Bioethics

Untested Waters (TMA on ObamaCare)

From the Texas Medical Association website:

Both Texas Oncology and ARC, for example, already participated in most major health plans in Texas before the launch of the exchange. Because not all of those insurers explicitly invited Texas Oncology to join their new marketplace networks, the group was combing through its contracts and contacting carriers to find out how to opt out of the exchange plans. All of ARC\’s existing contracts require insurers to renegotiate with the group before including it in any new products or networks. Some payers never approached the group; others came back with lower fee schedules, which ARC declined. On the other hand, 27 percent of respondents in the MGMA survey said they are participating in the exchange because their existing contract terms required them to participate in all of an insurers\’ products under so-called \”all products\” clauses.

Because a number of Dr. Buckingham\’s contracts include such clauses, the six-physician practice, Eye Physicians of Austin, faces the prospect of renegotiation in order to opt out of certain exchange plans.

\”To me, my hands are tied, and they are making me jump off of a plank I don\’t want to jump off of. And it\’s an expensive process, and it interrupts patient care,\” she said.

via Untested Waters.

Texas Tribune interview with abortion-seeking couple

First, I hope and (am praying) Marni begins to love her child and allows her to live.

The Texas Tribune has published an interview with a couple whose baby’s life has been spared – at least for a few days – by Texas law.

Here’s the interview:

However, she found 2 alternatives within 2 days, so her rights are not at all infringed upon.

Marni is mistaken about the number of abortions in Texas every year. There were 66,000, not 80,000 abortions in 2012. 72,000 in 2011, 77,500 in 2010, 77,850 in 2009.

Marni specifically asks what sorts of “resources” the State and pro-life people have made available. She should have already known – and should ask their abortionist at her next appointment – about the Texas Woman’s Right to Know “Resource Directory.” She should have been given a copy at her first abortion consult appointment with Planned Parenthood. It’s also available online here.,  The file in pdf includes the information she asked about. The booklet lists agencies and assistance that’s available  from the State, County, and private organizations for pregnant women  in Travis County.

I’m not surprised that their comments are so political, and that John talks about politicians “shoring up their base,” etc., since that’s a common talking point for abortion advocates when they talk about pro-life politicians. I’m sure that someone at Planned Parenthood fed them the inaccurate statistics and coached them on the motives of people like me and the legislators who worked to protect life.

(I do have to wonder how Marni and John missed all the press leading up to the passage of HB2. You would think they’d have heard about Wendy Davis’ filibuster at least!)

Hopefully, when they see the way they’ve been misled about statistics, they will begin to understand that the prolife activists and politicians are as honest as we can be about our motives.

Lubock Abortions to Stop

\”Upon the completion of the transfer of all assets to Generation Healthcare, Planned Parenthood will no longer exist in Lubbock Texas.\”

via Lubbock Abortion Clinic Bought Out, Abortions to Stop – EverythingLubbock KLBK KAMC.

#Stand4Life Victories: Texas’ law upheld, ObamaCare contraception mandate struck

Victory on two levels! Many of Texas’ abortion facilities are closed today because they don’t have doctors with hospital privileges and today, the DC Court of Appeals ruled in favor of religious conscience rights, even for people who own businesses!

From The Hill, a blog out of Washington, DC:

A federal appeals court on Friday struck down the birth control mandate in ObamaCare, concluding the requirement trammels religious freedom.

The D.C. Circuit Court of Appeals — the second most influential bench in the land behind the Supreme Court — ruled 2-1 in favor of business owners who are fighting the requirement that they provide their employees with health insurance that covers birth control.

Requiring companies to cover their employees’ contraception, the court ruled, is unduly burdensome for business owners who oppose birth control on religious grounds, even if they are not purchasing the contraception directly.

“The burden on religious exercise does not occur at the point of contraceptive purchase; instead, it occurs when a company’s owners fill the basket of goods and services that constitute a healthcare plan,” Judge Janice Rogers Brown wrote on behalf of the court.

via Court strikes down mandate for birth control in ObamaCare | TheHill.

Fifth Circuit Stays Yeakel Ruling: Court of Appeals says HB 2 abortion restrictions go forward – News Blog – The Austin Chronicle

Court of Appeals says HB 2 abortion restrictions go forward

By Michael King, 7:53PM, Thu. Oct. 31

Fifth Circuit Stays Yeakel Ruling

In a decision released late Thursday, the Fifth Circuit Court of Appeals granted the motion of Texas Attorney General Greg Abbott, overturning the ruling of federal District Judge Lee Yeakel and allowing enforcement of the restrictions that will likely leave thousands of Texas women without access to abortion care.

Specifically, the three-judge panel stayed Yeakel\’s injunction against the law — specifically the provision that will require doctors administering abortions to have admitting privileges in a nearby hospital – pending an appeal to the whole Fifth Circuit that will not be heard until at least January. That means many clinics will close, because most doctors will not be able to get admitting privileges to hospitals where they do not normally practice. The ruling left in place, in part, the judge\’s ruling that medication abortions could be performed in certain circumstances, when the mother\’s life or health is in danger.

via Fifth Circuit Stays Yeakel Ruling: Court of Appeals says HB 2 abortion restrictions go forward – News Blog – The Austin Chronicle.

Texas abortion clinic not safe

Who’s surprised that the abortionists aren’t concerned about sterile instruments, monitoring patients’ heart rates or keeping up with their life saving skills or equipment? They’re not in the business of saving life. They kill.

