Medicine

More evidence that Obamacare is just expanded Medicaid.

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I have been saying that Obama care is just Medicaid for all. As time goes by, here is more and more evidence that this is the case.

The latest evidence is in The Wall Street Journal and behind a pay wall but I will quote some of it.

But a new paper from the Heritage Foundation, however, suggests that nearly all of the increase came from adding nearly nine million people to the Medicaid rolls.

In other words, ObamaCare expanded coverage in 2014 to the extent that it gave people free or nearly free insurance. That goal could have been accomplished without the Affordable Care Act. To justify its existence, ObamaCare must make affordable private insurance available to a broad cross-section of uninsured Americans who are ineligible for Medicaid.

But with fewer people buying insurance through the exchanges, the economics aren’t holding up. Ten of the 23 innovative health-insurance plans known as co-ops—established with $2.4 billion in ObamaCare loans—will be out of business by the end of 2015 because of weak balance sheets.

And while rates vary widely by state, the cost for private insurance through the exchanges is also increasing dramatically. An analysis by consulting firm Avalere Health released on Friday shows that some of the most popular insurance plans in the ObamaCare exchanges will experience double-digit premium hikes in 2016.

My earlier objections to Obamacare were that it promises too much and pays too little.

As it turns out, Medicaid patients can’t get appointments with physicians.

“America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

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Medicine: The Public-Health Model is Wrong

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This Theodore Dalrymple post is a variation on a conventional argument whose unstated main premise is that medical cost decisions should be evaluated from a public-health perspective.

The annual medical is a kind of ceremonial or ritual which, according to its critics, is without rational foundation despite the fact that so many patients, and perhaps a majority of doctors, believe in it. This proves that superstition is not dead: but perhaps that is no fatal criticism of the annual medical after all, because superstition will never be dead. If it does not attach to one thing, it will attach to another.
 
[. . .]
 
In fact, most medicals are bureaucratic procedures rather than exercises in getting-to-know-you (as The King and I put it). The doctor asks a few questions, ticks some boxes on a computer screen, performs a perfunctory physical examination equivalent to examining a cubic inch of haystack to find a pin, and does a few selected blood tests, the interpretation of whose abnormal results (if any) will be far from straightforward. In fact, what has been done and measured in annual medicals over the years has changed, without any change in their ineffectiveness.

Ineffective for whom?

The answer depends on who is paying the bill. If it’s third parties such as govts or insurance companies then the conventional argument has merit: maximizing system utility is an important goal. However, if patients control their own medical spending then the main goals should be whatever the individual customers want them to be.

Dalrymple’s analyses are usually much better than this one. Perhaps his frame blindness in this case is a function of his background with the NHS.

Celiac Disease and the “Worried Well”

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My oldest daughter just got diagnosed with Celiac Disease. Maybe it really isn’t called that, but she had a strong reaction on the test. She was feeling sore in her joints and they decided to give her the test. We will be having her re-tested to be sure, but are already taking appropriate steps with her diet.

I have had a discussion over the years with my better half that the whole celiac thing is overblown and that most of it is b.s. So this is a funny diagnosis in a goofy sort of way. My wife and I pretty much eat anything and everything and had passed that along to our kids. There are literally only four or five things I don’t like to eat and my wife is the same way. Protein, starch, vegetables, fruit, all in moderation. A balanced diet. Seems to work for us.

A friend of mine on Facebook posted something interesting about some research that is proving that most people when they are lied to about what they are eating and given placebos, feel “better” or “worse” depending on what they THINK they are eating. I completely believe this. One doctor (or so he said he was one) provided this comment, that to me, became the quote of the day:

In my practice I frequently see people who have NOTHING WRONG WITH THEM but who have a strong need to assume the role of a patient with some kind of diagnosis. I encourage them to go see “alternative medicine” practitioners. Indeed, the great benefit of alternative medicine is to provide the “worried well” with a pantomime theater of treatment.

While my daughter’s diagnosis could be true, I still believe that the vast majority of people who are going “gluten free” are doing so out of misinformation or wanting to be part of a fad. Just for kicks, my wife and I are getting tested as well. We hear that it is hereditary. But we both feel fine. Maybe we need to get our chakras in order and everything will be OK.

The Doctor Shortage Update.

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There is an interesting piece today in the Daily Mail about young NHS GPs quitting and going to Australia.

In the past five years, the number of GP appointments made by Britons has risen from 300 million to 370 million a year, an increase of more than 20 per cent.
The number of GPs employed to meet that demand has risen by around 1,600, or just over five per cent.
All of which has led to the second major factor behind their exodus — in the UK, they often feel terribly overworked; after moving they find themselves having to spend far less time at the coalface.
‘More and more British GPs talk about the pressure they’re under,’ says Guy Hazel. ‘I’m not sure the general public understand how mentally draining it is to see 35 to 40 patients a day. All the British GPs I know are exhausted.’
An Australian GP, by contrast, will see 20-25 patients per day.

This concerns the young, newly trained doctors. I posted some concerns about the issue of primary care in the US.

Primary care here is referred to as “General Practice” in Britain and they seem to be having a loss at both ends of the doctor career.

Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.

According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.

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Melanoma and Pregnancy.

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This is just a brief post to mention that that today’s Daily Mail has an article about a pregnant women with a spreading melanoma. In my book, linked on this site, I have a chapter on melanoma and several stories of patients whose melanoma went wild during a pregnancy. There is no report in the medical literature that supports this connection. Most reports deny any connection, although a few mention some negative prognosis.

The literature continues to be split on the role of pregnancy in melanoma; however, most recent series show no difference in survival. Multiple studies have failed to show significant effects of female hormones on melanoma cells or on the incidence or progression of melanoma.

In my book, I describe several cases where pregnancy would “awaken” melanomas that had been removed years earlier or would stimulate worrisome growth in moles. Two of my patients had extensive metastatic melanoma during pregnancy that disappeared after the baby was delivered, in one case with my help. Both women were disease free many years later and neither had another pregnancy.

How interesting that this young woman has developed metastatic melanoma during pregnancy. I wonder how it will turn out.