Eideard

Doctor Patti McCarver meeting with a patient

With pain in her right ear, Sue Cassidy went to a clinic. The doctor, wearing a white lab coat with a stethoscope in one pocket, introduced herself.

“Hi. I’m Dr. Patti McCarver, and I’m your nurse,” she said. And with that, Dr. McCarver stuck a scope in Ms. Cassidy’s ear, noticed a buildup of fluid and prescribed an allergy medicine. It was something that will become increasingly routine for patients: a someone who is not a physician using the title of doctor.

Dr. McCarver calls herself a doctor because she returned to school to earn a doctorate last year, one of thousands of nurses doing the same recently. Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title “doctor,” but also the money, power and prestige that often comes with it.

As more nurses, pharmacists and physical therapists claim this honorific, physicians are fighting back.

An illegitimate characterization. “Fighting back” implies medical doctors are losing something. The quandary is over their ego-smitten self-worth. Standards for doctorates in most fields, medical or otherwise, allow the term “doctor” for anyone who reaches or surpasses those standards.

For nurses, getting doctorates can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients. But so far, the new degrees have not brought higher fees from insurers for seeing patients or greater authority from states to prescribe medicines.

Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power.

But many physicians are suspicious and say that once tens of thousands of nurses have doctorates, they will invariably seek more prescribing authority and more money. Otherwise, they ask, what is the point..?

The point is knowledge, skill and understanding. For the nurses. Obviously the point for the doctors is money and status. And money.

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Republican Congressional Troika

With Republicans in complete control of Maine’s state government for the first time since 1962, State Senator Lois A. Snowe-Mello offered a bill in February to limit doctors’ liability that she was sure the powerful doctors’ lobby would cheer. Instead, it asked her to shelve the measure.

“It was like a slap in the face,” said Ms. Snowe-Mello, who describes herself as a conservative Republican. “The doctors in this state are increasingly going left.”

Doctors were once overwhelmingly male and usually owned their own practices. They generally favored lower taxes and regularly fought lawyers to restrict patient lawsuits. Ronald Reagan came to national political prominence in part by railing against “socialized medicine” on doctors’ behalf.

But doctors are changing. They are abandoning their own practices and taking salaried jobs in hospitals, particularly in the North, but increasingly in the South as well. Half of all younger doctors are women, and that share is likely to grow.

There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.

That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.

No surprise to me. RTFA for details – for, more often than not, enlightened self-interest is re-entering American politics.

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Medicare has helped millions of seniors since the 60s receive the medical care they need. If Paul Ryan and the Republicans’ plan goes through, those of us who are younger than 55 years of age will continue to pay into the Medicare system, but when we retire we will receive a “voucher” to buy our own private insurance. The plan is supposed to “save” Medicare, but some reports that are trickling out say these are voodoo numbers the GOP and Rep. Ryan are promoting…

“But because commercial insurers cost more to run than government plans, the Wisconsin Republican’s proposal to privatize Medicare starting in 2022 would actually spark a dramatic increase in how much the nation spends on healthcare for the elderly, according to an independent analysis by the nonpartisan Congressional Budget Office…”

According to the CBO estimates, Ryan’s privatization plan would increase the cost of healthcare more than $12,510 a year, for our seniors…

The average American would receive a “voucher” for $8,000, which is roughly what the CBO estimates Medicare would have to pay out for the average senior in 2022. In addition to the government’s costs, the CBO estimates that seniors, in 2022, would dish out about $6,150.00 in out-of-pocket costs in the Medicare system. That totals an average cost of health care for participating seniors, in 2022, to be $14,770.

Under the GOP’s privatization plan, the cost to buy the health insurance policy would cost about $20,520 per year – leaving the seniors out-of-pocket in the amount of $12,510 or more than twice what they would pay in 2022 should the Medicare system we currently have continue forward…

The “vouchers” will be linked to the CPI (consumer price index), not the inflation of medical care expenses or health insurance costs. This protects the government and screws the seniors, period! So as years pass, the vouchers will cover less and less. This will further shift the cost of medical care onto the seniors’ pocketbooks…

So who will lose in this proposal. EVERYONE! Seniors pay more out-of-pocket and the younger generations pay higher premiums. Wait! There is one winner, health insurance companies, they will be raiding the U.S Treasury.

Anyone surprised at this conclusion? The Congressional Budget Office is about as stodgy and straight as anything could be in Washington, DC. They will be accused of everything from socialism to pederasty by the Republican Party and the Koch Bros KoolAid Party. The facts remain the same.