The October 3 inspection at Whole Woman\’s Health of Beaumont turned up potential health issues.

The report says the facility failed to provide a safe environment for patients and staff. The suction machines which were used on patients had numerous rusty spots which, \”had the likelihood to cause infection.\”

The report also says, \”the facility failed to have the EKG monitoring equipment ready if an emergency situation occurred…\”

Fatima Gifford, the spokeswoman for Whole Woman\’s Health, said Tuesday that at this time, the clinic did not have a comment

via Inspection of Beaumont abortion clinic raises health concerns – 12 News KBMT and K-JAC.

At least this news organization reported on the local facility. You won’t find much coverage, even among the “journalists” who are all over the lawsuit news.

From LifeSite News, here’s the rest of the story:

Whole Women’s Health facilities all over Texas failed inspections for the last two years, time and again. There were holes in the cabinets, rust on machines used during the procedures, and the staff didn’t know the proper method of sterilization or checking that supposedly sterile tools actually are sterilized in the autoclave. Where they were found to be lacking last year, they made no changes, no improvements.

Their focus and skills lie in taking life, not preserving or saving it.

PolitiFact Texas Defends – and Interprets – Davis On Abortion

If I were being exceptionally kind, I’d interpret Texas Democratic Governor candidate (and portable urinary catheter user) Wendy Davis’ position on abortion restrictions as, “Whatever the Supreme Court rules is good enough for me.”  When not so generous, I’d say she’s not answering the question.

What Wendy Davis said,

 “Davis, while addressing the National Press Club in Washington, D.C., Aug. 5, 2013, was asked, “Could you discuss what legal limits on abortion you do support?”

She replied, “You know, the Supreme Court has made that decision. And it’s one of the protected liberties under our Constitution. And I respect the constitutional protections that are in place today.”

.”

Politifact’s interpretation:

So in her response in Washington, Davis signaled that she both accepts letting states limit abortions after the first trimester and limit or ban abortions after fetuses are viable, unless the mother’s life is at risk.

via PolitiFact Texas | Davis opposes late-term abortions, with certain exceptions.

How refreshing it would be if one of the “fact-checkers” actually asked the hard questions of a pro-abortion Dem!

Study compares panhandle teen pregnancy and Planned Parenthood – KFDA – NewsChannel 10 / Amarillo News, Weather, Sports

It appears that Planned Parenthood doesn’t change teen pregnancy rates – it’s neither necessary nor effective:

The study uses pregnancy rates reported by the Texas Department of Health State Services.

In 1996, a year before opposition to Planned Parenthood began, the teen pregnancy rates across the panhandle was more than 43.6 per 1,000 girls.

Two years after all facilities had closed, teen pregnancy was at 24.1 per 1,000 girls. Researchers are claiming that this is a significant confirmation that Planned Parenthood\’s presence and its sex education programs are not a necessary tool in reducing teen pregnancy.

But that doesn\’t seem to be the case everywhere across the state.

NewsChannel 10 has done some more research of it\’s own. In other areas of Texas where Planned Parenthood is a part of sex education and teen pregnancy rates have also dropped.

via Study compares panhandle teen pregnancy and Planned Parenthood – KFDA – NewsChannel 10 / Amarillo News, Weather, Sports.

BOR: Lies from the Left (I know, it’s redundant)

And BOR is a much better acronym than anything I could make up.

The Burnt Orange Report is Texas’ own quintessential leftist blog, spinning and twisting any stories or facts to make conservatives look bad.

Good little far-left Democrat media tool that the BOR is, it seems almost superfluous to note that the blog is pro-abort. However, the reason I’m bringing BOR to your attention is Part 1 and Part 2 of “Why Texas Women Need Access to Later Term Abortions by someone named Natalie San Luis.

The BOR enjoys bold exaggeration in its fonts, to highlight the most emotional rants. There are the usual facetious arguments that women need abortions after 5 months such as, “wealthy women who have the means can jump over the barriers, but more and more women can’t” and “Amniocentesis, which tests amniotic fluid for fetal abnormalities and genetic problems, is sometimes performed as late as 22 weeks.” (The babies of less than wealthy women and their mothers deserve protection, too. And amniocentesis is usually done much earlier  and is still legal, just as it is at 30 weeks or 35.)

Ms. San Luis would also have us develop sympathy for doctors who fear the liability of making a decision about whether a baby’s birth defect is compatible with life.

After. 20. weeks.

Because: ” Accounting for factors like the woman’s health history and future complications, it is almost impossible to accurately guess the likelihood of fetal survival in each of these cases. “

(Maybe that’s why they can’t get local hospital privileges.)

While I can mock the poor logic of the author, it’s better to catch her repeating easily checked, but false “facts.”

The founder, President and CEO of the San Antonio Abortion facility, Whole Woman’s Health, Amy Hagstrom Miller, is quoted as saying, “We’ve seen a 10 percent increase in second trimester abortions just since the sonogram bill has passed,”.

Besides the fact that there’s only one year of data available “since the sonogram bill has passed” and went into effect in late 2011, the numbers don’t back up that statement, unless it’s local to the San Antonio facility.  According to numbers from the Texas Department of State Health Services, there were 136 fewer 2nd trimester abortions in Texas in 2012 than in 2011.

