The Wisest Choosers: You and Your Doctor.

If you have a headache, the Obamacare regulators and crony insurance companies may refuse to allow a brain scan to see if you have a brain tumor. Up to 8,400 Americans could be undiagnosed because of this.

If you have a headache, the Obamacare regulators and crony insurance companies may refuse to allow a brain scan to see if you have a brain tumor. Up to 8,400 Americans could be undiagnosed because of this.

“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.






One Reply:

  1. Deb

    Central Control measures leave the patient with debt and charges for meds and services with no person to turn to for bill charges that are incorrect.

    My recent experience at Mease Countryside Hospital Billing and Auditing proves the process is a mess.
    Be aware that Mease Countryside Hospital does not follow THEIR POLICIES such as presenting the patient with an ESTIMATE of charges prior to service .
    The minute you give an insurance identification they automatically deny you to pay out of pocket.

    Why would the hospital NOT want you to pay out of pocket?
    Mease Hospital Policy says if you have no insurance – YOUR BILL IS HALF as long as you pay it in full within 30 days of billing.
    YOU will not SEE that policy but in a small Admitting Office if by chance you go there, it is FRAMED on the WALL. If you are admitted through emergency room, You will not see THE SIGN , it is not there, or be told of the BILLING POLICY by the person that sees you when you are brought in, or that YOU MAY REQUEST AN ESTIMATE FOR THE PROCEDURE YOU ARE ABOUT TO RECEIVE.

    I was brought to emergency as non emergency transport. It was not a matter of life and death, those POLICIES would have been easily understood by me , but I was not afforded those options verbally or by brochure.

    Charges for meds and Other Ancillary Services ( Physical or Occupational therapy) not used but ORDERED by Physicians are automatically billed to the patient.

    Ask for an audit, you will receive an answer that all charges are correct!
    What you may not know and what you do know makes no difference because there is NO person to show your discrepancies to correct the billing errors! You will be told you must hire your own Auditor or Lawyer by the Billing Mease Countryside Hospital.

    You will pay for medical records $ 1.00/page and you can easily look at nurse notes and medicine records where it is noted you REFUSED the meds , BUT YOU will be charged because it is the doctors orders. THE Hospital AUDIT does not look at these records because if they did, they would find the charges on the bill that the patient refused.

    Technology and the “Central Control PROCESS” the Hospitals use. is all about the money, YOUR money.
    There should be a class for people to understand what they need to know long before ever entering a hospital so they are aware that it is a system that has many parts and the PROCESS is broken before you enter.
    The Bill collectors and those who are not insured ARE sucking off those that are paying all those high insurance premiums.

    Example: With insurance the Anesthesiologist gets paid double. Pay Cash ? Half price.

    So what if you opt to pay cash even if you have insurance? THEY won’t let you. Because once you sign to be Treated they take that as a go ahead with the insurance you said you had when you were asked if you had insurance. Should you lie? Remember, you never were told or saw the policy sign that you can pay cash or get an estimate on similar service.

    I am doing a report on what has happened to me in the process of trying to pay my medical bills. In the meantime, I feel for the elderly and sick that try to wade through the process of paying where there is any discrepancy because there is NO Person to sit down with , to show your records to . You can opt for payments or Medicaid, but you can not just pay for what you received in a dignified manner. It’s a corrupted process.

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