Thanks, Cinaedh

Administering methadone to a 4-week-old infant

As prescription drug abuse ravages communities across the country, doctors are confronting an emerging challenge: newborns dependent on painkillers…Infants…have to stay in the hospital for weeks while they are weaned off the drugs, taxing neonatal units and driving the cost of their medical care into the tens of thousands of dollars.

Like the cocaine-exposed babies of the 1980s, those born dependent on prescription opiates — narcotics that contain opium or its derivatives — are entering a world in which little is known about the long-term effects on their development. Few doctors are even willing to treat pregnant opiate addicts, and there is no universally accepted standard of care for their babies, partly because of the difficulty of conducting research on pregnant women and newborns.

Those who do treat pregnant addicts face a jarring ethical quandary: they must weigh whether the harm inflicted by exposing a fetus to powerful drugs, albeit under medical supervision, is justifiable.

“I’ve had pharmacies that have just called back and said: ‘This lady’s pregnant. Why do you want me to fill this scrip? I can’t do that,’ ” said Dr. Craig Smith, a family practitioner in Bridgton, Me. “But when you stop and think about what actually happens during withdrawal and how violent it can be, that would certainly be not in the baby’s best interest…”

There are no national figures that document the extent of the problem, but interviews with doctors, researchers, social workers and women who abused painkillers while pregnant suggest that it has grown rapidly, especially in rural regions, where officials say such abuse is most common…

RTFA. Please. This is an addictive disaster that is not slowing down in the least.

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Republicans have always hated Medicare, but most Americans have always loved it. Now, led by Rep. Paul Ryan, the Republicans are trying to kill it once and for all.

When JFK and LBJ proposed and passed it, Ronald Reagan called Medicare socialism and warned that it would lead to the end of freedom. If Medicare passed, the Gipper said, “… one of these days, you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

A half-century after Reagan’s dire warning, I suspect most Americans see Medicare — the single-payer health system that covers seniors — as an essential element of our freedom. But not Congressman Ryan, nor many other Republicans. Ryan would end Medicare as we know it, replacing it with a voucher that seniors would take to insurance companies, upon whose tender mercies their lives and health would then depend…

There is no doubt that Mr. Ryan is bright. He is also engaging and charming. But forgive me if I fail to see the courage in a young and privileged man harming the most vulnerable while rewarding the most wealthy. Born to a family whose 125-year-old corporation boasts that it is “one of the nation’s largest site-work contractors,” Mr. Ryan won the genetic lottery. There is no doubt that his great-grandfather worked hard to build that company. But a century and a quarter later, young Mr. Ryan — who estimates his net worth at up to $2.4 million — has no calluses on his hands. Just on his heart.

The question for Republicans is, will they follow Ryan’s plan? The nonpartisan Congressional Budget Office says that under Ryan’s plan, “most elderly people would pay more for their health care than they would under the current Medicare system.”

A lot more. In fact, under Medicare, a 65-year-old would pay just 25% of the total cost of her or his health care coverage.

Under the Ryan Republican plan, that jumps to 68%. (Individuals currently 55 or older would not be affected by the changes.)

If Republicans follow Ryan like lemmings, they should not be surprised when they find they’ve taken a firm step into thin air. Back in 1995, Newt Gingrich virtually assured President Bill Clinton’s re-election by proposing $270 billion in cuts to Medicare…

Clinton’s defense of Medicare was so central to his re-election that the word “Medicare” appears 49 times in his two debates with Sen. Bob Dole…

Medicare – like Social Security – is a single payer system that is run by our federal government at an efficiency rate about 4 times better than the average corporation. The cost of management for either socially-beneficial plan is less than 4% of the operating budget. American corporations think they’re mean and lean if they get down to 16%. Insurance companies? Well, they don’t even pretend to be mean and lean.

They don’t need it anymore than do the oil companies.

Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry.

Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday.

Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

I hold no brief for Freudian analysis; but, what I’ve learned over time about psychotherapy – especially in a clinical environment – leads me to conclude this is just one more modality, one more method of treating human ills that is being crushed into a tidy little profit center by hospital corporations, insurance companies and medical associations that are little more than trade groups and lobbyists.

RTFA for details. Decide who is worthy of more contempt. Corporate medicine or the politicians taking a payoff as obedient toadies?

The White House wants states to take the lead in consumer protection

Faced with the need to review insurance rates and enforce a panoply of new rights granted to consumers, states are scrambling to make sure they have the necessary legal authority to carry out the responsibilities being placed on them by President Obama’s health care law.

Insurance commissioners in about half the states say they do not have clear authority to enforce consumer protection standards that take effect next month.

Federal and state officials are searching for ways to plug the gap. Otherwise, they say, the ability of consumers to secure the benefits of the new law could vary widely, depending on where they live.