Year      Total Abortions      2nd Trimester Abortions  1st Trimester Abortions   %1st

2012       66098                          5204                             60882                          92.1
2011       72470                          5340                             67121                          92.6
2010      77592                           5542                             72042                          92.8

(I couldn’t resist showing the steady decrease in abortions in Texas, even though it horrified me to put those large numbers into the calculator.)

Did anyone else notice that there’s no obvious way to make comments on BOR?

Edit 10/10/13 – correcting punctuation, removing my own redundancies — BBN

NEJM “I want” ethics

In the Abolition of Man, C.S. Lewis notes that, “When all that says ‘it is good’ has been debunked, what says ‘I want’ remains.”

Last week, the New England Journal of Medicine published a “Perspectives” column, “Life or Death for the Dead Donor’s Rule?,” in which the authors  illustrate Lewis’ point with their redefinition of non-maleficence to better serve a re-defined autonomy.

They would convince us that there is no harm in hastening the death of a dying patient even by intentionally causing it if he or his surrogates ask. They ignore a 2500 year old First Principle of Medical ethics,focused on the health of the patient in front of us: “Cure when possible, but first do no harm, ”

Autonomy, like all rights, is a negative right: the patient has the right to refuse invasive medical interventions that will harm him or that he does not want. Patients and surrogates, if they can compel the use of medical skills and invasive technology, can only do so for the medical benefit of the patient himself.

Illogically, in these times of reducing costs, the authors would have us consider taking a patient from the ICU to the OR “and then take him back to where life support would be withdrawn.” The return to the ICU is nothing but our own “medical charade.”

The Abolition of Man can be read online, here, or you can buy the Kindle version at Amazon.com.

I want to thank Nancy Valko, who runs an email list covering a range of traditional ethics issues, her email alerting me to this editorial.

“Choosing Wisely” doesn’t

Back in September, WingRight promoted a program, “Choosing Wisely,” an initiative by the American Board of Internal Medicine. Well, the other shoe dropped.

For years, I’ve told patients that we need to periodically screen for hypertension and diabetes because most people don’t feel bad when their blood pressure or blood sugar is high. The Center for Disease Control reports that about a fifth of people with high blood pressure and that nearly a third of diabetics are undiagnosed.

But these facts didn’t impress the Society of General Internal Medicine, which released their “Choosing Wisely” list suggesting that doctors not ask non-insulin dependent diabetes patients to check their sugars at home or schedule “routine general health checks for asymptomatic adults,” including the ‘health maintenance’ annual visit”  The SGIM claims that these common medical practices cause more harm than good — or is it that they cost more money than they save?

Even the CDC is victim to the #ShutDown #TemperTantrum!

Someone was paid to put this notice on the Centers for Disease Control website! On the home page, it’s on a red background! (But don’t worry: they also have a reminder to sign up for ObamaCare.)

Due to the lapse in government funding, only web sites supporting excepted functions will be updated unless otherwise funded. As a result, the information on this website may not be up to date, the transactions submitted via the website may not be processed, and the agency may not be able to respond to inquiries until appropriations are enacted.

Updates regarding government operating status and resumption of normal operations can be found at http://www.usa.gov.

via CDC – Diabetes Public Health Resource – Data & Trends.

Update, 7:30 PM 10/7/13: The National Institutes of Health also has a disclaimer.

Study: 20,000 a Year Will Go Without Abortions Due to Texas Law

Texans paid for this study by the University of Texas College of Liberal Arts, Texas Policy Evaluation Project, founded to “evaluate” the effect of the 2011 State budget cuts on Family Planning, ignoring the deep cuts on everything else the State funded. (Speaking of ignoring: the website hasn’t updated the information on Family Planning since the 2013 Legislature added over $200 Million dollars to the program.)

Tx-PEP, as they call themselves, got some publicity on a San Antonio radio station, WOAI, today, complaining that women will have to “go without” elective abortions.

A pro choice activist group says the strict new abortion restrictions which were approved by the Texas Legislature in July will result in more than 22,000 Texas women per year being unable to undergo an abortion, 1200 WOAI news reports.

“Women particularly in rural areas and outside of cities who want to terminate a pregnancy, will have no recourse because there will be no late term providers left,” Jody Jacobsen of the Texas Policy Evaluation Project, told 1200 WOAI news.

Elective abortions are “elective.” These are not abortions to save the life of the mother. They are abortions due to “choice.”

Of course, the Texas Policy Evaluation Project doesn’t admit that none of the current abortionists are in rural areas. In other words, anyone seeking an elective abortion today must go to a big city and may be inconvenienced.

Forget any pretense at impartiality:

  The laws do not cover women who are less than twenty weeks gestation, and abortions will still be available to them.

  But Jacobsen says it’s all a matter of personal freedom.

  “Who is Rick Perry to tell me what decisions I should or should not have made, or what any other woman should or should not have made,” she said.

Abortionists file suit against (only 2) new Texas regulations

The (oxymoronic) “Center for Reproductive Rights” and other abortionists have filed suit to prevent two of the provisions of Texas’ new requirements on doctors who perform abortions – not on the management or owners of the abortion facilities. The new law becomes effective October 29, 2013 and was passed by the Legislature and signed by the Governor.

From the on-line, liberal Texas Tribune:

The next stage in abortion rights advocates’ efforts to block implementation of strict new regulations on the procedure in Texas began on Friday, as the Center for Reproductive Rights, the American Civil Liberties Union and a group of abortion providers across the state filed a lawsuit in federal court.

