Should the Topic of Bi-polar Disorder Be Made Into A Lighthearted Movie?

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The other day, (well now it has been a couple of months!  I am so not keeping up with this blog!)  some friends and I went to see the movie “Silver-Lining Playbook.”  It was a good movie.  The acting was excellent.  I assume that if Bradley Cooper had not been up against Abraham Lincoln, he would have won an Oscar for his portrayal of an individual with bi-polar disorder.

However, the story line itself was total fantasy and, as the movie proceeded,  it became more and more a fantasy.  Maybe the author of the book/movie entitled the story, “Silver-Lining Playbook” precisely to let the movie viewer know that we would be shown a fantasy. But any of us who have seen/lived with someone diagnosed with bi-polar disorder knows that this dis-ease (at least up until now) does not have a silver lining attached to it.  I found the fantasy that the movie portrayed a bit over the top.  Now I know that American movie goers tend to love the happy ending story and this was as fairy tale-ish  “…and they lived happily ever after” as it gets.  But I found it a little disturbing to approach the topic of an illness wherein there has been no cure found [as of yet] in such a fantasy like way.

Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder. Yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol.  These imbalances purportedly can be modified with pharmaceuticals.  But pharmaceuticals have their side-effects, some of which can be pretty nasty.

External environmental and psychological factors can be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

  • Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes–either good or bad–such as getting married, going away to college, losing a loved one, getting fired, or moving.
  • Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
  • Medication – Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.
  • Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.
  • Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.

Lithium is the oldest and most commonly used mood stabilizer. It is “highly effective” for treating mania. Lithium can also help bipolar depression. However, it is not as effective for mixed episodes or rapid cycling forms of bipolar disorder. Lithium takes from one to two weeks to reach its full effect.  But some of the side effects of lithium include:

weight gain, drowsiness, tremors, weakness and fatigue, memory and concentration problems, stomach pain, thyroid problems, nausea, vertigo.

Of course every doctor will tell you that not everyone develops these side effects, but if you happen to be one of the ones who does, would you willingly subject yourself to them?

In extreme cases, antipsychotics may be prescribed for bipolar disorder.

Antipsychotic medications used for bipolar disorder include:

  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ariprazole (Abilify)
  • Ziprasidone (Geodon)
  • Clozapine (Clozaril)

The common side effects of antipsychotic drugs are similar to those of the mood stabilizers: Drowsiness, Weight gain, Sexual dysfunction; Dry mouth; Constipation; Blurred vision.

Often, antipsychotic medications are combined with a mood stabilizer such as lithium or valproic acid.  So you can imagine what someone on both antipsychotic drugs and mood stabilizers might look like.  This is why I put the words “highly effective” in quotes.  By whose definition?

My apologies to the readers: I seem to have lost the sources by which I got my details on symptoms and remedies.  However, a google search for bipolar disorder will bring up pages with which you can further educate yourself.  But please, please, do not think that the two individuals portrayed in “Silver-Lining Playbook” are representative.

© Yvonne Behrens, M.Ed  2013

 

 

 

 

Abraxane™ The New Marketable Cancer Cure

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The parent of someone close to me was diagnosed with Pancreatic Cancer last fall.  At first, the parent, citing her age, determined that she would not do chemotherapy.  Her husband, older than she, became very upset.  So she agreed to see an Oncologist.  The Oncologist, a young, energetic, positive individual suggested that the parent do chemotherapy to shrink the cancer and when it was small enough, surgery could be done and the cancer removed.

Thus, the parent entered the medical system.  She was to do chemotherapy for five months and then be scheduled to have surgery.  Fortunately, side effects to the chemo were not so intense that she could not continue to maintain her day to day activities.  She did loose her hair.

Somewhere along the way, those she was relying on for medical care, decided they would not try to do surgery, yet.  Instead, they suggested that she add a new drug, Abraxane ™,  to the chemo regimen.  This is a new drug that claims to improve the chances of survival for a person with Pancreatic Cancer.

According to an article in MNT (Medical News Today):

Results from the study revealed that 35% people on the combination of Abraxane™ and chemotherapy were alive at the end of the first year compared to only 22% who just underwent chemotherapy. This translates into a 59% increase in one-year survival as well as double the rate of survival in two years for the patients on Abraxane™ versus those who only received the chemotherapy. Those who were solely on chemotherapy survived for only 6.7 months compared to a median of 8.5 months among those who also took Abraxane™.

