Discussing Healthcare

Does Polio still exist? Surprisingly, yes it does.  However, the last case of naturally occurring polio in the United States was  in 1979 and polio was considered eradicated from the Americas in 1994.  It now only occurs in a handful of countries, but is endemic in only 3 countries: Afghanistan, Nigeria and Pakistan. Why is this important? Well, an article from the Wall Street Journal titled "Pakistan's Polio Crisis Poses Wider Threat" details the very serious problem occurring in Pakistan that is creating a potential threat to the rest of the world. Amazingly, the threat reportedly stems from one of the worst days in our history as a nation, 9/11/01.  (Please read the article for more detail) What is Polio? Polio is a virus.  Unfortunately, in some cases it can cause paralysis and death.  But, for many there are no symptoms or flu-like symptoms at most.  Only 1/200 infections lead to irreversible paralysis. Polio mostly affects children under 5 years old. Some people who contract polio will have post-polio syndrome which leaves the individual with permanent deficits, such as weakness, fatigue, or breathing problems. When polio was epidemic hospitals had iron lung wards as depicted above to treat patients who were paralyzed and could not breathe on their own. Here is an interesting 3 minute video about the iron lung   Polio is spread easily from person to person and it can spread around the world if not kept in check. Just think of the 2011 movie Contagion which tells the story of how a deadly virus rapidly spreads around the world.  Although this movie is fictional, the idea of the movie is real and gives the gist of what can happen if a lethal infection such as polio is unleashed on the world.   The second half of the interview with Jeff Singer, MD is presented in this episode.  He continues to discuss how to decrease the cost of healthcare.  Again, he claims that healthcare expenses are high because of the 3rd-party payer system, where the physician and patient have little knowledge as to what healthcare costs and the 3rd-party (insurance company or Medicaid/Medicare) pays the bills.  He uses Milton Friedman's four ways to spend money to illustrate how we waste money on healthcare and how to decrease healthcare costs.  (See the article "Friedman's Four Ways" for an explanation of the four ways to spend money).   Dr. Singer has presented some very interesting ideas and possibilities for the future of healthcare.  You can hear more from Dr. Singer by listening to a recent interview on The Bob Zadek Show which airs on San Francisco radio, 910 KKSF. If you would like to contact Dr. Singer you can find him on Facebook. Dr. Singer's Cato Institute profile has links to more written articles and video of his national interviews.

Have you ever wondered how our healthcare system developed and why it has led to the Affordable Care Act? Well, in this episode of Discussing Healthcare I am joined by Jeff Singer, MD.  He talks about some of the history that shaped healthcare as we know it.  We also begin to discuss possible ways to reshape and improve healthcare for the future. Jeffrey A. Singer, MD is a general surgeon in the greater Phoenix, Arizona area.  He has been practicing general surgery since the early 1980s and has an interest in healthcare policy both at the state and federal levels.  Dr. Singer has written several articles on the current state of healthcare in the United States and is an Adjunct Scholar at the Cato Institute.  He has been featured in interviews on national television, speaks publicly about healthcare policy, and has his finger on the pulse of the current healthcare debate. If you would like to contact Dr. Singer you can find him on Facebook. Here are links to some of Dr. Singer's articles: Health Care's Third-Party Spending Trap The Depressing Future of American Health Care How Government Killed the Medical Profession The Coming Medical Ethics Crisis The Man Who Was Treated for $17,000 Less Dr. Singer's Cato Institute profile has links to more written articles and video of his national interviews. Dr. Singer referred to the Surgery Center of Oklahoma as an example of a medical business that does not accept any insurance, including Medicare and Medicaid.  Rather they only accept whole payment from the patient according to a predetermined menu of services that can be found at their website, www.surgerycenterok.com/. Here are links to Wikipedia explaining a few of the things Dr Singer mentioned: The Flexner Report The McCarran-Ferguson Act Here are links to a few articles discussing the American Medical Associations history.  I found them by searching the internet, so I cannot speak to their accuracy, but it will shed more light on the topic and allow you to come to your own conclusion. American Medical Association self reported history AMA on Wikipedia True History: The AMA was built on racketeering and pocketing of 'non-profit' profits 100 Years of Medical Robbery    