 

 

Everyone in Texas politics has been waiting for the lawsuit(s) challenging this summer’s hotly debated legislation. Surprisingly, the abortionists aren’t asking the Courts to stop the prohibition on elective abortions after 5 months or on the requirement that abortion facilities meet requirements for Ambulatory Surgical Centers. Instead, only two parts are challenged and both are requirements on the State-licensed doctors, not on the facilities.

The dispute is over the requirement that doctors personally hand the pills for medical abortions to their patients, rather than delegating the dispensing to a nurse or med tech or sending the woman home to take the pill. Doctors must also have privileges at a hospital within 30 miles of the office or facility where they perform abortions, so that they are able to admit their patients and care for any complications that might arise from the abortions they perform.

The agreement that doctors sign with the company that makes Mifeprex (also known as RU486 or mifepristone) was reaffirmed a year ago by the FDA. By signing the contract with the manufacturer, the doctors pledge that they will dispense the pills themselves. State law now requires them to keep their word.

As to the requirement that the doctors performing surgical and medical abortions maintain hospital privileges: It’s standard of care to expect doctors to care for complications of any intervention they perform – whether it’s setting a broken bone, cleaning an abcess or performing some outpatient surgery such as removing a mole or ingrown toenail. To fail to provide timely follow-up and/or call coverage for after-hours care is abandonment. Why should it be different for Doctors intervening to perform an abortion?  When I delivered babies, those of us who were on call for Obstetrics had to be able to physically show up at the hospital (and patients’ bedside) within 30 minutes in order to maintain hospital privileges. My Family Medicine privileges (without OB) required me to be able to respond (if not appear at the hospital) within a certain time. (I can’t remember the specifics, but believe it was similar.)

We’ll see if the Austin-area federal judges think it’s appropriate for the State to regulate the physicians we license. I’m especially looking forward to hearing why the State is “unconstitutional” by holding physicians to a contract they’ve already signed.

“Choosing Wisely: Five Things Physicians and Patients Should Question”

Bookmark this page: “Choosing Wisely: Lists.”

Whether you are seeing your doctor for a cold, a routine physical or a “new patient visit,” or when you suspect that he’s offering you the famous notorious “blue pill or red pill,” how do you as a layman know whether a medical test or procedure is needed? Will it lead to a treatment decision or just more tests? Does it help? Or does it actually cause harm?

Or politically, will ObamaCare cost cuts and rationing deny you a procedure, test, or treatment that would be helpful?

The American Board of Internal Medicine Foundation asked the various physician sub-specialty organizations in the US to list tests, treatments and procedures that don’t help or might actually hurt patients. The lists are published on the “Choosing Wisely” website.

Remember, there’s a difference between screening tests that look for something you might have, and diagnostic tests to explain a symptom from your history or chief complaint, a finding on an exam or to determine whether a treatment is working or harming. And there’s certainly a difference between starting a treatment, doing a procedure or ordering a test that leads to more risk than the disease or condition we’re treating just because . . . of money, out-of-date knowledge, or patient desire. Or because we can.

Whatever health care problem or concern you have, take a look at the list from the medical specialty for the pertinent body part or organ system. Which tests and procedure do you need, and which have you had that are on these lists?

I don’t quite agree with all the items on all the lists. After all, patient care is not a recipe from a given cookbook – and besides, patients’ bodies can’t read the books to follow the recipes.

Let’s talk! Ask me questions and/or let me translate the jargon.

Dr. Jeffrey Singer: The Man Who Was Treated for $17,000 Less – WSJ.com

Nothing in the world is free, but we’re being told that a lot of expensive health care will be, thanks to ObamaCare. Why would anyone think that this time, government interference will result in anything different?

The savings talked about in this article aren’t an option for anyone eligible for Medicare, because few doctors and virtually no surgical facilities are willing to take their cash since any “provider” who enters into these cash-pay contracts must “opt out” of Medicare for two years.

Jeffrey Singer writes about the benefits of self-pay medicine and the hazards of involving a third party in the Wall Street Journal:

This process taught us a few things. First, most people these days don’t have health “insurance.” They have prepaid health plans. They pay premiums to take advantage of a pre-negotiated fee schedule arranged for and administered by a third party. My patient, on the other hand, had insurance.

Second, even with the markdown for upfront “cash-pay” patients, none of the providers was losing money on my patient. Otherwise they wouldn’t have agreed to the prices. With the third-party payer taken out of the picture, we got a better idea of the market prices for the services. It is the third-party payment system that interferes with true price competition, so “market clearing prices” can’t develop.

Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care.

When my patient returned for his post-op visit we discussed the experience. It was clear to both of us that the only way to make health care more affordable is to diminish the role of third-party payers. Let consumers and providers interact through market forces to drive down prices and drive up quality, like we do when we buy groceries, clothing, cars, computers, etc. Drop the focus on prepaid health plans and return to the days of real health insurance—that covers major, unforeseen events, leaving the everyday expenses to the consumer—just like auto and homeowners’ insurance.

