Single-Payer More About Power Than Money

 

The issue is power – government control – more than money. That’s the lesson to be learned from our friends across the pond. We can thank Great Britain for the latest lesson in the evils of single-payer healthcare.

Alfie Evans is a toddler from England who suffered seizures at age seven months and has been hospitalized ever since at Alder Hey Hospital in Liverpool. Eventually his condition deteriorated to the point where life support measures were necessary. His doctors diagnosed him with a severe neurological condition of the brain.

The hospital took his situation to court in February requesting permission to remove his life support with the expectation he would soon die. The doctor treating Alfie testified she believed the child would “only be able to muster just a handful of breaths and survive just a few minutes if ventilation were completely stopped. Any decisions we come to are rigorous, and me personally I would not be making this decision unless I felt 100% it was the right decision.”

The court approved the hospital’s request but the decision was appealed by the family. This week the British Court of Appeal upheld the earlier court’s ruling.

In the mean time, the family reached out to the world for assistance and got it. The Catholic Church, at the request of the Pope, accepted the expense of transferring the child to an Italian hospital for continued treatment. But British authorities refused.

Alfie was taken off life support this week but the expected outcome has taken the doctors and the hospital by surprise. Alfie is still alive!

Government Control

Whether or not Alfie Evans survives this ordeal is not the issue. The issue concerns the British government’s need to control the outcome. Alfie’s parents are not being allowed to choose their child’s treatment. Despite having made medical and financial arrangements for the child’s ongoing treatment at an Italian hospital, the British hospital and government has refused to comply with their wishes.

James Freeman, writing in The Wall Street Journal, says, “it’s not a question of money or the use of the British medical resources. The Catholic Church and the Italian government are ready to take the child off Britain’s hands. It’s a question of a medical and legal system that denies parents the right to make such decisions. Such abuse appears to be part and parcel of a health system dominated by the state rather than the individual or the family.”

This case is eerily similar to that of Charlie Gard, another British infant whose parents wanted to take him to the United States for continued treatment but the British government refused. (see Charlie Gard Crisis Offers Warning to America)

Could this happen in America?

There is precedent for this in the United States. The State of Texas gives hospitals the power to make such decisions. Betsy McCaughey, writing in The New York Post, says:

           “Texas law gives life and death power to hospitals, never mind what families want. In most states, including New York, families are likely to win if they go to court to stop a hospital from pulling the plug. Unfortunately, they don’t know that and get steamrolled by hospital staff. . 

            In 2005, a court gave a Houston hospital the go-ahead to turn off the ventilator keeping baby Sun Hudson alive, over the mother’s objections. In 2017, again with a court’s OK, another Texas hospital cut off life support from 46-year-old Chris Dunn, who was awake and communicative, but descending into organ failure because of pancreatic cancer. His mother pleaded with the judges that the hospital was “trying to play God.” But Texas law gives hospitals that power.

            George Pickering’s adult son was on life support in a Texas hospital. Doctors declared him brain-dead, but Pickering felt his son squeeze his hand to communicate, and was convinced he could recover. When the hospital started to cut off life support, Pickering holed up in his son’s room with a handgun to stop the process. “They were moving too fast,” he said. He was arrested and jailed, but when he got out, his son had recovered – a rare outcome.”

 

This should be a wake-up call for America. While situations like this have rarely occurred in states like Texas, there is little doubt they will become commonplace if we implement a single-payer healthcare system like Great Britain.

The wave of intrusive government control in our lives can only be halted by an electorate determined to stop it!

Medicare Advantage Plans – A Quiet Victory

 

Medicare Advantage plans are gaining in popularity. At least one-third of all Medicare patients have these plans and the numbers are growing.

What is a Medicare Advantage plan?

The Balanced Budget Act of 1997 introduced Medicare Part C and the term “Medicare + Choice” and the Medicare Prescription Drug, Improvement and Modernization Act of 2003 renamed “+ Choice” to Medicare Advantage. Both bills were passed by a Republican-controlled Congress.

Medicare Advantage plans pay for managed health care based on a monthly fee per enrollee (capitation), rather than on the basis of billing for each medical service provided (fee-for-service). Most such plans are health maintenance organizations (HMOs) or preferred provider organizations (PPOs). Medicare Advantage plans provide beneficiaries the same medical services via capitated-fee as “Original Medicare” Parts A and B Medicare provides via fee-for-service.

A Medicare Advantage beneficiary must first sign up for both Part A and Part B of Medicare but all three of these Parts, A, B and C, are administered by private insurance companies (usually the same insurance company). Part C health plans, including Medicare Advantage plans, not only cover the same medical services as Parts A and B but also typically include an annual physical exam and vision and/or dental coverage of some sort not covered under Original Medicare.

