The situation at Grady Hospital in Atlanta of cutting off dialysis for poor patients without insurance (which will make them, um, die) is an echo of the national political farse of throwing out public option health insurance and throwing more good money after bad (Karen Ignagni and her group of health insurance criminals). I am glad to see that Max Baucus (D-Mont) who was the author of the bogus healthcare reform bill (and a top recipient of pharma contributions) was able to get some extra healthcare money for some miners from Libby, Montana, as well as shell out even more profits to the pharmaceutical industry, health insurance, etc. Here he is in action shelling out the pork.

Max Baucus is keeping the industry guys well fed.

Here is an update on the Grady story from Neil Shulman MD:

IT IS SAD.  I had a meeting with the woman who wrote the book THE GRADY BABIES and a woman who works at Channel 11 and the nurse from Nigeria who has been here ten years, Is married to an American and just got her Green card.  SHE NEEDS TO BE HERE 5 MORE YEARS BEFORE GEORGIA MEDICAID PAYS FOR HER DIALYSIS.  The Channel 11 lady and the author (WROTE A GREAT BOOK WITH DICK GREGORY) are connecting with Dorothy to get the book on the dialysis crisis rolling (30 people who may lose their lives after Jan 3rd when the inner city hospital stops supporting dialysis for their kidney failure.)  They are planning on putting personal stories about the patients on the internet.

In the meantime,  there is a movement by some docs within Grady Hospital to change things such that humanization takes precedence over monetazation. ALSO,  THERE IS A PLAN TO TAKE A BUS LOAD  OF THE DIALYSIS PATIENTS TO A HOSPITAL EMERGENCY ROOM ……….ALL AT ONCE…EVERY FEW DAYS ……after Jan 3rd.

 ON another front,  the medical volunteerism conference WWW.EMORYIMVC.ORG  is MOVING ALONG VERY WELL…………..we have some fantastic presenters,  the first edition of the book about  these heroes is almost ready,  the White House is sending folks………….AN OUTPOURING OF SUPPORT FROM HUMANIZERS.

IF YOU HAVE SOME TIME,  WE SHOULD AT LEAST CHAT ON THE PHONE TODAY.  I AM AT 404-321-0126.  IF NO ANSWER,  JUST LEAVE YOUR NUMBER AND I WILL RETURN YOUR CALL SHORTLY.

NOW A SHORT OVERVIEW OF THE CURRENT CIVIL WAR IN THIS COUNTRY:

We are in the middle of a war in this coutry between the monetizers and the humanizers.  Sadly,  the victims of this war are poor sick people.  IF everybody was a humanizer as the folks involved in the medical volunteer activites………….there would be no problem.  We would have peace and poor sick people would not suffer and die……. One of the major obstacles to winnning this war is the barrier between the poor sick patients and everybody else.  The caring nurses and doctors AND LAY FOLKS who are on the front lines Understand the current atrocitIES.  The further one is away from connecting with poor sick people,  the less likely you can empathize with them.  It is easy to use words like “ILLEGAL ALIENS”  OR “LIMITED RESOURCES FOR POOR SICK AMERICANS”  and just let people suffer and die when you don’t have to look in the eyes of these people or hear their stories. 

One of the free clinics in South Atlanta struggles with getting patientsurgent health care by specialists every day.  Recently, there was a case of a man needing back surgery before “he became paralyzed.”  The community clinic (docs, nurses, and pastors) FOUGHT HARD AND got the patient into Grady Hospital for the surgery.  On the other hand, there are folks like the 23 year old woman who recently died in Grady because she was shut out of her access to steroids for her Lupus.  She did know how to overcome the new barriers (more paperwork and more upfront fees to be seen for a few minutes so she could get her refills).  She ended up in Grady’s ER very very sick. She was admitted and died. Medical students and staff docs told me the story.  Many folks are familiar with this recent tragedy.  There are many folks in similar situations every day who die at home without even getting to the emergency rooms.