A little history: Before I went to Medical school, my husband and I felt lucky to have major medical insurance, to cover hospital bills and some procedures. We paid cash for office visits – less than we pay for co-pays now. My first childbirth wasn’t covered by insurance, but we paid less than $1000, including the hospital and the $300 to the doc. Twenty years ago, I received $1100 (Medicaid) to $1800 (Insurance) for pregnancy and delivery Obstetrical care and the hospital charged about the same. Today, the total is $20,000 or more. (In Texas, 55% of those babies are paid for by you, the taxpayer, through Medicaid.)

While some people think our National problems began back when employers first started offering insurance, at least that was insurance and medical costs remained fairly stable until the late 1960’s. The real problems began when Medicare allowed Congress to collect taxes with a promise of a (hospital, Part A) safety net for those over 65, but spent all the money by “loaning” it to the general budget. From the beginning, Medicare inflated costs by encouraging doctors to raise their fees 10% a year. Private health care costs followed or leaped ahead.

Less than 10 years later, the Democrat Congress invented HMO’s in a failed attempt to control costs – but they still didn’t stop spending Medicare and Social Security dollars. A few years later, there was the very mistaken attempt to limit training to cut the numbers of doctors. The Hill-Burton Act, Stark laws, HIPPA, and on and on, further increased the actual costs, the hassle factors, and government ownership of medical care, while promising more by adding outpatient and drug coverage. Bill Clinton’s Attorney General Janet Reno not only armed Donna Shalala’s Health and Human Services Inspectors, she threatened to prosecute Medicare-eligible patients for contracting private pay agreements with their doctors. She and Shalala held “fraud rallies” in football stadiums with the Director of the FBI, to teach Medicare patients how to turn in their doctors for fraud.

If there is to be a government “solution” (short of getting out of the way), future laws should support innovations like “Direct Primary Care” combined with patient-owned major medical *insurance,* rather than pre-paid health care. For those who truly need help, give tax credits similar to the child credit or even the earned income credit.

Just take care of the patient

What causes a frail elderly person to become a patient in the hospital and can we do something in the home to prevent that event?  What causes some people to develop chronic illnesses and can other people intervene to prevent the consequences of those illnesses?

What if healthcare reformers asked these questions rather than focusing (or appearing to focus) only on costs? Better yet, what if they recognized the system changes that work, rather than insisting that all doctors must become employees of mammoth organizations, touting the business opportunities inherent in expensive, user-unfriendly electronic medical records and/or forcing an even more expensive change from the 5-digit medical diagnosis codes in ICD-9 to the 7-digit ICD-10 codes?

The source for the graph above is a report by the Oliver Wyman Healthcare Innovation Center, reviewed in Forbes Magazine last January by author Dave Chase. Yes, 5% of patients are responsible for 45% of the costs. What works to lower costs? Taking care of the patient:

In 2008, when physicians from CareMore, an independent medical group based in Cerritos, California, heard news reports of a brutal heat wave, they began contacting their elderly emphysema patients. Physicians worried that the scorching heat would drive their at-risk Medicare Advantage patients to the emergency room. So when patients said they had no air conditioner, the physicians purchased units for them. The theory was that the roughly $500 cost paled in comparison to the cost of an emergency-department admission. As it happened, this non-medical “intervention” kept CareMore’s patients out of the hospital. But if they had needed to go and lacked transportation, CareMore would have offered a free ride.
CareMore has an expansive, counter intuitive approach to healthcare. The group fends off falls by providing patients with regular toenail clipping and by removing shag rugs—a common household risk for the elderly. Patients engage in iPhone conference calls with healthcare professionals and are remotely monitored with devices that feed data automatically to doctors;  for example, patients with congestive heart failure are given a wireless scale that reports their weight on a daily basis—a key step in preventing hospitalization. They have singing pillboxes that chime when it’s time to take medications.

These unusual tactics produce enviable outcomes: CareMore’s  hospitalization rate is 24 percent below average, hospital stays are  38 percent shorter than average, and the amputation rate among diabetics is 60 percent below average. Overall member costs are roughly 18 percent below the Medicare average.

The electronic medical record helped CareMore identify patients at risk, but the EMR is a minor tool compared to the minds of the innovators who recognized the real problems and acted in the best interest of the patients.

Obamacare Consumer Cost Protections–Delayed! | National Review Online

Or, as my granddaughter said, “Was he BORN dumb?” We, the people, will now pay more than we were promised!

The Obamacare “train wreck” continues. Now, the NYT reports, the caps on out-of-pocket expenses–you know the “affordable” part of the Affordable Care Act–are being delayed a year

via Obamacare Consumer Cost Protections–Delayed! | National Review Online.

Why not “delay” the whole thing?

Texas or DC: Who do you want regulating your doctor?

Peggy Fikac once again proves that she’s not a reporter, and most certainly not anything like a fair and balanced media representative.

From the Houston Chronicle’s coverage of events in Austin, today:

“Obamacare is the wrong prescription for American health care, and I will never stop fighting against it,” Abbott said, joined by small business people and a doctor who also oppose the law at a company, the Texas Mailhouse.

One reason that Abbott gave for fighting the law came in response to a doctor who asked him from the audience about what Texas could do to keep the federal law from interfering with doctors’ judgment about the best way to treat their patients.

“You’re raising one of the more challenging components of Obamacare, and a hidden component in a way, and that is government is stepping in between the doctor-patient relationship and trying to tell you what you can and cannot do, interfering with both your conscience and your medical oath to take care of your patient,” said Abbott, who is campaigning to succeed Gov. Rick Perry.

