Healthy Frog

Before you rush out and get vaccinated for the Swine flu consider this important article by Paul Watson.

 It is clear that there will be significant risk in receiving a vaccine that has only been tested on a handful of people.  There are questions about what ingredients will be used, and even if none of the human guinea pigs have an adverse event in the next month we will have no idea what the long term effects of the vaccine will be. Essentially everyone who receives the vaccine will be a test case.

In the UK, physicians were warned to look for an increase in the number of Guillain-Barre cases in those vaccinated.  Guillain-Barre is a serious autoimmune disease of the nervous system that in the worst case could lead to permanent paralysis and even death.  Additionally, the pharmaceutical companies that will be paid for the vaccines are being granted immunity from injury as a result of receiving the vaccine, but we in emergency medicine get not even minimal immunity from the unfunded mandate of EMTALA care!

My recommendation: Get vaccinated for the regular seasonal flu which kills many more patients each year then the swine flu and has an excellent safety record over the years.  Skip the swine flu vaccine.

Today's Wall Street Journal has commentary from Dr. Scott Gottlieb on the Obama healthcare plan I have been blogging about.  He notes how successful Federally Qualified Health clinics have been in Chicago. 

"those clinics have been hampered by state and federal regulations that try to promote "fairness" in our health-care system, only to undermine simple, local efforts aimed at genuine reform.

First among these regulations are mandates that require clinics to offer certain health-care services. In many cases a particular mandate can be defended. But the accumulated total makes it harder for some bare-bones clinics to offer any services at all."

 As discussed previously, Mr. Obama wants to pull patients from private type insurance into a similarly federally mandated program.

As I have been ranting it is about access to care not insurance or registering in a federal program. Dr. Gottlieb agrees and adds to our reasons why access is the problem:

One big challenge is attracting and retaining skilled medical professionals. Pay is low, and the risks to providers high. Here, Sen. Obama's plan is no help. The Economic Policy Institute estimates that the Obama plan will cost about $1.6 trillion over 10 years. Give or take a handful of billions, funding his plan will eventually mean the same cuts to providers working under programs like Medicare and Medicaid that were used to subsidize other big health-care expansions.

Finally, the Federally Qualified clinics even had built in immunity much like the docs in the military, but recently even some of this protection has been taken away. Certainly, the Democrats do not support tort reform, so what else is there to attract good docs to such a program.

8/12/08 Marie Coco, syndicated columnist with The Washington Post, echoed my sentiments regarding the health care crisis.  Mentioning that if it was not for the price of gas, the real estate market crumbling, and the credit and banking crisis, healthcare would be the number one issue.

The reason I like her perspective is because for the first time she and I agree.  Quote:

"To say you're going to provide affordable coverage to people is not the same as giving them health care," she says. "Just because you have insurance coverage does not guarantee you access to the care that you and your doctor decide you need. And people with insurance understand that."

This has been the montra of the Democratic platform for decades, and frankly as I mentioned previously in my columns about the McCain and Obama health platforms, providing access to care, not just insurance is lacking.  As all of us know, just because you have insurance does not mean you can go to a doc when you want where you want easily.

In a front page article by the San Francisco Chronicle , they describe a report by the CDC, that reveals what we in Emergency Medicine know all too well.  We have become the primary care providers of the community. To quote the article:

"The likely cause is there are just fewer and fewer primary care physicians," he said. "If you were to get the flu and your doctor says, 'Sure, I'll see you in two weeks,' you may not be able to wait. It's hard for even insured people to get quick appointments and be seen quickly."

The study over 10 years from 1996 to 2006, reveals that the number of uninsured has increased by 5 million in that 10 year time frame, while the number of ED visits has increased by 32% from 90 million to 119 million visits. At the same time the number of emergency departments that have closed dropped by nearly 5%.  This puts added pressure on existing emergency departments and hospital systems.  I would add that those closings also do not necessarily mean more money for hospitals as most hospitals are losing money on nearly every ED visit or admission.

To quote Dr. Billy Mallon, current California ACEP Chapter president:

""The main problem with ER overcrowding is I can't get the admitting patients out. I can't get them to the ICU, to the operating room or to the wards," Mallon said.

He said people who lack access to other care options contribute more to overcrowding than patients who rush to the emergency room in nonemergency situations. "

Ahhh, finally what I have been saying all along. The Obama, McCain camps and all these other state universal health care plans that are being tried have it wrong. It is not about being insured, it is about having access to care.  Insured patients cannot get access to their primary care doctor or their orthopedist or their dermatologist or their gynecologist so they are going to where they know they can get the care they need....the country's emergency departments.

So how can this be solved?

The primary care specialties need incentives to attract students.  Why would a medical student select internal medicine, family practice or pediatrics, put in long hours and hardly make a living , when they can be in a surgical specialty that may pay them 400-500% more and have a better lifestyle.  With the aging population the demand on ED's and hospital admissions will increase, so while it is easy to say we need to cut Medicare programs now, we will pay the price in the future. Hospitals need more dollars to have capital expansion projects in areas of need.  What will Atlanta do if Grady hospital closes?  Will everyone move out of Atlanta?

The state of our health care system is a shambles, to say the least. I would say it is a "crisis".  In as little as 5 years time, I predict the system will completely collapse, meaning every ED and every hospital will be beyond capacity everyday, not just a couple days per week as it is now.  The next presidential administration and congress needs to grab the bull by the horns, and get it fixed or what will develop is a system of the haves and have nots.  Smart industrious healthcare administrators will start cash only hospitals and clinics that those that can afford will go to primarily and the rest will suffer in s system with little access and poor quality care. ( I won't even mention what could happen if there is a major terrorist event or natural disaster.)

Senator McCain's Health Care plan says that the problem with healthcare is that it is too expensive and that there are 47 million who are uninsured.

The McCain plan wants it to be easier for families to get the insurance they need.  This will be done with a tax credit of $2500 for individuals and $5000 for families. You choose the insurer and the money from the credit goes directly to them. I would  prefer to have the credit go directly to me and let me put it in a Health Savings Plan.

He plans on expanding the benefits of health savings accounts.

 The plan then goes on to a number of ways to lower the cost of healthcare,  which includes tort reform of some kind. Tort refrom is the only issue not present on Mr. Obamas plan, otherwise the plans closely mirror one another.

 So to summarize, both candidates offer some form of a move to socialized government controlled medicine.  Is this really what we want as a nation?  Time and again we have seen the inefficiencies of Medicare, Medicaid and Social Security.  Neither addresses the issue that is really at hand and that is access to healthcare.  Hospitals and healthcare providers need to be paid for the services they provide, if the plans do not pay adequately then hospitals and health care providers will not participate.  Those who can afford to , will pay out of pocket to get the care they need and those who become part of this government run madness will be forced into a system that will be more stagnant than the one we have now.