Breaking this paragraph down, I see a claim that somehow the percentage of people alive at the end of the first year who were taking a combination of Abraxane™ and chemotherapy was 35% as compared to only 22% of people alive after a year of taking just chemotherapy.  Those percentages are not very high.  But through the magic of playing around with numbers, this 13% differential “translates into a 59% increase in one-year survival”  Sounds phenomenal!  But is it really?  Not only that, but if we take these numbers, as the researchers have done (there is no indication that there were any tests done to actually prove this to be fact), this doubles the survival rate in two years.  Hunh?

The last line in the paragraph totally contradicts the claims above it by stating that (without qualifiers) those using solely chemotherapy “only survived 6.7 months” and those who did chemo in combination with Abraxane™ survived “a median of 8.5 months.”  Hard to imagine all those individuals who had Pancreatic Cancer and were solely doing chemotherapy keeling over at 6.7 months from start of chemo regimen.  Even if this were the case, the claims that adding Abraxane™ to the chemotherapy increases survival rates by an amount that is exciting seem a bit exaggerated if the median survival rate with this addition is only 8.5 months.

I would not be so offended by all of this if it in fact reflected an industry desperately wanting to find a cure for cancer and dedicating all their waking hours to that end.  BUT, unfortunately, the facts do not demonstrate this.  What the facts demonstrate is that this new drug,  a bit short on its healing claims, is doing incredibly well in the area of generating income.  From the same article:

Abraxane™ made sales of close to $386 million in 2011 for it’s use as breast cancer treatment. It is expected to generate close to $2.1 billion as a treatment for pancreatic cancer. Abraxis BioScience was the original company to develop the drug, they were bought out by Celegene in 2010 for $2.9 billion. Celegene can expect to see good sales of the drug [emphasis by author], although it might see strong competition from the drug Folfirinox™ which was found to similarly improve survival among pancreatic cancer patients.

In the meanwhile, debilitating side effects have increased quite a bit in our 89 year old patient since the incorporation of Abraxane™ into her chemotherapy regimen.

© Yvonne Behrens, M.Ed  2013

 

 

 

 

Chow Down

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“Americans are sick.  Over 130 million [author's emphasis] are suffering from chronic disease.” So begins the documentary, Chow Down** a film by Julia Grayer and Gage Johnston, The film is tightly put together and does an excellent job of presenting a sobering view of the state of eating in our country. It focuses on the eating habits of Americans today, the influences which direct those eating habits, and more specifically, on the lives of three individuals who were told that unless they radically changed their approach to eating, they would die.  Grayer and Johnston do not gloss over the fact that it is not so easy to change one’s eating habits even if it means potentially saving one’s life.

Charles, a man “who has it all,” including heart disease, has a very supportive wife and because of this, the whole family has changed their eating habits.  Charles speaks about how as an Italian, whose grandfather owned a meat shop, large meals with lots of meat were a big part of life’s enjoyment.  Yet he and his family have made the adjustment, to the point of bringing their own food when they take trips.  (May Charles live to watch his grandchildren grow up and may he and his wife grow old together).

Two other individuals who are also working at changing their diets were interviewed.  One interviewee lamented that he missed his Kentucky Fried Chicken™  The other spoke about how difficult it was to maintain a more plant-based diet when the rest of her family was not.

And yet the medical profession does not focus on nutrition and diet when interacting with patients, but rather pills and surgery.  Dr. Esselstyn, a former heart surgeon at the Cleveland Clinic and one of the interviewees in both Forks Over Knives and Chow Down, learned through his practice that there was a direct relationship between diet and heart disease.  He says that surgery does not prevent the disease.  He states that the medical industry is “… selling sickness right now.  We are selling sickness as a profession.  You don’t get health out of a bottle of pills.  You don’t get health out of a bunch of operative procedures.  I know that as a former surgeon.”

Another interviewee in Chow Down, Neal Barnard, MD, shares that ” the most popular pill on the market today is Lipitor ™ ….a pill created to curb the effects of dietary excess.”

According to the www.chowdownmovie.com home page,

…. three factors …. fatally impact our country’s health: the medical community’s allegiance to the status quo, the government’s allegiance to the food industry, and Americans’ allegiance to cheap, convenient food.

