More thoughts on the "Affordable" Heathcare Act

Last April I gave a speech at a tax day rally here in Thousand Oaks, CA expressing my opinions on some of the chilling effects of the government getting into the healthcare business. The text of that speech can be found in the April 2011 archives on this blog. On October 12th I will be a member of a panel speaking on this same subject at a dinner in North Ranch, CA. I will post the details here as the date draws closer for anyone locally who would like to attend.

One of my biggest criticisms of the health care bill is the intrusion of immense government into the realm of the very personal issues of healthcare and the expansion of the administrative state well beyond its scope granted by the U.S. Constitution. Taking a closer look at what this legislation is about reveals it has almost nothing to do with the distribution of medical care and is simply about control and bean-counting of our lives and enrichment of some favored groups.

Writing in the September 2011 publication, "Imprimus", of Hillsdale College, author Edward J. Erler has this to say:

"The administrative state, of course, always seeks to extend its reach and power. This is an intrinsic feature of a system where administration and regulation replace politics as the ordinary means of making policy....This is tantamount to denying that legitimate government derives from the consent of the governed...(taken from The Declaration of Independence). Obamacare certainly fits the description of the activities denounced in the Declaration. The number of regulations and the horde of administrators (not to mention lawyers) necessary to execute the scheme are staggering. We have only to think here of the Independent Payment Advisory Board. It is commission of 15 members appointed by the President, charged with the task of reducing Medicare spending. This commission has rule-making power which carries the force of law. The Senate, it is true, will have the power to override its decisions--but only with a three-fifths majority. There are no procedures that allow citizens or doctors to appeal the Board's decision. The administrative state--here in the guise of providing health care for all--will surely reduce the people under a kind of tyranny that will insinuate itself into all aspects of American life, destroying liberty by stages until liberty itself becomes only a distant memory."

As a concrete example it has been announced that diagnosis coding, required by Medicare and all insurance companies, will be changed in 2013. Currently, ICD-9 coding has about 12,000 diagnoses. The new ICD-10 coding to go along with the mandated electronic medical records provision of the bill will have 140,000 diagnosis codes. Is this for the betterment of health care or will it be used for micromanaging and regulation and eventual rationing of health care resources? What do you think? You know what I think! Dr. F

Junk Science or an Inconvenient Truth?

In a recent article published in the Green Journal, ACOG's monthly academic publication, and much their credit, it was revealed that many guidelines used as "gospel" to counsel patients on OB/Gyn matters are not based on good science. In an article by Christie Haskell on the CafeMom web site she notes the following:

According to Professor of Medicine, Dr. Andrew D. Auerbach, "more than two thirds" of recommendations are based on anecdotal evidence or even just expert opinions, which are wrought with personal biases. While opinion can be helpful where we don't know things, it doesn't always translate into what's best for the patients.

In the new study, Dr. Jason D. Wright of Columbia University in New York and colleagues went through 717 practice recommendations from ACOG, the nation's leading group of ob-gyns.

They found 30 percent of those were based on top-notch evidence, so-called randomized controlled trials. About 38 percent came from observational studies, whose value is limited, and 32 percent were purely expert opinion.

Awareness of this information is crucial in the informed consent process. Asking questions of your doctor about the veracity of the evidence for his/her recommmendation is a good idea and should be greeted with respect by your practitioner. Remember, ACOG guidelines are meant to be just that, guidelines, and yet once published they become the basis for strict hospital policies and fodder for trial lawyers. Again, I give credit to the editors and the author for pubishing this article. Hopefully, it is based on good scientific method. Dr F

Trip to Israel

Every now and then it is beneficial and theraputic to take a mental and physical break from our routine. We all need a refresher course on what are the really meaningful things in life and a change of perspective that comes with traveling can be just the thing. Such was my experience in my first trip to the holy land. My daughter and I, along with 168 other Dennis Prager listeners, enjoyed 10 fantastic days touring Israel. From Tel Aviv to the Golan Heights, Ceasaria to Kfar Blum, Nazareth, Bethlehem, Masada, floating in the Dead Sea and, finally, Jerusalem we experienced history, religion and the co-existence of a vibrant working society. After a visit to these places it is unlikely that one can ever look at the world the same again. We had the opportunity to hear interviews and lectures from a cross section of ideas including the Palestinian Mayor of Bethlehem, a member of the Israeli defense forces and an amazing woman at Yad Vashem to a former ambassador along with the wisdom of Mr. Prager. As he always says, "Prefer clarity over agreement". Seems pretty clear to me that any real peace in the Middle East will not occur in my lifetime. Nonetheless, one must continue to try and it begins with open dialogue and free access to information for the children of the Arab world. For freely educated children are the only hope that old enmities will die out.

As I return to Los Angeles and the work that I love I am hopeful that some of the lessons I learned in Israel can be applied to my profession. I believe more than ever that my profession has been going in the wrong direction. Widening the divide between caregivers for birth by hardened rhetoric does not benefit those we wish to serve. We have a duty to educate the future generations of obstetricians in the skills needed for vaginal birthing and encourage them to reach out to our midwife colleagues in a way that organized medicine has vehemently resisted in my professional life. Collaboration benefits everyone and honored co-existence makes for a more peaceful world for children like my daughter to inherit. That would leave a beautiful legacy for the Middle East and for the birthing world. Dr. F