Misinformation serves as placebo rather than actually curing our health care system

The Senate Finance Committee held a hearing Tuesday on overhauling the heath care system. Among those testifying was Steven Wojcik (left), vice president of public policy for National Business Group Health.

The country is about to have a very frustrating debate over health care, characterized more by misdirection than an honest discussion of the alternatives.

A good illustration was provided by the Monday confab at the White House, in which health care executives committed to reduce expenditures by $2 trillion over the next decade.

Or did they?

President Obama, in his remarks, said that they did: “They are pledging to cut the rate of growth of national health care spending by 1.5 percentage points each year – an amount that’s equal to over $2 trillion.”

The actual letter signed by the executives, however, says something importantly different:

“We will do our part to achieve your administration’s goal of decreasing by 1.5 percentage points the annual health care spending growth rate – saving $2 trillion or more.”

“Our part” is much different, and far more ambiguous, than “we will do the whole thing.”

This is best seen as collusion by the health care industry and the Obama administration to misdirect the American people.

In the first place, what health care expenditures will be over the next 10 years is unknowable. So, the “pledge” is written on water.

More importantly, the commitment was made by trade associations that don’t actually deliver health care. What happens on the ground with health care costs is unaffected by press events held by politicians and lobbyists.

Most important, what happens on the ground already provides incentives for true economies. There are serious distortions in the health care marketplace, but market share can still be gained by reducing costs and prices.

The real significance of the press event wasn’t the phony pledge of cost savings. The event signaled the political capitulation of the health care industry. They will now accept whatever role in the health care system the politicians assign them.

The more substantive event that happened that day was the release of an “options” paper for health care reform by Senate Finance Chairman Max Baucus and Ranking Member Chuck Grassley.

But, again, “options” is a misnomer. This paper doesn’t really spell out fundamentally different approaches. Instead, the choices are all a variation on a single theme: a government-managed system of private health insurance.

Existing plans would be grandfathered in. But all future health insurance would have to be purchased through a government exchange.

The government would decide the benefit options insurers could offer, and insurers would have to offer all options. Pricing would be strictly circumscribed. Medical underwriting would be prohibited.

The fight over whether there would be a “public option,” a health plan actually administered by the government, is misplaced. If government controls the benefits and pricing of private plans, politicians and bureaucrats are in charge irrespective of whether there is a formal public plan.

The political need for action is driven by the uncertainty over coverage in the American system. The gaps in coverage are hugely worrisome even for those who currently have good insurance.

This uncertainty, however, is easily eliminated at no cost to the taxpayers. There already is a national health care plan, Medicaid for the low income. Universal access could be provided simply by allowing any legal resident to buy into Medicaid at the government’s cost.

The system as a whole, however, makes no sense. Obtaining health insurance through your employer is an artifact of World War II wage and price controls.

Some Republicans want to eliminate this dependence and stimulate a market for individual health insurance. That makes more sense, but the public is unlikely to be comfortable with such a radical restructuring without a government backstop, such as the ability to buy into Medicaid.

This debate will be sad and frustrating.

And the end result will probably be neither fish nor fowl – a system that provides neither the certainty and security of a European-style national health care system, nor the choice and freedom of a vigorous individual health insurance market.

Robert Robb, an Arizona Republic columnist, writes about public policy and politics in Arizona. E-mail: robert.robb@arizonarepublic.com

Lawrence A. Hunter

The pain in Bill Murray’s arthritic hip throbbed for more than a year while he waited to see a specialist.

When he finally got an appointment, the specialist said Murray needed a cutting edge hip-resurfacing treatment. Murray, a 57-year-old living in Alberta, Canada, tried to schedule the procedure, but was flatly rejected.

It wasn’t an insurance company that turned him down or even a hospital worried about his ability to pay. In fact, Murray tried to pay for the procedure out of his own pocket.

Instead, Murray was denied by the Canadian government’s health care bureaucracy, which declared that he was just too old to appreciate the benefits of the procedure. Simply put, his pain wasn’t worth the cost.

Anyone who thinks a health care horror story like this couldn’t happen in the United States needs to think again.