In developing countries where there is lack of access to health care………..at least there is not a COVER-UP.  When we brought a little girl from Kenya to Univ of Alabama Med Center for heart surgery…………..the Kenya media, the local Kenya politicians,  the local roatary club,  THE HAVES AND THE HAVE NOTS…..ALL JOINED TOGETHER AND HELPED SAVE THIS LITTLE GIRL’S LIFE.  IT WAS AN ENTIRELY DIFFERENT CULTURE.  THERE WAS NO HIDING OF “THE FACTS.”  THERE WAS NO INTIMIDATION OF THE CARING FOLKS BY  MONETIZERS.  We are experiencing a larger and larger class of HAVE-NOTS in this country because of the economy.

DAILY MEDIA ATTENTION SHOULD BE FOCUSED ON EFFORTS OF THE HUMANIZERS TO HELP POOR SICK PEOPLE.  THIS WOULD GALVANIZE EVEN MORE PEOPLE TO JOIN IN.  THIS WOULD GALVANIZE MORE PEOPLE TO ADVOCATE FOR LEGISLATION TO ELIMINATE THESE ATROCITIES.  Maybe we could even get the Georgia Legislature to allow poor people to get medicaid coverage BEFORE THEIR CANCER SPREADS.  THE MEDIA WILL NOT INFOMORM THE PUBLIC THAT IF YOU HAVE A MALIGNANT MELANOMA ON YOUR SKIN AND YOU ARE POOR…………..THE STATE MEDICAID EMPLOYEES ARE FORCED TO TELL YOU “SORRY MEDICAID DOES NOT COVER YOU UNTIL YOUR CANCER SPREADS THROUGHOUT YOUR BODY.” 

 We need more media attention, legal action, and MORE folks EDUCATED AND involved.  IT IS A STRUGGLE WHICH CAN ONLY BE WON WITH AN ARMY OF HUMANIZERS.  I have found that people with resources who are humanizers are MUCH HAPPIER than people with resources who are monetizers.  You are surely one of the humanizers.

 IF THE MAJORITY OF MEMBERS OF THE US CONGRESS WERE NOT MONETIZERS………….THEN TRULY MEANINGFUL NEW LEGISLATION WOULD BE PASSED TO ELIMINATE THE BASIC HEALTH DISPARITIES BETWEEN  THE HAVES AND THE HAVE-NOTS.  WE CAN STILL HAVE PEOPLE WITH BIG HOUSES AND SMALL HOUSES, PEOPLE EATING AT FANCY RESTAURANTS AND PEOPLE EATING BASIC HEALTHY FOOD AT HOME,  PEOPLE GOING ON  EXPENSIVE VACATIONS AND FAMILIES DOING MEDICAL MISSIONS………..BUT AT LEAST WE WOULD HAVE A COUNTRY WHERE POOR SICK PEOPLE HAD ACCESS TO BASIC HEALTH SERVICES AND BASIC MEDICAL THERAPIES……….WHICH ARE AVAILABLE TO MOST PEOPLE IN EUROPE, CANADA, JAPAN, KOREA, ETC.

AND BY THE WAY,  IT WOULDN’T HURT IF MEDICAL LITERACY WAS AN INTEGRAL PART OF OUR EDUCATIONAL SYSTEM………..WHY DO JUST DOCTORS AND NURSES LEARN HOW TO EXAM THE HUMAN BODY, WHAT SYMPMTOMS ARE IMPORTANT, HOW TO PERFORM SIMPLE PROCEDURES LIKE TAKING BLOOD PRESSURES?……………..WHY NOT EMPOWER CONSUMERS SO THEY CAN USE THE HEALTH CARE SYSTEM MORE EFFICIENTLY.  READING, WRITING AND ARITHMETIC ARE IMPORTANT BUT YOU CAN’T DO ANY OF THOSE IF YOU ARE DEAD.  MARTIN LUTHER KING EMPOWERED FOLKS BY TEACHING THEM HOW TO VOTE.

LET’S EMPOWER AMERICANS BY TEACHING THEM MEDICAL LITERACY………….LET’S EDUCATE THE SCIENCE TEACHERS SO THEY ARE MEDICALLY LITERATE, SO THEY CAN TEACH OUR FUTURE GENERATIONS ON HOW TO EFFICIENTLY USE THE HEALTH CARE SYSTEM.