That is similar to arguments raised against tighter abortion restrictions approved in special session, including a ban on the procedure at 20 weeks, along with stricter regulations on clinics and abortion-inducing drugs.

 

I am that doctor from the audience. Ms. Fikac is correct that I voiced concern over the Federal interference between the patient and the doctor. She’s flat wrong about Texas regulation of medicine by bring abortionists up to standards being equivalent to the

I prefaced the question by noting that it is the State of Texas that properly regulates Texas Doctors and medicine. At the State level, patients and doctors have more influence on our elected officials and the people they appoint to write regulations and enforce the law than we do on the Federal level.

I also noted that because of the increasing interference over the years by Medicare, I am concerned about the reach that this new set of regulations will have, including ever-invasive micro-reporting of patient’s private medical conditions. (I named the upcoming move to the ICD-10, which will be a nightmare, requiring doctors to make distinctions between medical conditions, out to five (5) decimal places.

As bad as the bureaucracy of the Office of the Inspector General for the Federal Health and Human Services and the Centers for Medicare and Medicaid Services have been in the past, I don’t look forward to the additional layer of IRS income verification, audits and enforcement.

We could stick closer to home, with the Texas Health and Human Services, the Texas Medical Board, and the Texas Insurance Commission!

Freedom2Care: Now Secretary of Health and Human Services Kathleen Sebelius is not radical enough to work at Rite Aid

Conscience? More “Trust me, I’ll violate my conscience” news:

Tolerance. Diversity. Broad-mindedness. Those are the words.

Bullying. Discriminating. Compelling. Those are the deeds.

The contradictory words and deeds often come from one and the same individuals–and in a case I learned about today, companies. Turns out the words of tolerance, diversity and broad-mindedness only apply to those who comply with the dogma and submit to the will of the speakers.

Here’s an email I received this morning from a pharmacist member of the Christian Medical Association:

“Subject: Forced to resign over mandate to sell the morning after pill.

“Just to let you know that Rite-Aid corporation came out with a stricter policy on July 5, 2013 that requires all employees to accommodate the sale of the morning-after pill to all comers, of either gender and of any age.”

Read more via Freedom2Care: Now Secretary of Health and Human Services Kathleen Sebelius is not radical enough to work at Rite Aid.

While I don’t believe that Plan B is an abortifacient, I do believe it’s a powerful drug and that adolescents shouldn’t be able to buy it over the counter. I also find it hard to trust someone who will agree to go against their conscience!

Dr. Wes: A Case of (Medicare) “Fraud”

A real-life, real medicine tale of the risk that doctors face – and are willing to face – when taking care of our patients under arbitrary and often outdated Medicare regulations. It will only get worse under ObamaCare and the IRS.

He was a slender-framed man, mid- to late-sixties, with a kind of ridden-hard-put-away-wet complexion.  It was clear the years had not always been good to him, but being the kind soul that he was, he had plenty of friends.  It was a beautiful summer day to spend with friends for a barbecue, but he arrived feeling puzzled why he collapsed at home earlier in the day.

He stopped at the keg and poured himself a beer in a red solo cup, and as he approached his friends with a smile, he did it again, this time which such gusto that his beer went flying and the thud he made when he hit the ground made everyone gasp.  He laid motionless for a moment face down on the ground while his friends rushed to his aid.  An ambulance was summoned as others rolled him over onto his back.  He began to move – slowly at first – then more purposefully.  As sirens approached, he asked his friends, “What just happened?’

Read the rest of the story here.

The author’s comments:

It is becoming abundantly clear that conflicts between the [sanctity] of human life will confront the government’s unwillingness to pay for procedures. No where is this more clear than with approval of payment for the implantation of an ICD, which might run in excess of $200K for the procedure at some instituions. As a result, doctors who strive to provide state-of-the-art care to their patients will continue to confront similar ethical dilemmas that risk their legal standing (and credentials) as they care for their sickest arrhythmia patients.

By publishing this case scenario, my hope was to draw attention to these ethical dilemmas that are becoming increasingly prevalent in medicine as a result of these outdated, inconsistent, and incomplete coverage decisions, guidelines for care, and “appropriateness use” criteria. Further, the potential for legal action against physicians y imposes real fear for do

ctors if they stray at all from these outdated decisions. This fear is to the point where it might do actual harm – and even cause death – to patients who are left without appropriate treatment as a result.

via Dr. Wes: A Case of Fraud.

Mapping Humans’ Mental GPS | The Scientist Magazine®

Now, we need to find out once and for all whether male brains are better at directions than female!

First recognized in rats, humans may also owe their sense of direction in part to grid cells—neurons that fire in a triangular pattern and help keep track of navigational cues—according to a study published yesterday (August 4) in Nature Neuroscience. Recording the neuronal activities of people asked to locate invisible objects in a virtual environment, researchers at Drexel University observed grid-like firing in two regions of the brain, providing the most concrete evidence yet for the existence of grid cell activity in humans.

via Mapping Humans’ Mental GPS | The Scientist Magazine®.

CANCELLED: UN Medical Women International Association Prolife Drs’ Presentations

Last weekend, organizers cancelled officially scheduled scientific presentations at the United Nations sponsored Medical Women International Association (MWIA) meeting in Seoul, Korea.

The American Association of Pro-Life Obstetricians and Gynecologists have reported the information and published the women doctors’ planned presentations on their blog.

