments Sunshine Provision. This includes a careful review of every physician’s involvement with medical investments, contacts with industry and pharmaceutical companies, acceptance of drug samples,and much more. Fines from $1000 to I million. I’m certain the AMA approves!

Page 660-671 Residency Programs. Government will indicate where residency programs will be and which hospitals will be given preference.

Page 676-686 Government to regulate how hospitals run residency programs, and this appears to include medical school hospitals.

Page 686-700 Increased Funding to Fight Waste, Fraud, and Abuse.

Pages 701-704 If your health care plan isn’t in Government Health Care Exchange, no payment, even if you qualify for federal aid.

Page 705-709 If Secretary gets complaints (ACORN) about a health care provider or supplier, government will do exhaustive background check.

Page 711 The Secretary has broad powers to deny health care providers/ suppliers into the Health Care Exchange.

Page 719-720 Any Doctor who orders durable medical equipment or home medical services must be enrolled in Medicare.

Page 722 Government mandates that doctors must have a face-to-face with patient in order to certify patient for Home Health Services.

Page 724 Government reserves right to apply face-to-face certification for patients requiring other health care services

Page 724-725 As in Page 722, the same government certifications apply to Medicaid and CHIP.

Page 735 For law enforcement purposes, the Secretary of HHS may give Attorney General access to all data.

Page 740-757 Government provides guidelines for subsidizing the uninsured

Page 757-762 Federal Government to shift the burden of payments to Disproportionate Share Hospitals (DSH) to States.

Page 763 DSH/EAH hospitals won’t be paid unless they provide services without regard to national origin. Does this mean undocumented aliens??

Page 765 Government requires Preventative Services including vaccines.

Page 769 Nurse Home Visit Services – “increasing birth intervals between pregnancies.” What does this mean?? Contaceptives? Abortions? Nurse Home Visit Services will also include economic self-sufficiency, advice on employment, school-readiness, etc.

Page 770 Federal Government mandates eligibility for State Family Planning Services. Does this include abortion services? Does this ultimately include how many children to have? Does this interfere with state sovereignty?

Page 789-797 Government to set and mandate drug prices.This controls which drugs are brought to market. What will this do to innovation?

Pages 797-800 Payments allowed for graduate medical education. The government will now control the educational process??.

Page 801 The government will decide the health care conditions for which they will pay. Sounds like rationing.

Page 810 Billing Agents, clearinghouses, etc.need to register. Government seems to be taking over the private payment system.

Page 820-824 Government will identify individuals ineligible for subsidies by accessing personal financial information.

Page 824-829 Government sets up Comparative Effectiveness Research Trust Fund. Another tax entity requiring tax dollars??.

Page 829-833 Government to impose a fee on all private health insurance plans including the self-insured in order to pay for the Trust Fund.

Page 835 The fees imposed by the government for the Trust Fund to be treated as if they were taxes.

Page 838-840 Government to design and implement a Home Visitation Program for families with young children and families expecting children.

Page 844-845 The Home Visitation Program includes government coming into your house and telling you how to parent.

Page 859 Government to establish a Public Health Fund to cost $88 billion.

Page 865 The government to mandate the establishment of a National Health Service Corps.

Page 865 to 876 The NHS Corps is a mandatorty program for two years for doctors as part of a loan repayment.

Page 876-892 Government to control the education of medical students and doctors.

Page 898 The government to establish a Public Health Workforce Corps to provide a supply of public health professionals. It is to consist of civilian employees of the U.S. as ordered by the Secretary. The Public Health Workforce Corps is also to consist of officers of Regular and Reserve Corps of Service.

Page 900-901 The Public Health Workforce Corps to include veterinarians. The Public Health Workforce Corps also to include commissioned Regular and Reserve Officers.

Page 910 The government to develop, build, and run Public Health Training Centers.

Page 913-914 Government to develop a health care affirmative action program by the establishment of diversity scholarships.

Page 915 Government will mandate cultural and linguistic competency training for all health care professionals.

Page 932 The Government to establish a Preventative and Wellness Trust fund at the cost of $30 billion.

Page 935 Government to identify specific goals & objectives for prevention & wellness activities for the public.

Page 936 Government to develop “Healthy People and National Public Health Performance Standards”

Page 950- 980 Government to develop core pubic health infrastructure that includes workforce capacity, lab systems, health info sytems, etc.

Page 993-994 Government to establish school based health clinics. These clinics are to be integrated into the school environment.

Page 1001 The government to establish a National Medical Device Registry. Patients with any devices will be tracked.

And if you think I’ve misread exaggerated, misinterpreted, etc.,these 1006 pages, you can download the bill yourself at the address below.

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText 071409.pdf

I urge everyone to contact their Representative. If you are against this bill that takes a stranglehold on your life and your family’s, call your Representative and tell him/her to vote against it. If the bill sounds good to you, tell your Representative to vote for it.

And the president hasn’t read this!!???

William S. Frankl, MD, All Rights Reserved