BEST,

NEIL SHULMAN

Our friend Senator Max Baucus (D-Mont.) came out with the bill that we had long been anticipating that Judas traitor and bed partner of healthcare industry “stakeholders” would come out with, namely dumping public option healthcare insurance and eliminating the chance that the government could negotiate prices of prescription medications. His plan calls for an expansion of Medicaid and financial penalties to induce individuals and their employers to sign up for healthcare insurance. This will be paid for by cutting Medicare spending to hospitals, taxing family healthcare insurance plans that cost over $21,000 a year, and getting some concessions from industry. This continues his pattern of serving up the grub for his industry partners who contributed so handsomely to his campaign. Too bad for us little guys.

Max Baucus is keeping the industry guys well fed.

This development caused the stock in insurance companies to rise and led to the comment that the insurance companies had “ducked a bullet”. I thought that was an interesting choice of, well, animals, since we had previously noticed that a congressman had observed that introducing a public health insurance option into the health insurance mix would be like having an “alligator compete with a duck.”

Karen Ignagni (AHIP). If it walks like a duck...

And Billy Tauzin of PhRMA negotiated supposedly negotiated an 80 billion “payment” from drug companies which is essentially the “doughnut hole” between when Medicare stops paying for prescription drugs and when it kicks in again for super high bills. In concession the government gives up the right to negotiate prices, so it really isn’t much of a concession to give up the doughnut hole for drugs that are way overpriced anyway.

Those healthcare industry guys must all be high fiving each other right now. Without a public option and without the government retaining the right to negotiate prices the costs of healthcare will only continue to rise and there will continue to be individuals who are not covered, perpetuating an inhumane and immoral system, that will eventually lead to an implosion of the economy.

President Barack Obama basically gave away the farm today when he indicated that he was open to giving up the public option for healthcare insurance, saying that he would not “draw a line in the sand” over the issue. Rahm Emanuel was quoted as saying:

The goal is to have a means and a mechanism to keep the private insurers honest. The goal is non-negotiable; the path is negotiable.

Them’s some ominous words.

With both Charles Grassley (R-Iowa) in the Senate and Max Baucus (D-Montana) opposed to a public option, it looks like our leaders have sold us down the river yet again as I have predicted before. It is my opinion that without a public option things will only deteriorate as the healthcare industrial complex cannot cut costs on its own.

The Obama administration state that they want nonprofit cooperatives to compete with private insurance plans. They say that if they don’t find evidence of competition, that the public option will “kick in” at a later date.

There has been a lot of negotiating going on. For instance, the hospital lobby just agreed to taking 155 billion in cuts over the next decade, mostly in reduced Medicare and Medicaid payments. This is in addition to cuts agreed to by pharma. They have been admonished not to bitch about the process if they want to keep their spot at the negotiating table with Baucus. Meanwhile we stories like this one about expensive treatments for prostate cancer that are being performed with the cost of over $100,000 when they have never been shown to be better than the “wait and see” approach (i.e. doing nothing). Only in America guys.

It looks our industry friends will agree to just about anything with the Obama administration to avoid going on a diet. Problem is they are for-profit and motivated by making money.

Richard Umbdenstock (AHA), Karen Ignagni (AHIP), Nancy Nielsen (AMA), Billy Tauzin (PhRMA), and David Nexon (AMTA)

Yep. Our friends from the American Hospitals Association (AHA), American Health Insurance Plans (AHIP), American Medical Association (AMA), and American Medical Techonology Association (AMTA) can all be counted on for one thing. Following their instincts. Which are greed.

I wonder if David is going to get some of the yummies or if they are going to let him get up to the table.

Meanwhile, 69% of Americans support a public option insurance plan, as do 59% of doctors. Only a third are opposed to it. And only 19% of doctors are members of the AMA, which officially opposes it. So those right wingers like Dr Bill Frist in the Senate do not represent our views.