According to the published official press release (available in Word format) by the President of MWIA, Ghana’s Dr. Afua Hesse, she personally “intervened” to cancel “listed speakers at our 29th International Congress of MWIA who would deny women their basic right to choice.” She further claimed that the presentations had “no scientific merit and threaten women’s reproductive rights and therefore do not belong at our triennial meeting.”

Dr. Donna J. Harrison, an OB/Gyn and member of AAPLOG, was one of the three presenters who found out that their presentations were cancelled only after arriving at the site. The other two presenters were OBGyn Dr. Mary L Davenport, MD, FACOG and Psychiatrist Dr. Martha Shuping, M.D.  After their session was cancelled, Dr. Anna Choi, Chair of the Public Relations Committee of the MWIA 2013 Organizing Committee, invited the three to speak at a press conference.

Canadian Family Physician Dr. Shelly Ross, Secretary-General to the United Nations for MWIA, physically intervened in an attempt to stop a press conference to which the three were invited. Here’s an excerpt from Dr. Davenport’s letter to AAPLOG members about the confrontation:

“They put the three of us up front like a “panel” discussion, and the reporters started asking us questions about our presentation, allowing us an opportunity to talk about what we came to present. About 20 minutes into the interview, the Secretary General of MIWA, a Canadian woman, burst into the room (I kid you not. …and all of this is on camera), and came up to the table and said “What presentation is this? Donna Harrison said “it’s not a presentation”. So she snarled “Why are you being interviewed? At that point, the answers were left to Anna, our host. Anna said that this was a requested interview by the press.

“The SecGen then said “Who gave you permission to interview these people?” And the reporters said “We are the press, we don’t need anyone’s permission. We have freedom of the press” And the Sec Gen snarled at Anna and said “Did you arrange this? Did you talk to the organizing committee?” And Anna said “I am on the organizing committee. I don’t need to talk to anyone.” And the Sec Gen stood in front of the camera, and refused to move, and said “The interview is over.” Then the reporters said “You can’t do this. We have the freedom of the press. You are interfering with the freedom of the press.” But the Sec Gen would not move and said “The interview is over.””

If you’ve never been to one of these big conferences, I’ll explain how they are set up. The tentative schedule is published months in advance. The separate presentations are grouped with similar- or same-topic presentations per “breakout” session, and many separate sessions may be held at one time. In this case, the final schedule of talks and even the signs (as you can see above) had been printed and posted.

I have viewed the three presentations and found them scientifically sound. They’re in PowerPoint format and easy to read, with great graphics and the first, by Dr. Davenport, is excellent and includes the bibliography of her references.

Texas Still Fighting Funding to Planned Parenthood!

In spite of repetitive fraud, in spite of Texas’ laws prohibiting sending money to affiliates of abortionists, in spite of all our work.

Planned Parenthood clinics could be facing a legal fight that could keep them from receiving funding for impoverished Medicaid patients.

When the state passed the Women’s Health Program in 2005, legislators said the intent was to provide more family planning services, but not abortions, to low-income Medicaid patients.

State Sen. Bob Deuell said due to a loophole in the law, Planned Parenthood is part of the program, but thinks they shouldn’t be. As such, he has requested the attorney general clear up the matter.

*****

While Sen. Deuell admits he isn’t in favor of Planned Parenthood, he said his “goal is to provide comprehensive care and — abortion issue aside — the Planned Parenthood clinics don’t provide comprehensive care.”

It could take Attorney General Greg Abbott months to give his opinion.

In a brief HHSC officials sent to Abbott, they told him if the agency limits providers based on the way the law currently reads, the state risks violating Medicaid rules. State health officials said that could result in a loss of federal funding for the program.

via AG to rule on Planned Parenthood funding question – YNN – Your News Now.

Every Slice of Drug-Rep Pizza Counts Starting Aug. 1

It’s possible that I can be bought, and no one’s come up with the right amount of money (or pens or pizzas), yet.

Or maybe, just maybe, I’m honest. Of course not!

I’m assumed to be guilty (where’s the opportunity to prove innocence, much less their duty to prove me guilty?) of all sorts of fraud by authors of the Physician Payments Sunshine Act included in the thousands of pages of PPACA – otherwise known as Obamacare:

From now on, companies must keep track of virtually every payment and gift bestowed on each clinician and report them to the Centers for Medicare & Medicaid Services (CMS), which will report them to the world.

This accounting exercise stems from a provision in the Affordable Care Act (ACA) that seeks to expose the financial dealings between industry and physicians and discourage conflicts of interest for the latter that might skew education, research, and clinical decision-making. Under the ACA provision, called the Physician Payments Sunshine Act, drug and device makers must report any “transfer of value” of $10 or more made to a physician. Transfers of value under $10 — a cup of coffee, say — aren’t reportable unless they add up to more than $100 in a year. Companies also must disclose whether physicians have any ownership stake in them.

via Every Slice of Drug-Rep Pizza Counts Starting Aug. 1.

Of course lawmakers assume that we’re being bribed – that’s what they do! Why aren’t the limits at least as high as those our Senators and Representatives are allowed? Like Democrat Senator Harry Reid, can we form a “Friends of Dr. Practice” and get more, as long as we don’t accept donations at our office?

BTW,  there’s an app available to help doctors keep up with the bribes.