Less often, hearing and wellness benefits not found in Original Medicare are included in a Medicare Advantage plan. The most important difference between a Part C health plan and FFS Original Medicare is that all Part C plans, including capitated-fee Medicare Advantage plans, include a limit on how much a beneficiary will have to spend annually out of pocket; that amount is unlimited in Original Medicare.

Most but not all Medicare Advantage plans (and many of the other public managed-care health plans within Medicare Part C) include integrated self-administered drug coverage similar to the stand-alone Part D prescription drug benefit plan. The federal government makes separate capitated-fee payments to Medicare Advantage plans for providing these Part-D-like benefits if applicable just as it does for anyone on Original Medicare using Part D.

There are drawbacks to Medicare Advantage. Like all HMOs, you must pick your primary care provider from an approved list and must have a referral to see a specialist.The providers on the approved list have accepted lower reimbursement rates than original Medicare, and therefore may be in less demand than other physicians.

Growing Popularity

With the cost of healthcare rising rapidly, these plans are growing in popularity. Enrollment in Medicare Advantage plans has risen steadily, now exceeding 20 million or one-third of the Medicare market. They are projected to reach 40% of the market by 2024. If limiting healthcare expenses is your goal, this is your answer. If you prefer freedom of choice (and don’t mind the higher costs), stick with original Medicare.

Former Louisiana Governor Bobby Jindal, writing in The Wall Street Journal, warns Republicans to encourage these popular and successful plans by maintaining adequate funding. He says these privately-managed government-funded plans are doing a good job of keeping costs down by competing for patients. He says, “Specialized companies have sprung up to help avoid medication conflicts, manage specialty care, or prevent complications. Medical providers are taking risk and measuring patient outcomes, not just services performed.”

He suggests encouraging these plans by making them the default enrollment of new seniors while still allowing them to opt-out if they want original Medicare. He also suggests pursuing a similar program for seniors also enrolled in Medicaid.

The real “advantage” of these plans is lower costs and they are privately-managed. The less we allow the government to meddle in our healthcare, the better.

 

PRP and Stem Cells – Miracle Cure or Snake Oil?

 

Since the frontier days that established this great country, people have been selling snake oil to cure whatever ails you. Have things changed or is this déjà vu all over again?

If you’re not aware of the controversy I’m referring to, it’s the sudden surge of stem cell and plasma rich protein (PRP) treatments to treat sports injuries and other ailments of the body. Clinics are popping up all over the country with claims to cure a myriad of ailments – and prices to match these claims.

I recently attended the Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in New Orleans, as I have done for the last 35 years, and this was definitely the hottest topic of the week. Many orthopedists, like myself, were eager to hear what the experts in the field had to say about this controversial topic.

The AAOS says there are over 570 clinics representing 351 businesses marketing “stem cell” treatments for orthopaedic problems. They say that most clinics use autologous “minimally manipulated” preparations that do not contain clinically significant numbers of stem cells. Widespread use of these cash-for-service, unproven, and poorly described treatments raises concerns for public health and safety.

Due to their concerns, the AAOS held a Symposium at Stanford University in February with the following objectives:

  1. Establish a clear, collective impact agenda for the clinical evaluation, use, and, optimization of biologics in orthopaedics
  2. Develop a guidance document on clinically meaningful endpoints and outcome metrics for the evaluation of biologics for common orthopaedic problems

 

Attendees at the Symposium agreed the following are needed:

  • Clear guidelines on the conduct and reporting requirements for clinical studies involving PRP
  • Disease-specific biologic targets and clinical outcomes
  • Clinical registries to examine outcomes

 

Areas of Treatment

Stem cell and PRP preparations are being used after rotator cuff and ACL surgery, for tendinopathy in multiple areas of the body, hamstring tears, osteoarthritis of the knee and meniscus injuries. While anecdotal evidence (case studies) suggests some usefulness, especially after rotator cuff repair, there are no double-blind clinical studies yet to document the effectiveness of these treatments.

Part of the problem is the lack of uniformity of stem cell and PRP preparations from one clinic to another. The result is widespread variations in the content of the preparations given. This means comparisons are difficult and conclusions meaningless.

Compounding the difficulty is the fact that these treatments are considered experimental and therefore not covered by health insurance. Clinicians have a wide variety of expertise from orthopaedic surgeons, to family practitioners, to pain management specialists, or anyone who calls themself a “sports medicine” doctor. Patients must be aware there is no national certification for these treatments.

There may be hope for the future in this area of “biologics” treatments but at present patients should have their eyes (and their wallets) open to the unproven success. Fortunately, there has been no clinical evidence yet that such treatments are harmful; just not necessarily helpful.