Meanwhile, state governments that have for years allowed insurers to set premiums virtually at will are gearing up to establish procedures to review rate increases.

Does that sink in to voters around the country? The bureaucrats and elected officials in your state may have been happily trundling along rubber-stamping whatever rates insurance companies requested.

It certainly happened here in New Mexico. In fact, a mid-level bureaucrat in the state insurance commission granted Blue Cross a 21% rate increase – the day before the public hearing on whether it was legitimate or not!

States have the primary role in enforcing many of the new standards. If a state fails to enforce a standard, the federal government will step in to do so — as it did in several states after passage of a health insurance law in 1996.

Some state regulators said they would ask state legislators to expand their authority by putting the federal standards into state law next year. Others said they would rely on their powers of persuasion, the good will of insurers or general state laws that ban unfair or deceptive trade practices…

Arizona said it was unlikely to pass legislation authorizing any state agency to enforce federal insurance standards, in view of its participation in a lawsuit challenging the federal law. Moreover, it said, Gov. Jan Brewer has “instituted an indefinite rule-making moratorium, so we have no plans to adopt rules related to enforcement” of the law…

Yup. Republicans truly have an unusual style when it comes to law enforcement.

The well-worn notion that patients in the United States have unfettered access to the most expensive cancer drugs while the United Kingdom’s nationalized health care system regularly denies access to some high-cost treatments needs rethinking…

Critics of the U.K. system say care there is rationed — that patients are denied some expensive therapies so that better health care can be provided to the nation as a whole. Critics of the U.S. system say care is rationed here, too — that only those with the very best insurance and those who can afford sky-high out-of-pocket expenses have meaningful access to any and all high-priced therapies, especially at the end of life.

The authors found that with regard to very expensive cancer drugs, both characterizations are largely correct. “The issue is not whether rationing is a good thing or a bad thing,” Doctor Ruth Faden says. “The issue is what we should do about extraordinarily expensive treatments, some of which do very little to improve how well or how long people live.” At the same time, she adds, “there is no ethically defensible reason why some Americans have access to expensive cancer drugs and some do not.”

“Policy makers and our society now need to do the hard work of developing a reasoned, evidence-based system of using health care resources wisely, and the first step is to engage in an honest and transparent conversation about the values that should guide these decisions, a conversation that is informed by facts, not politics,” she says.

RTFA. Doctor Faden goes into the details.

The fact remains, unless you have the bucks – here in the States – you are screwed.

Dead at 17 – courtesy of CIGNA healthcare

Wendell Potter says he is finished defending the insurance industry, which he says is “beholden to Wall Street.”

At a hearing last week before the Senate Commerce Committee, the former vice president of corporate communications at the insurance giant Cigna testified, “I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry…”

In his testimony and during an interview with CNN, Potter described how underwriters at his former company would drive small businesses with expensive insurance claims to dump their Cigna policies. Industry executives refer to the practice as “purging,” Potter said.

“When that business comes up for renewal, the underwriters jack the rates up so much, the employer has no choice but to drop insurance,” Potter said…

Now a senior fellow on health care for the nonpartisan watchdog group Center for Media and Democracy, Potter writes a blog on health care reform. In particular, he is keeping an eye on efforts to defeat legislation that would give Americans the option of joining a government health care plan, something he now supports.

He says he witnessed how the insurance industry torpedoed health care reform efforts during the Clinton administration.

“They conduct what I call duplicitous PR campaigns. They’ll say what people want to hear,” Potter says. “It’s how they operate. You cannot trust these guys.”

Potter is also taking aim at some of the TV commercials aired by groups opposed to changes. One such ad caught Potter’s eye. Run by the conservative organization Patients United Now, the ad says that “now, Washington wants to bring Canadian-style health care to the U.S.”

“Sometimes you’ll see misleading information. And sometimes you’ll see outright lies, like that [ad] is,” Potter said, referring to the spot…

Potter notes that the leading proposals for health care in Congress do not seek to set up Canadian-style health care in the United States. He says claims that overhauling the system would lead to “rationing” of care are missing his point.

“What we have is rationing by corporate executives who are beholden to Wall Street. And it happens all the time,” Potter said.

I’m not certain which is worse. My gullible fellow-citizens who eat up right-wing lies fed to them as TV commercials – or the fracking politicians who enjoy service akin to Canadian-style health insurance which we pay for – who know better and still repeat the lies on behalf of insurance company lobbyists.

I didn’t realize Canada was center of the subversion of everything held dear by the U.S. Chamber of Commerce. More power to ‘em!