Thanks to recent efforts to build a national health information technology system while beefing up spending on comparative effectiveness research, the infrastructure for health care rationing in America is being created even now.

To start with, the recently passed economic stimulus bill designates roughly $20 billion for the creation of health information technology architecture. The aim would be to create a centralized electronic database of health records for every American.

Doctors might resist, but any such effort would likely deal out financial penalties to any health care provider who refused to take part.

Murray was denied his request because Canada’s health care bureaucrats decided that his procedure wasn’t worth the cost. How did they decide? Government-funded cost-effectiveness research, an idea that’s gaining traction – and considerable funding – here in the U.S.

The same bill that provides funding for health information technology also allocates $1.1 billion toward comparative-effectiveness research. And it creates a Federal Coordinating Council for Comparative Effectiveness Research – an advisory group intended to coordinate the research and advise the president and Congress on its future needs.

Centralized health information technology is intended to make the management of U.S. medical records more efficient, and comparative-effectiveness research is designed to save money by determining which treatments create the most patient value.

In theory, these would allow health agencies to better coordinate and more effectively prioritize treatments by focusing on those who would benefit from it most.

But in combination, these programs put in place all the necessary infrastructure for health care rationing in the U.S.: A council with a broad mandate armed with cost-effectiveness data could easily use a centralized health information technology system to push doctors away from treatments they deemed ineffective.

Bureaucrats already are under instructions to “guide” treatments. How long before that guidance becomes a push – or a mandate?

Overseas, this already has happened. In the U.K., a similar formula for determining cost-effectiveness resulted in elderly patients suffering from retinal decay being forced to wait until they are blind in one eye before seeking treatment.

It’s a formula that affects older individuals in particular, because part of the formula calculates how long any given treatment will provide value. In other words, as Bill Murray found out, anyone deemed “too old” is liable to be left without treatment.

Murray, of course, tried to pay for the treatment himself. But even then he was denied. Why? Because government bureaucracies survive by barring competing services – and health care is no exception.

A 2005 Canadian Supreme Court ruling, for example, ostensibly gave the country’s patients the right to purchase health insurance on the private market. But Quebec’s government responded with a set of rules designed to protect its monopoly on health care that essentially made the ruling moot.

The U.S. already has taken steps down this path. Medicare effectively prohibits those it covers from going outside the system for many common services: 97 percent of U.S. doctors accept Medicare funding, and they’re all restricted from taking Medicare patients for any services covered by the program.

No government should leave its citizens helpless to provide medical care for themselves, but with the provisions for cost-effectiveness and health information technology, that’s just what Washington has decided to do.

We ought to seek out ways to promote efficiency and cost-savings in health care, but too often, when the government is involved, the tough truth is that all those words are just Beltway code for bureaucratic rationing and control.

Lawrence A. Hunter is president of the Social Security Institute and a senior fellow at Americans for Prosperity (www.americansforprosperity.org).

During President Obama’s “not quite a state of the union” speech last week, he called for a new era of honesty and accountability in government.

Those are fine words, but he broke that promise even before leaving the podium.

Discussing health care reform, he said, “This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes.

“In the last eight years, premiums have grown four times faster than wages. And in each of these years, 1 million more Americans have lost their health insurance. It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas.”

None of that is true. Let’s look at each of those claims:

• Health care “causes a bankruptcy in America every 30 seconds.”

That rate would mean 1,051,200 medically induced bankruptcies per year. But the total number of bankruptcies in 2007 was just 822,590, and only a small fraction of those, possibly as low as 5 percent according to a University of California study, were attributable to medical costs.

Interestingly, the population with the greatest growth in bankruptcy rates is those covered by Medicare.

Since 1991, bankruptcies have actually decreased for people below age 65, but increased 125 percent for those between 65 and 75 and rose 433 percent for those over age 75.

• “By the end of the year, it could cause 1.5 million Americans to lose their homes.”

This one is a mystery. Sure, plenty of people are “losing their homes,” about 3 million this year, but to think that half of those are due to medical bills rather than adjustable-rate mortgages or layoffs seems highly fanciful.