Grayner and Johnson, through very tight interviews with key players in the medical industry, the food industry, and the government demonstrate how, at least at this stage in time, we, as consumers, are controlled by the relationship between the food industries, the government and the medical community.

Dr. Barnard points out that the USDA has two mandates.  One is to promote health and the other is to promote American agricultural products.  This could certainly become a potential conflict of interest, particularly since the Federal Government participates in creating generic advertising for certain products (Got Milk? for example) from a fund that they administer but which is provided by the food industry.  In fact, the federal government even has worked with the fast food industry to help them advertise foods that include cheese, not because the foods are healthier but to promote the dairy industry.

Even the food pyramid, which has undergone many changes in recent years, is influenced by the needs of the Agro-business.  One outcome is that we have come to believe that certain foods are more important than others, ie, meat rather than lentils, both sources of protein.  Yet studies have shown that a primarily meat based diet can be harmful to one’s health.  [Whether it is the meat itself or whether it is all the additives that farmers put into their livestock is a topic for further research and another article].

At one point in the documentary, Grayer and Johnson interview Louise Light, a nutritionist who was hired by the USDA in the late ’70′s to come up with a food pyramid.  She and a team of experts had concluded that fruits and vegetables were the most important foods to eat, but when their pyramid came back from the Secretary’s office, it had been revised, emphasizing grains as the most important food.  Apparently, when the meat industry heard about this, they put the pressure on for meats to be better represented. [Recently the food pyramid has undergone a further transformation to MyPlate].

During her tenure at the USDA, Ms. Light had created a nutrition course for the Red Cross.  In the course, she cited several foods that had direct links to cancer.  She states that she was approached by a representative from one of those food industries who offered her $60,000 to drop the word cancer from her coursework.

I applaud Ms. Grayner and Ms. Johnson’s superb documentary.  As more and more information comes out about how our eating habits greatly influence our health, we might just be able to change the course that the food industry has taken in our country.

(As I was “going to press” I came across this link, which I think reflects how the movement for eating right is starting to take off http://www.upworthy.com/i-m-sick-of-rich-people-telling-me-how-to-spend-my-money-but-i-think-this-guy-is?c=ufb1

© Yvonne Behrens, M.Ed  2013

** Following my write up on the documentary Forks Over Knives, I received an e-mail from Julia Grayer, a filmmaker, who along with Gage Johnston, wrote, directed, and produced Chow Down.

 

 

Our Expensive Health Care System

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The other day, I was reading an entry by Ronni Bennett in her blog posts in which she reviews an article entitled:  Bitter Pill: Why Medical Bills are Killing Us,  a report written by Steve Brill, the founder of Court TV and American Lawyer.  Shortly after reading her review of the article, I came across several other reviews of the same article.  I am very happy that this topic is beginning to be looked at.  I have written on the topic of expensive health care.

Although Ms.Bennett had some issues with Mr. Brill, she states:

Nevertheless, “Bitter Pill” is the best damned report about the sorry state of the U.S. Health care industry I’ve ever seen (and I read a LOT about health care).

What makes it so good is its clarity. It is filled with case and interview details, comparisons among costs, charges and profits, and written not for lawyers, doctors or policy wonks with the intention to obfuscate, but for you and me, the average reader.

Plus, it reads like a good novel in the sense that you can’t wait to get to the next paragraph, the next page. By the end, Brill shows what we old folks already know – that in health care delivery and in cost control, Medicare beats private coverage every time.

Brill’s conclusions about what to do to rein in health care costs appear to me to be weak but I want to spend more time considering them. What’s important, however, is that he gives us plenty of information to use as a basis for an honest, public conversation about how to change American health care.

Not that I’m holding my breath given the power of the medical industry lobby.

from the article, Ms. Bennett shares some interesting statistics.  According to Mr. Brill:

we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia.

We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care.

Medicare pays $11.02 for a CBC [complete blood count] in Connecticut. Hospital finance people argue vehemently that Medicare doesn’t pay enough and that they lose as much as 10% on an average Medicare patient…..But even if the Medicare price should be, say, 10% higher, it’s a long way from $11.02 plus 10% to $157.61.” [which the hospital charges for the same test.]

