“The most basic question is not what is best, but who shall decide what is best.” Thomas Sowell
The main motivation of so-called “health care reform” by most Democrats and Republicans is money. There will be denials, and lip-service paid to “access” and “quality”, but when it comes down to it, it is all about the Benjamins. Democrats want to cut health care spending on all patients, so they can cover up the failure of their empty promises of “universal access” and “affordable care” through Medicare and Obamacare. Democrats and Progressive Republicans (RINO’s) want to ensure that their health insurance buddies have bigger profit margins by cutting spending, while increasing their revenues through mandated purchase of health insurance. So, in the name of “reform”, patients are denied care and their doctors are bullied to cut spending on patients to ensure care is rationed. Case in point? The “Choosing Wisely” campaign and brain tumors. A new study released in the Journal “Neurosurgery” (January, 2015) calls into question the value of limiting brain scans for headaches as part of the “Choosing Wisely” approach. Lives are at stake since brain tumors will be missed to save money for the politicos, government programs and insurance companies.
Choosing Wisely is a political campaign designed to limiting the number of tests and treatments that patients receive. Many physicians have described this as “rationing” and a past president of the American College of Emergency Physicians has criticized it, and now a past President of the Congress of Neurological Surgeons in this report. The initiative, put together by the American Board of Internal Medicine Foundation (ABIM) and the National Physicians Alliance states as a primary motivating goal “to promote the more effective use of health care resources.” That goes along with the new inappropriate “ethical” standard of the AMA to advise physicians that they have a major responsibility to be “prudent stewards of shared societal resources” – equal to that of caring for the individual patient before them. This is based on the idea of “population health” which places the statistics of a group of people above the actual outcomes and satisfaction of individual patients. In the population health model, the primary goal is ostensibly to improved health of individuals and populations “by investments in the determinants of health through policies and interventions that influence these determinants”. By investments in “determinants” of health they mean what a group of planners determine is “right”. By “policies and interventions”, they mean bureaucratic control of physician and patient choices through penalties on physicians that don’t serve the goal of the planners. Other “interventions” include higher costs (co-pays/deductibles) or denial of services for patients who don’t qualify in the population to receive the service. The objective of the planners is to limit choices and coerce all to ensure the “determinants” of the planners can be reached. In nearly every case, that “determinant” is the amount of money spent for the population. This tracks closely to the “comparative effectiveness” goals of Obamacare and the use of the QALY measure (Quality Adjusted Life Years) used by the socialized British health system to ration care. While a physicians group (ABIM) has added the patina of credibility to rationing through creation of the “Choosing Wisely” campaign, they are simply among the many collaborators in the medical community who have helped create rationing programs based on the misguided believe in a need to protect “shared societal resources”.
Brain Tumors occur in up to 120,000 Americans every year and the most common symptom is that of headaches, occurring in nearly half of patients. About 11.5% present with headaches alone and about a quarter present with isolated headaces, no symptoms or non-specific symptoms. The “Choosing Wisely” guidelines for imaging in headaches call for no imaging in patients with isolated headaches and that scans should only be done if the headache is accompanies by neurologic symptoms like weakness, numbness, loss of speech function and more. By then it would likely be too late to get an early diagnosis. The “Choosing Wisely” guidelines are actually based on recommendations in “Consumer Reports”, making them more widely available to average Americans.
The recently published study in the journal “Neurosurgery” indicates that up to 64% of patients with isolated headaches would have their diagnosis of brain cancer go completely undetected if no imaging was done early on. Thus, up to 7% of patients with brain tumors would be completely missed if the “Choosing Wisely” guidelines had been followed. That means up to 8,400 Americans can be completely ignored by the Choosing Wisely Guidelines and never get the treatment they need, likely until much later in their disease when treatment would be harder and less effective. There are already government measures in place that are used to penalize doctors who dare to order tests that Medicare and insurance companies don’t want to pay for. Headaches are no exception with the Agency for Healthcare Research and Quality (AHRQ) designating a measure for “Diagnosis and treatment of headache: percentage of patients diagnosed with primary headache using the appropriate diagnostic criteria.” These measures are touted by Politicians, government bureaucrats, insurance companies and their hapless collaborators in the medical community as the tool to ensure patients get the “right care, at the right time” and that care is “efficient”. Instead, they merely harm many individual patients in the name of a better “population health” statistic of dollars spent/patient.
Obamacare has many failures: higher insurance costs, loss of preferred doctors and insurance plans, massive growth of national debt, tax penalties for non-purchase of mandated health care and more. But the biggest threat of Obamacare is the all-out assault on the patient-physician relationship and the profession of medicine itself. Doctors are penalized financially and professionally if they refuse to comply with the sub-standard government “quality and efficiency” measures. Good doctors are driven out of practice altogether or into the arms of the corporate crony health care complex through hospital and insurance company employment. Patients then suffer as the doctors are unable to order the tests and treatments that will save their lives for fear of losing their livelihood. If Americans want to ensure their healthcare freedom, and good access to high quality, affordable health care, they will need to support repeal of Obamacare and replacement with a Freedom Based Health plan. The next time you are told you don’t need a scan when you have the new onset of headaches, remember it was Obamacare that made it happen. Insist on the scan, then write your Congressman to get rid of the Obamacare nonsense.