Sunday, June 26, 2016

Cut Medicare, and guess what? Obama regulations you haven't heard about

I have complained before about the huge amount of paper work that makes it hard to actually talk to patients, and about how the Indian Health Service has medical rationing for "non emergency" stuff, where you wait forever or maybe don't get it at all.

My area of expertise in bioethics is the pushing of euthanasia and avoiding traditional arguments in favor of "personal" choice.

But one of the dirty little secrets in medicine is that it has become a business: First, by HMO type care and now by Medicare/Medicaid and Obamacare experts telling you how to practice.

(Yes, based on "scientific" investigations, where they take a bunch of papers and average them, nevere mind that a lot of the papers are not very well done. So you are pressured to do what they tell you, never mind what is best for the patients.

Let's face it: An Objibwe patient in an isolated rural village in northern Minnesota or a rancher in rural Oklahoma might not need the same treatment as a rich obedient OCD yuppie in the suburbs. (which is why a lot of us overuse antibiotics instead of telling people to wait a few days to see if the second strep test turns positive, or if the rash of RMSF pops up for their "viral syndrome".

The NYPost has this good summary on how Obama's minions are changing regulations so your grandmom can't get her knee or hip replacement.

This is partly due to comorbidity (we have a relative who needs hip/knees/one shoulder and bladder surgery. All are "elective" but she probably won't get any, because she is also diabetic and 300 pounds making her a high risk for complications.

But as the article points out:

Another Obama rule penalizes hospitals for doing hip and knee replacements on patients likely to need rehab after surgery, causing hospitals to shun older patients with complex conditions. Grandma will have to settle for the painkiller as candidate Obama notoriously suggested. 
whoops: The feds are also making it impossible for people to get narcotics...blaming docs instead of heroin dealers and druggies who lie.

It's mainly about the money, of course.

the beancounters who have decided medicine is now a business also will decide what you get, and people like Daniel Callahan, as early as 1990, already made lists suggesting not to treat those who are old or lack "quality of life.

LINK from SantaClara Univ:

Currently, about 12% of the population is 65 years or older. By the year 2030, that figure is expected to reach 21%. The fastest growing age group is the population aged 80 and over -- the very segment of the population that tends to require expensive and intensive medical care. 
Two problems with this:

One, a 65 year old today is not as "old" as one was in 1980, and probably this trend will continue into the future.

Two:  most people over age 80 do have living wills, or relatives who will not demand all the expensive care. Part of this is logical because of comorbidity, where treatment of one thing means you probably will die of something else (which is why both I and my husband refused chemo for his leukemia: he had heart and renal problems from his hypertension, and it probably would not have prolonged his life).

However, the trend is if you refuse extraordinary treatment (as in a living will) you might end up with no ordinary treatment (e.g. antibiotics or fluids or being fed properly in your nursing home because hey, who has time for such things when the person is a dead man walking?)

the article goes on:

The projected demands from a growing elderly population on a health care system that is already taxed to the breaking point, together with continual advances and availability of expensive life-extending technology, have led to troubling questions about society's ability to meet future health care demands, and to the increased tolerance of proposals for rationing. Perhaps the most prominent advocate of aged-based rationing is Daniel Callahan, author of Setting Limits. In this book, Callahan proposed that the government refuse to pay for life-extending medical care for individuals beyond the age of 70 or 80, and only pay for routine care aimed at relieving their pain.
so now the NYP article cited above observes:

 Obama claims his rules reward quality instead of quantity. Don’t believe it. Adirondack Medical Center in Saranac Lake has one of the worst scores in New York on patient outcomes, indicating its patients get more infections and die sooner from heart problems and pneumonia than at other hospitals. Yet Adirondack got a Medicare bonus because it’s a low spender.

more about Callahan and rationing HERE. 
one of the least discussed stories you never read about: How unelected "experts" will decide if you can get medical care.

Twenty-two years ago, the co-founder and president emeritus of the Hastings Center, a nonpartisan bioethics research institute in New York, wrote the highly controversial book, “Setting Limits — Medical Goals in an Aging Society.” It made the case for limitations on care based on age – a topic that recently provoked intense, if sometimes hyperbolic arguments during the health care debate — and against the provision of extraordinary, expensive medical procedures for people who have already lived a full life...
that was 22 years ago but even then, the NEJM was already quietly pushing the idea of euthanasia...

follow the money.

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