In 2008, Gregory Demske, an assistant inspector general at the Department of Health and Human Services, told a Senate committee that ‘physicians routinely receive substantial compensation from medical-device companies through stock options, royalty agreements, consulting agreements, research grants and fellowships.’”

MD Anderson’s charge of $7 each for “ALCOHOL PREP PAD.” This is a little square of cotton used to apply alcohol to an injection. A box of 200 can be bought online for $1.91.”

”More than $280 billion will be spent this year on prescription drugs in the U.S. If we paid what other countries did for the same products, we would save about $94 billion a year.”

Ms. Bennett concludes:

Brill’s report reinforces more vividly what others before him have shown many times over – that what is wrong with our health care system is not Medicare, it’s the private sector.

When I googled Steve Brill’s article, there were pages and pages of respondents from around the United States.  Most seemed to support the contents of Mr. Brill’s article.  Although I have as yet to read it myself, I do look forward to it.   I quote Ms. Bennett’s response to the article because in reading her reflections on Mr. Brill’s article, they  reflected my concerns about our healthcare system.

© Yvonne Behrens, M.Ed  2013

 

 

“Forks Over Knives”

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The other day, my yoga teacher invited several of her students to share in a potluck lunch and to watch a documentary called, “Forks Over Knives.”  The setting was beautiful, the company delightful and invigorating, and the documentary educational.  The movie

examines the profound claim that most, if not all, of the degenerative diseases that afflict us can be controlled, or even reversed, by rejecting our present menu of animal-based and processed foods. The major storyline in the film traces the personal journeys of a pair of pioneering ….. researchers, Dr. T. Colin Campbell and Dr. Caldwell Esselstyn.

Dr. Campbell, a nutritional Biochemist at Cornell University had embarked on a research project in the late 1960′s to help bring high quality meat protein to the undernourished of the third world.  In the Philippines, he made a life altering discovery:  Children who lived on a meat based diet were more likely to develop cancer than children who lived on a plant based diet.

Dr. Esselstyn, a surgeon at the Cleveland Clinic, on his part, started to observe that many of the diseases he routinely treated were rarely found in countries where animal-based diets were not the norm.

Their separate but mutual discoveries brought them together and they have conducted many studies since.  One of the most comprehensive was conducted in China.  the 20-year China-Cornell-Oxford Project, led by Dr. Campbell, found that most degenerative disease can be reversed by changing one’s diet.  Remove the meat, the sugars, the dairy and you remove the tendency towards many cancers, type 2 diabetes, obesity, and heart disease.

Through media, we have learned that we are at pandemic levels with cancers, diabetes, obesity and heart disease in our country.  Yet over the years, we have been taught that meat is the best source of protein and milk is the best source of calcium.  This belief system is so ingrained in us that many people are unwilling to change their diets.  Not only that, but many nutritionists still insist that meat and dairy are primary sources of protein and calcium.  Add to this the fact that fast food restaurants still dominate in our very busy world and empty calories (ie snacks, sugar filled cereals, and soda pop) continue to be a mainstay in most people’s daily lives, the truth of the matter becomes that we are all willingly poisoning ourselves.

the film [Forks Over Knives] advocates a whole foods, plant-based (vegan) diet as a means of combating a number of diseases. It suggests that “most, if not all, of the degenerative diseases that afflict us can be controlled, or even reversed, by rejecting our present menu of animal-based and processed foods.

When my husband was first diagnosed with pancreatic cancer (and by the time they “uncovered” what was ailing him, it had already spread to his liver), we were told to go home and try and make him as confortable as possible.  But our friends rallied and we learned of a clinic in Chicago, The Block Center on Integrative Cancer Care.  I believe that going there and completely changing our diet had a lot to do with the fact that my husband came back from death’s door to live another year, most of that year with good quality of life.  Had we foregone the chemotherapy, would he still be alive today?  Clearly, there is no way of answering that question.  His cancer was at a very advanced stage when found and he was at an age where the first two oncologists we saw basically gave the thumbs down.  Our choices were very limited by that point.

BUT there is no question in my mind that a whole foods, plant based diet is healthier than a fast-food, meat/sugar/dairy based diet is and there is no question in my mind that the chronic diseases that are so prevalent in our society are caused by the foods we choose to eat.  Unfortunately, the lower income citizens of our country have much less choice as to what is available for them to eat, and by turn, we see much chronic illness and obesity in that population.