• “In the last eight years, premiums have grown four times faster than wages.”

Actually, premiums have stabilized for the past five years at about a 6 percent annual increase, while wages have been increasing about 4 percent, according to the Mercer consulting service.

Obama may have been thinking about the spike in 2002 when premiums rose 14 percent and wages rose about 3 percent, but that was a one-year exception and not at all representative.

It’s worth remembering, also, that companies that have adopted consumer-directed plans are seeing premium increases well below inflation and wage increases.

Watson Wyatt global consulting found the “best performing” companies had a two-year cost increase of just 1 percent while other companies’ costs increased 10 percent.

• “(I)n each of these years, 1 million more Americans have lost their health insurance.”

That’s not true, either. The most recent report by the Employee Benefit Research Institute, in September 2008, showed the raw numbers of uninsured rose from 39.5 million in 2001 to 45 million in 2007.

But raw numbers aren’t the right way to count, because of population growth.

The percentage of uninsured between 2001 and 2007 went from 14.8 percent to 15.3 percent according to the Census Bureau, which is lower than the percentage in 1995 (15.4 percent), 1996 (15.6 percent), 1997 (16.1 percent) and 1998 (16.3 percent).

• “It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas.”

No, it’s not, and it won’t be until the government mandates that employers provide coverage. Small employers drop coverage instead of going out of business because of health care costs.

Likewise, the whole “shipping jobs overseas” claim is a myth. When American companies set up foreign affiliates, it is generally to serve foreign markets, as Toyota and others have done in the United States. Any advantage in locating abroad has far more to do with better local regulations, taxes, and wages there than with health care costs.

Let’s hope the president starts taking his own advice and applies some “honesty and accountability” to his own speeches and the national budget.

Greg Scandlen is director of Consumers for Health Care Choices (www.chcchoices.org) at The Heartland Institute (www.heartland.org), a Chicago-based think tank. E-mail: gscandlan@heartland.org

Question: How can I tell if someone has hypothermia?

Answer: Winter temperatures can lower the body temperature and it can be dangerous – even deadly – if not treated quickly. The drop in body temperature, often caused by staying in a cool place for too long, is called hypothermia.

So, how can you tell if someone has hypothermia? It can be tricky because some older people may not want to complain.

Signs of hypothermia

• Confusion or sleepiness

• Slowed or slurred speech

• Shallow breathing

• A change in appearance / behavior during cold weather

• A lot of or no shivering

• Stiffness in the arms or legs, slow reaction or poor control of body movements

• Symptoms of being in a cold place for a prolonged period

Know your risks

There are some things that put any older person at risk for hypothermia. Here are some things to keep in mind:

• Stay away from cold places. Changes in your body that come with aging can make it harder for you to feel when you are getting cold. Plus, it may be harder for your body to warm itself. Pay attention to how cold it is where you are.

• Eat enough food to keep up your weight. If you don’t eat well, you might have less fat under your skin. Fat can protect your body by retaining heat.

• See your doctor to keep any illnesses under control. Some conditions and illnesses may make it harder for your body to stay warm. These include: hormone system problems, such as hypothyroidism; health conditions, such as diabetes, that impede circulation; and skin problems, such as psoriasis, that allow your body to lose more heat than normal.

• Wear several layers of loose clothing when it’s cold. The layers will trap warm air between them. Clothing can make you colder or help keep you warm. However, tight clothing can keep your blood from flowing freely, which can lead to loss of body heat.

Be aware of health conditions that may make it difficult for you to put on more clothes or leave a cold environment. Some examples are severe arthritis or other illnesses limiting mobility, stroke, memory disorders, dementia or other illnesses that can cause paralysis or impede clear thinking.

• Ask your doctor how the medicines you take affect body heat. Some medicines often used by older people also increase the risk of accidental hypothermia. These include drugs used to treat anxiety, depression and nausea. Some over-the-counter cold remedies can also cause problems.

• Drink alcohol moderately, if at all. And do not drink alcohol before bedtime during colder months. Alcohol can also make you lose body heat faster.