President Barack Obama adressed the American Medican Association (AMA) today and stated that he was not gonna try and split up doctors from their patients or cut off their insurance plans if they liked them. You can read the entire transcript of his speech here. Obama argued that people must beware of “scare tactics and fear-mongering” that have killed healthcare reform in the past (Hi Hillary!) including the bogeyman of “socialized medicine” and said ”we know there are those who will try to scuttle” the program no matter what. He said that “because these fear tactics have worked, things have kept getting worse.” He also said that if we don’t do something about healthcare now that it will sink the country’s economy as a whole and America itself will become the next GM.

WE DRIVZ 2 DA RESKEW!

Meanwhile the quote of the day on healthcare reform was from Mike Pence (R-Ind) who said on CNN that “the government entering the private sector is like an alligator competing with a duck.” Well I’ve got some advise for YOU Ms Karen Ignagni (American Health Insurance Programs, or AHIP) direct from my South Georgia friends. The best was to get away from an alligator is to run zig zag.

Is Karen Ignagni (AHIP) ready?

Everyone was shocked when Bill Maher made fun of Obama and I watched him live on MSNBC tonight and couldn’t agree more when he said that Obama should have some guts and stand up for what is right, that he doesn’t need the help of the Republicans, and that the AMA is a lobby and “they are not your friends.” Here, here.

Nancy Nielsen, MD, Director of the AMA

Other news came from the Congressional Budget Office who said that healthcare reform would cost one trillion over ten years and insure an additional 16 million people (i.e. not all of the 50 million uninsured). Republicans of course jumped on this. And now the rhetoric has become “government take over” v “public option.”

The lobby for hospitals, the American Hospital Association (AHA) headed by Richard Umbdenstock, contacted heads of hospitals across the land and urged them to “push back” against President Barack Obama’s healthcare reform. Obama decided that he could come up with part of the one trillion dollars he will need over the next decade to pay for healthcare for all by cutting payments to hospitals by 200 billion dollars.

Richard Umbdenstock of AHA makes his move to push back against healthcare reform

Nancy Nielsen (AMA), Billy Tauzin (PhRMA), Karen Ignagni (AHIP)

David Nexon, AMTA. Go team!

Maybe it’s time we did a little “pushing back”, like pushing back against the AMA for their greedy and selfish opposition to healthcare reform, or against the medical establishment for the huge disparities in regional medical spending without differences in care that demonstrate the gaming of the system to make money.

Yesterday the American Medical Association (AMA) announced that it would not be in favor of any kind of government sponsored health insurance for people under age 65. They said that that would not help keep costs down or expand coverage. Only a cretin would conclude that government sponsored plans with 2% administrative costs would be more expensive that bloated private plans with 32% overhead. That is why the private insurance guys are so scared. This dinosaur organization, which incidentally fought tooth and nail against Medicare, is largely responsible for the pathetic state that American healthcare is in today. The AMA is nothing more than a representation of everything that is wrong with American physicians, i.e. greed, gluttony and self interest, in case you haven’t read the papers lately. While Nancy Nielsen MD of the AMA pigs out with the likes of Janet Ignani of the American Health Insurance Plans (AHIP), thousands of people dying because of no access to medical care.

Mmmm. Supper time for medical Gang of Four: (from L) Max Baucus (D-Mont), Karen Ignagni (AHIP), Rich Umbdenstock (AHA), Billy Tauzin (PhRMA), Nancy Nielsen MD (AMA).

The New York Times today pointed out today that the AMA does not speak for all doctors. Ahem. At this point any doctor that would be associated with that foul organization should hang their head in shame.

An article in this month’s New Yorker called The Cost Conundrum by Atul Gawande MD has gotten the attention of the current administration in Washington. The news that McAllen TX had the most expensive healthcare in the country as measured by Medicare expenditure per capita, twice as much as Rochester MN, site of the Mayo Clinic, with three thousand more spent per person than the average per capita income in the county, caused President Barack Obama to say “we’ve got to fix this.”