Texas Planned Parenthood pays $4.3M (but media attacks Greg Abbott)

The $1.4 Million previously reported was the part that Texas will receive, not the total. Can you guess how the (very few) media reports (if you can find them) are playing the story?

From the July 30, Houston Chronicle:

Planned Parenthood Gulf Coast Tuesday settled a whistle-blower lawsuit that alleged the Houston nonprofit engaged in fraudulent Medicaid billing for $4.3 million – nearly $3 million more than was announced last week by Texas Attorney General Greg Abbott.

Yes, Planned Parenthood is quoted as claiming that the settlement for the AG’s finding that they are guilty of over $30M in fraud is “baseless” and simply a way to end harassment and to avoid turning over the (altered) medical records of patients. But the spin on the story is that Texas’ Attorney General, Greg Abbott, didn’t report the total and sent out his announcement before the settlement was signed by all parties.

My news search yields some op-eds and stories by Texas’ newspapers and a few more on pro-life sites.

‘Obamacare’ National Marketing Campaign To Cost Nearly $700 Million « CBS DC

In the meantime, doctors who still accept Medicare (not hospitals or other “providers”) are facing decreased payments and increased hassles.

As President Barack Obama’s health care law moves from theory to reality in the coming months, its success may hinge on whether the best minds in advertising can reach one of the hardest-to-find parts of the population: people without health coverage.

The campaign won’t come cheap: The total amount to be spent nationally on publicity, marketing and advertising will be at least $684 million, according to data compiled The Associated Press from federal and state sources.

via ‘Obamacare’ National Marketing Campaign To Cost Nearly $700 Million « CBS DC.

Democratic Congressman: ‘Not Fair’ To Subject Congress To Obamacare Just Like Everyone Else – Forbes

Brain drain? In DC? Oxymoron?

Now that the time to sign up for exchange coverage is nearing, a Democratic member, Rep. John Larson (D., Conn.), is saying that “this is simply not fair” – as key staff members head for the exits to avoid Obamacare.

Politico reports that “many on Capitol Hill fear it could lead to a brain drain” and notes that “[t]he problem is far more acute in the House, where lawmakers and aides are generally younger and less wealthy.

via Democratic Congressman: ‘Not Fair’ To Subject Congress To Obamacare Just Like Everyone Else – Forbes.

Protect the right to life – San Antonio Express-News

I wrote this to the San Antonio Express News, in response to an “Other Views” Commentary a couple of weeks ago that claimed our pro-life HB2 violated the “separation of church and state.” It was rife with errors, easily corrected:

1. Abortion isn’t “private.” It is performed by licensed doctors in licensed abortion facilities, under laws regulating the practice of medicine passed by the elected Legislature of the state of Texas.

2. Women’s health and family planning clinics that offer federal and state funded health and cancer screenings and contraception are prohibited by both state and federal law from performing elective abortion. These clinics aren’t licensed abortion facilities and aren’t affected by HB2.

3. After Pennsylvania, Virginia and Missouri passed laws requiring safety standards similar to those in HB2, most abortion facilities in those states remained open.

4. Abortion facilities are allowed 16 months to come up to standard. If abortion facilities close, it will be because business owners decide not to invest in their facilities.

5. HB2, like earlier Texas laws, protects the mother if her life is endangered by continuing the pregnancy.

6. HB2 doesn’t create any criminal charges for the mother, only for physicians who perform illegal abortions after five months.

HB2 does require doctors who perform abortions to have admitting privileges in case their patients have complications requiring hospitalization and abortion facilities to meet building standards known to improve patient safety.

More, including some philosophy, via Protect the right to life – San Antonio Express-News.

Abortion and Informed Consent: American Thinker

#Stand4Life: As only a woman with first-hand experience can tell us:

If a woman tells her doctor she wants to have a double mastectomy, the doctor won’t assume she’s made a sound decision. He or she will want to review her health history, get a detailed family history, find out if the woman has tested positive for the gene that will put her at increased risk, and so forth.

Similarly, when a woman expresses her desire to have an abortion, the health care provider should not assume she’s making a sound decision. It is their duty to make sure she understands her Carbaby’s development, including a way for her to see an image of her baby. And if that’s not possible, at least an image of a baby at the same developmental stage. Pregnant women deserve exposure to as much information as possible. I would argue that there is no more serious matter than the creation of a new life, save the destruction of it. This is no time to withhold vital information and resources.

As a point of comparison, several years ago my routine screening mammogram showed something abnormal. The immediate follow up diagnostic mammogram confirmed an abnormal mass. The radiologist brought me into her office to discuss the images with me. She showed me the area of concern. Explained the difference in color and shadow and what that meant. She also discussed why the image suggested a mass that was hard, and why that added to her concern. She recommended we move forward with an ultrasound and a fine needle aspiration. Throughout the entire discussion she checked in to make sure I understood everything. She invited questions. During the fine needle aspiration, she showed me the image on the monitor as she was guided with the needle to the area in question. When she withdrew the contents of the mass, she showed it to me and explained, to our great relief, that it appeared that I had nothing more than a benign cyst.

Looking back, I now realize that I knew more about the cyst in my breast than the 3-month old baby who once grew inside me. And that is dreadfully wrong. Not because I knew too much about the cyst. But because I knew too little about my baby.

via Articles: Abortion and Informed Consent.

Edited – title for typo – 8/1/13 at 7:45 AM — BBN