Stay warm inside and out

Health, age, what you eat or drink, even your clothes can make it hard for you to stay warm. But what you may not realize is people can get cold enough inside a building that they become dangerously sick.

Spending long periods of time in poorly heated homes or apartments – even tho se with temperatures of 60 to 65 degrees – can make you sick. Set your thermostat to at least 68 to 70 F.

And, if your residence is without heat temporarily, for example, in a power outage, try to stay with a relative or friend.

Today’s question is answered by Adina Wingate, PCOA’s public relations director, using information provided by the National Institute on Aging. E-mail: generations@tucsoncitizen.com

Pets, music help support group fight illness

Flo with one of her pet chihuahuas, who keep her busy.

Flo rocks. Not just because she was born in Coney Island and married a doting man she nicknamed Cookie.

Nor merely for her ability to spin hilarious yarns about her miniature pincher who is as fat as a moose or her two chihuahuas who engage in more antics than the year has days.

But because she is living with a debilitating and often fatal condition and is kicking its butt.

Flo, no last name please, has had depression for so long she can’t even remember when it was diagnosed.

While it’s taken her up, down, sideways and to the violent point of throwing rocks at Cookie’s head, the 64-year-old grandmother is still around to talk about it.

She joined several others at a recent Wednesday meeting at the Northside YMCA where they sat around discussing what ailed them. Unlike those hit by seasonal, holiday or economic anxiety, the people at the meeting cope with their conditions year-round.

While Tucson’s Desert Rat Chapter of the Depression and Biploar Support Alliance meeting may seem like it could be, well, depressing, there was definitely more laughter than there were tears.

Come to think of it, I’m not sure anybody cried at all.

Not even when Doug’s mom, who was there for support, told of his plight. Her son once had a job, wife and nice house, stuff that all went out the window when his bipolar illness was diagnosed.

Now he’s not sure what his mind-set will be from one day to the next.

“He can’t plan anything,” his mom said.

“It’s like a switch,” Doug added. “I’m fine once day and wake up the next and it’s the worst it’s ever been.”

Group President Ron Melzer, too, got a bipolar diagnosis, a condition marked with ecstatic highs and manic lows.

Jimi Hendrix sings about it, but the only song going through some folks’ heads may be one filled with rage.

“I was a very angry individual,” Melzer said. His kids used to tense up if they did the smallest thing wrong. Yes, he mentioned the proverbial spilled milk.

“Now I’m on mood stabilizers and I’m Mr. Mellow,” he said.

Medication coupled with therapy has an 80 percent success rate treating many mental illnesses. Unlike the group members, only a handful of folks seek that help.

Some may be unaware they are suffering from a mental illness. Others may not want to admit it.

“For me it was hard to accept I was sick,” said Lori, another bipolar group member. “Once I got on board, things got better.

“I learned that mental illness is a genetic disposition that was brought about when I was under enormous stress.”

Flo attributes much of her depression to her traumatic childhood.

Her cousin regularly molested her. Her older sister repeatedly beat her. Rather than crumbling, however, Flo became enraged.

Once she got big enough, she said, no brick, no garbage can, no barstool, bottle or table was safe from being hurled across the room.

“The first time I was locked up,” she said referring to her stay at a mental health facility, “I terrorized the whole place.”

She then became suicidal.

Husband Cookie found his wife overdosed on 90 Xanax.

“Thank God, I walked into the bedroom,” he added.

Only later was Flo able to change her attitude. “I decided that I love myself,” she said.

Meeting members shared other coping techniques. Regular exercise, eating right, sleeping enough and talking about their woes work wonders.

Other pluses are pets, even a miniature pincher as big as a moose, and supportive friends and family such as Cookie.

Music is another mood shifter, not necessarily Hendrix. Flo’s favorite pick-me-up tune is “Play That Funky Music (White Boy).”

One more must is a determination to overcome the condition rather than allowing it to consume you.

“I won’t let it,” Flo said.

“I won’t let it take me to the dark side.”