What was more interesting to me was the fact that none of the hospital administrators had any idea that their spending was so far out of control. The fact is for years researchers at Dartmouth and elsewhere have been documenting the gross aberrations in healthcare spending on a regional basis. And does it translate into better healthcare outcomes? Nope. States like Florida and Texas with the highest spending are in the bottom 25% on health outcomes. And you can’t blame it all on lifestyle. Smoking and alcohol use is lower in the US than in most European countries, and we have worse healthcare outcomes and spend more on healthcare. 37% of Americans skip medical care or don’t take prescribed medications because of an inability to afford it, and the US has the highest rate of medical error of any industrialized country, with 32% of patients with chronic conditions reporting that they had been subjected to medical error. And the frequent comparisons made to the Canadian healthcare system are a bunch of nonsense.

The problem, as pointed out in the article, is that there is no disincentive to avoid costly medical tests. And the doctors can’t blame it on fear of lawsuits because Texas now has a cap on damages that has caused those to dry up. The fact is, that physicians are now becoming partners in imaging facilities and hospitals, so they have a conflict of interest.

When I was in training in our Nuclear Cardiology seminars at Yale, I would joke that the conclusion of every case was that the patient should receive a cardiac catheterization (where they pass a wire into your arteries and shoot die and take a picture)– so why bother talking about it? It’s gotten even worse now. If you have chest pain in McAllen, you will probably get a cardiac catheterization. For what? Cardiac surgery results in real benefit for only 3% of patients, and that is for those who actually have heart disease. Stomach pain? Take out your gall bladder. The problem of skyrocketing costs is related to use of medical testing and procedures that is not beneficial to patients. I for one would not let a surgeon bully me into an unnecessary surgery that could possibly result in cognitive complications from the anesthesia.

Update: read Alison Bass blog “More doctors disagreeing with AMA on universal healthcare.”

President Barack Obama has decided to take a more hands on approach to healthcare reform, with plans for speeches, town hall meetings, and direct meetings with legislators, instead of sitting back and waiting for Congress to mess things up. That might be a good thing, rather than sit back and let people like Max Baucus (D-Montana) bring all the special interest groups to the table (health insurance (AHIP), hospitals (AHA), Pharma, and doctors (AMA)) and chow down while the rest of us get crumbs (see “Medical Gang of Four Cling to Table of Healthcare Reform“).

Mmmm. Supper time for medical Gang of Four: (from L) Max Baucus (D-Mont), Karen Ignagni (AHIP), Rich Umbdenstock (AHA), Billy Tauzin (PhRMA), Nancy Nielsen MD (AMA).

Don’t forget to toss some yummies to David Nexon (Medical devices, AMTA). Ruff!

The unidentified man looking away is probably a Canadian spy.

Well just in case you were feeling depressed the Medical Gang of Four all gave us a laugh last week by offering to (as I wrote before) voluntarily cut spending by two trillion over the next ten years (how they would do this is a mystery, but it surely won’t involve cutting out the 30% of medical tests, scans and screenings that are useless for the patient). Conveniently this is about what Obama would need in order to introduce a government health insurance. However Karen at the AHIP is probably flipping out about him using the “g” word since she knows that private health insurance companies in the US with their bloated 25% administrative overhead costs could never compete with a government plan that has a 2% administrative overhead cost, and that anyone in their right mind would choose the government plan, unless they had money to burn. Billy also doesn’t want a healthcare plan that would be able to negotiate lower drug costs. In fact as we speak they are lobbying to get the government plan parceled into many smaller entities or relegated to the states. In other words take the teeth out of any negotiating power that the plan would have. An alternative floated by Olympia Snowe (R-Maine) is to have the government plan only come into effect if it is “triggered” by excessive healthcare costs somewhere several years down the road (i.e. never). One thing for sure is that whomever kills the healthcare plan doesn’t want to be caught with the murder weapon in their hands. It looks like all of this is going to go down pretty quick as Obama just announced that he wants to finish this during this legislative session.

Burning money to keep warm

Well as Sen Grassley said if he wants to take on healthcare reform himself he better put on his kid gloves. As I have said before he is swimming in shark infested waters taking on healthcare reform. 

Good luck.