Episode 009 contains the second half of the interview with Dr. Ammon.  He continues to present his argument against the Affordable Care Act.  He does not see the Affordable Care Act as a benefit to patients and thinks it obstructs the ability of a physician to best care for a patient.  We discuss some of the issues with a government run single-payer healthcare system.  He uses England as the example to show some of the flaws of a single-payer system. You can find Dr. Ammon on Twitter:  @DrJ4PatientCare Dr. Ammon has been actively involved in an organization called Docs 4 Patient Care which can be found at Docs4PatientCare.org A few updates about the Affordable Care Act: CNN/ORC International released poll results today that show the public is not happy with the Affordable Care Act.  Only 35% of those who were polled support the Affordable Care Act while 62% oppose the law.  Here is a link to the article on CNN that also contains the actual data from the poll. The deadline to sign up for health insurance has been moved from December 15th to December 23rd and now to December 24th.  Most people will have to pay their first premium by January 10th, but the deadline to pay may be earlier depending on your state.  See Healthcare.gov for additional information. Now, 1 million Americans have signed up for health insurance through the federal or state exchanges.  This number is much higher than the 365,000 that signed up by the end of November, but nowhere near the 3.3 million people that were expected to sign up. Some Democrats are now concerned that the Affordable Care Act is not decreasing the cost of care and could be increasing costs for the individual while offering limited plans compared to previous. 2013 was an interesting year for healthcare.  Although, we have discussed healthcare as a nation in the past it has never been the focal point of discussion.  It is now the center of debate at the highest levels of government.  The Supreme Court has debated the law and decided that the tax penalty is constitutional.  The federal government roll out of the Affordable Care Act has been anything but good. Next year elections will be decided partly because of a politicians voting record on  the Affordable Care Act and there is no doubt that there will be more heated debate to come in 2014.  I hope you will join me to discuss and debate these issues and many more in the new year. Thanks for listening.  Merry Christmas, Happy Holidays, and Happy New Year.

John Ammon, MD joins me for a discussion about the future of healthcare in the United States.  He is a practicing anesthesiologist who is actively involved in the debate about healthcare that is ongoing in our country.  Dr. Ammon has strong opinions about the Affordable Care Act.  He believes that the Affordable Care Act is not healthcare reform, rather a law that gives the government a stronghold on almost 20% of the economy.  He is involved in Docs 4 Patient Care, an organization of concerned physicians committed to the establishment of a health care system that preserves the sanctity of the doctor-patient relationship, promotes quality of care, supports affordable access to all Americans, and protects patients' freedom of choice. Dr Ammon can be found on Twitter. His Twitter handle @DrJ4PatientCare. You can find out more about Docs4PatientCare at Docs4PatientCare.org    

In this episode we finish the interview with Carol Ann.  She discusses the differences in healthcare between the United States and Canada.  Specifically, she discusses waiting times, paying cash for healthcare outside of the Canadian healthcare system, and Canadian review boards to determine who receives care in certain circumstances.  She gives a personal example of a family member whose case went to the review board and determined that the family member did not qualify for the care in question. I did read an interesting article titled "A Doctor's Formula for Care" by Abigail Zuger, MD on the New York Times website.  The article addresses physician productivity and points out that it is almost impossible to see more than 20 patients per day while appropriately addresses the needs of each patient.  It is certainly an interesting perspective and supports the arguments of Jeff Baird, MD (episode 2) and Jack Rzepka, MD (episodes 4 and 5).  

The state of Oklahoma has filed suit against the Obama administration.  The claim by Scott Pruitt, Attorney General for Oklahoma, is that those individuals who obtain insurance through the federal government's health insurance exchange (healthcare.gov) are not eligible to receive subsidies for health insurance premiums. He refers to section 1401 (page 110) of the Affordable Care Act that specifically states that the individual is only eligible for subsidies if they obtain health insurance through a state exchange.  An interesting argument that will work its way through the court systems and likely will be argued in the Supreme Court. Here is a link to the Wall Street Journal article written by Scott Pruitt. This is a pdf copy of the Affordable Care Act. Look at page 110 (which is page 129 of the pdf file) where it says: ‘‘(A) the monthly premiums for such month for 1 or more qualified health plans offered in the individual mar- ket within a State which cover the taxpayer, the tax- payer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act..." An email from Steve in Ontario highlights some of the issues with a single-payer healthcare system through a first-hand account of a recent hospital visit.  He also discusses some of the limitations of the primary care system in Ontario.  Although we deal with some of these issues in the United States, we should be mindful of the limitations and problems that are occurring in other countries that have a single-payer healthcare system.  There are certainly benefits of a single-payer system, but do the benefits outweigh the downfalls? The interview in this episode is with Carol Ann.  She is a nurse and nurse practitioner in obstetrics.  She has worked both in Canada and the United States and has a unique perspective on healthcare and obstetrics.  In the first half of this interview we discuss what her roles are in obstetrics, she defines what it means to be a nurse practitioner and we discuss what the role of a nurse practitioner in our healthcare system.  We also discuss some of the trends in obstetrics and start to discuss Canadian healthcare. The second half of the interview will focus more on the differences between healthcare in the United States and healthcare in Canada.