Ryn Gargulinski is a poet, artist and Tucson Citizen reporter whose favorite mood-lifting music includes Franz Schubert’s “The Earl King” and anything by Igor Stravinsky.

———

TO LEARN MORE

Meetings

• Wednesdays, 6:30 to 8 p.m. (no meeting Dec. 31)

Northside YMCA, 7770 N. Shannon Road, Room 303

• Sundays, 6 to 7:30 p.m.

University Medical Center, 1501 N. Campbell Ave.

‘Breast Cancer: The Complete Guide’

By Yashar Hirshaut, M.D., FACP and Peter I. Pressman, M.D., FACS (Bantam Books, $17 softbound)

An essential book about fighting breast cancer is being issued in a fully revised 5th edition. Hirshaut, an oncologist in New York City where he is an attending physician at Mount Sinai Medical Center, Beth Israel, and Lenox Hill Hospital, and Pressman, clinical professor of surgery and director of the Genetics Risk Assessment Program at Weill Cornell Medical College in New York City, discuss the latest advances in the treatment of breast cancer in their landmark book, first published in 1992. They provide detailed new information about mammography, sonography and MRIs, the latest diagnostic procedures;,changes in the treatment of noninvasive cancer, improved surgical techniques, gene testing, partial breast radiation and preventive medications.

‘Outliving Heart Disease: The 10 New Rules for Prevention and Treatment’

By Richard A. Stein, M.D. (Newmarket Press, $16.95 softbound)

The information available about the prevention and treatment of heart disease is often contradictory. In his revised and updated book, Stein, former chief of cardiology and professor of medicine at the State University of New York-Downtown Medical Center, provides essential, cutting-edge, exactly-what-you-need-to-know potential life-saving information such as how to recognize the first symptoms of an imminent heart attack, how depression, anxiety, and stress impact the heart and how to assess the risks. This book is enlightening and presents everything you need to know about heart health. His easy-to-understand 10 rules represent the huge strides that have been made in cardiology tests, treatments and surgery, all backed by the latest research.

‘Multiple Sclerosis: New Hope and Practical Advice for People with MS and Their Families’

By Louis J. Rosner, M.D. and Shelley Ross (Fireside Books, $15 softbound) Since the 1990s, the study of multiple sclerosis has been revolutionized. New advances have been perfected that can help modify the course of the disease, lessen the frequency and severity of attacks, manage symptoms and improve quality of life, both for people with MS as well as members of their families. This revised and updated edition discusses the most effective treatments and therapies in what some in the medical community believe is one of the best patient-oriented books on MS. It is the ultimate reference, filled with sane information written in language that is accessible to most readers. Once known as the crippler of young adults, advances in treatment have made it possible for more than 75 percent of MS patients to function without the aid of a wheelchair.

‘Autism Life Skills: From Communication and Safety to Self-Esteem and More – 10 Essential Abilities Every Child Needs and Deserves to Learn’

By Chantal Sicile-Kira (Perigee Books, $14.95 softbound)

Whether your child has Asperger’s syndrome or is on the more severely impaired end of the autism spectrum, this action-oriented guide by a national speaker, advocate and expert, will provide help and hope so that every child has a chance to reach his or her potential. Topics include making sense of the world, communication, safety, self-esteem, self-regulation, social relationships, self-advocacy and even earning a living. This is a positive and empowering book that contains a bill of rights for every person on the autism spectrum.

‘Writing Through The Darkness: Easing Your Depression with Paper and Pen’

By Elizabeth Maynard Schaefer, Ph. D (Celestial Arts Press, $15.95 softbound)

Depression strikes 1 in 5 people at some point in their lives. Schaefer, a science journalist and editor who also suffers from bipolar depression, is convinced that by expressing feelings in words, the emotional reactions to past and present trauma can be lessened. Her book gives readers precise ways how they can understand and organize their negative thoughts, process painful feelings and even gain insight on how to cope with moods that can cripple. Her techniques include the therapeutic benefits of freewriting, starting a memoir, composing poetry and creative storytelling. There are inspiring quotes and writing samples from Schaefer’s students to encourage readers along the way.