There is still mass confusion about the Affordable Care Act and how it applies to each individual. We hear everyday in the news how some people are losing their insurance coverage and some are finding more affordable options. But, how does the Affordable Care Act apply to those on Medicare.  Well, that is exactly what I discuss in response to a question from Darl. Fortunately, not much will change for those who currently are covered by Medicare. There are changes that will occur to Medicare, but the basic coverage will remain the same. Darl also wanted to know about "death panels." That's right..."death panels." The panel of people that will decide if you receive care or if you do not qualify for life saving medical care. Well, good news for Darl and all others on Medicare, there is no such thing as a death panel. However, it is an important topic that should be discussed. The second half of the interview with Jack Rzepka, MD highlights the pressures placed on a primary care physician to see more and more patients.  Ultimately, sacrificing the patient-physician relationship. In addition, patients with more complicated medical problems take more time on the daily schedule which takes away from time that could be spent with less sick patients.  Meaning the healthier the patients, the more patients a primary care physician can see in a day and the more revenue a physician can generate.  WHAT???!!!  That seems crazy.  Well, it's not crazy, it's reality.  I am not saying that primary care doctors avoid seeing patients with complicated and chronic disorders.  On the contrary, the reason most of us are physicians is to help those who have the medical problems.  But, when you have to see a new patient every 8-12 minutes during the work day it is easier to see the healthy people.  We also discuss the future of primary care which will likely employ fewer physicians and more Nurse Practitioners and Physicians Assistants. Like it or not, this is what is happening in primary care.

Today's episode includes an email from Derek as a rebuttal to the interviews in episodes 1 and 3 with Darren.  Derek is frustrated with the costs of the uninsured and sees the Affordable Care Act as a cost saving measure for individuals to obtain health insurance.  His point of view is certainly understandable, but will requiring all of us to have health insurance fix the uninsured problem or bring down costs? The featured interview with Jack Rzepka, MD focuses on primary care and the pressures that are pushing primary care physicians out of business.  Dr. Rzepka shares his story about how he maintained a primary care clinic for 20 years before he walked away.  His candid comments should strike fear into all of us.  Where will we be in the future without primary care doctors? The interview will be heard in two parts.  Part 2 will be presented in episode 5.

In this episode I sit down for a second interview with Darren.  He discusses his experience with the healthcare.gov health insurance marketplace and other avenues of finding health insurance. The interview was done on October 20, 3013, but not much has changed since that time. Healthcare.gov is still experiencing major problems.  Only about 25,000 people have signed up for insurance through the website and about another 75,000 people through state exchanges.  That is only 20% of the expected number of people. Jason called in with a question about where his tax dollars go to support the Affordable Care Act.  The answer includes Medicaid funding and subsidies for those who make under 400% of the federal poverty level and pay for health insurance premiums. Finally, I would like to call everyone to action to pay close attention to what is happening to the Affordable Care Act.  Be involved by contacting your legislator and give your opinion.  Also, call me and let me know your thoughts about the new healthcare law.  

Jeff Baird, MD is board certified in family practice and sits down for an interview to discuss healthcare from a primary care standpoint.  He offers insight into the business of running his own primary care practice and we discuss why it is difficult for primary care doctors to survive in the current healthcare market.  Dr. Baird offers some very important insight on insurance, primary care shortage, and the future of healthcare. Gregg, from Georgia, called in with some great questions about the Affordable Care Act and how it will affect his family.  He asked specifically about dental and vision insurance coverage.  More information about dental coverage can be found at healthcare.gov and the American Dental Association.  While information about vision coverage can be found at The Vision Council.  

Welcome to the first episode of the Discussing Healthcare podcast.  In todays show I will introduce you to Discussing Healthcare.  I am the host, Joshua Lewis, MD.  Currently, I practice Emergency Medicine in Phoenix, Arizona.  Thank you for listening. Darren is the first guest of the show.  He is a healthcare consumer and patient.  Darren is uninsured and I will introduce him to the Affordable Care Act.  Darren will join me in future episodes as we follow him on a journey to find health insurance. Please contact me with any questions or comments.  Additionally, if you would like to contribute to Discussing Healthcare then contact me and I will get in touch with you as soon as possible.