Our country has a lot of work to do to turn this situation around.  It may take years, but we have to start somewhere.

With regard to sugar, which is found in most processed foods,  many of the symptoms related to withdrawal from other “drugs” are similarly experienced by individuals who remove sugar from their diet.  it takes two weeks for withdrawal of sugar from the system.  An individual can experience agitation, ill-temper, lethargy, headaches, a sense of depression.  But these really are just withdrawal symptoms.  If one recognizes this, one can control those symptoms and know that they will go away with a little time.  No need to get pills from your doctor!

© Yvonne Behrens, M.Ed  2013

 

 

Moderation in All Things

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As I have stated in previous posts, our healthcare system is dominated by what I term the Big Three: Insurance Companies, Pharmaceuticals, Hospitals.  As with most communication, and by the fact that I am passionate about the need to re-vamp our healthcare approach, I may have sounded a little too strongly at how the system being dominated by the Big Three with focus on profits has a potentially adverse affect on the health of our country.

There is no question that the Three developed as the needs of our population arose.  Our Democracy is based on a capitalistic foundation.  Thus it would follow that pursuing profits would be an inherent part of any business.  We, as a country, also put great stock in the Scientific Community.  Thus it would follow that pursuing new means of coming up with cures would play a dominant factor in medicine.

However, as with any pursuit or endeavor in life, when the focus leans too much in one direction, it can have adverse affects on the opposite side and I do believe that at this stage, the focus of the Big Three has veered too much on the profits and finances, ultimately undermining the service side of their work.  If a doctor is required to bring X amount of $s into the “firm” and that can only happen by seeing X amount of patients in a given day and/or suggesting so many procedures or specialty visits, then the patient and his/her health is affected (not to mention the doctor’s, whose life has the added stress of having to bring in so much money).  Nowadays, often, young people go into the field of medicine because it assures a good living.  Even if a young person has gone into the field for idealistic reasons, ie, helping those in need, the demands of the system and the focus on the money side of things will quickly overwhelm the original intent of the young person going into the field.

When my grandfather practiced medicine, he was a General Practitioner.  He was the one that people went to if they had a tummy ache, or a toothache, or a wart, or were about to give birth.  If his patients didn’t have the money to pay, he might receive a side of ham instead.  If he did not have an answer, he would suggest a visit to someone who might have a more specialized background.  Litigation against doctors did not exist back then.  As far as I know, my grandfather never lost a patient on an operating table.  But people were much more accepting that death COULD be an outcome.

So the times they have changed.  But just as they have changed into this extreme scenario in which it is now considered natural to spend 15 minutes with a doctor and leave with a prescription and/or to try everything that is being offered to keep someone alive (regardless of statistics that may help families recognize that there is very little chance for survival),  maybe now is the time to re-focus our attention on the promotion of health, rather than playing catch up to ill-health and permit change to again occur.  (In fact, I believe the ability to change and see things in new ways is one of the elements that makes our country so great).

This, then, is the basis of my passionate writing on this subject.  Thus, just as I make the point that it is time for our system to moderate itself, I, too, plan to moderate my writings on the subject.

© Yvonne Behrens, M.Ed  2013

 

 

“Obama Care” summarized – part 4

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…and so here is the final entry to the long story of trying to implement universal health care in the United States.

The opposition fought a dirty war, even incorporating racism to try and prevent the Health Care Reform Act from becoming law.  But politics is a dirty game and often has very little to do with us, the people.

The reality is that health care in this country has become so exorbitantly expensive, the system would become financially bankrupt were it allowed to continue in the direction it has been.   Thus, all the posturing by the opponents of the bill had more to do with buying time in order to figure out how to ensure their interests under the new system.  In the end, much of the original bill was watered down and implementing universal health care will be much more expensive than it would have been when originally considered.  However, some important laws did get passed and, hopefully, States will recognize the benefits to them.  Unfortunately, since so much of the focus on the part of big businesses is on how to take advantage of circumstances, (and by this I mean milk the system) we have become a society that is encouraged to look at how to take advantage of legislation.  I really do not know a remedy for this since the example in front of us is that one can get away with milking the system (Wall Street being the biggest example of getting away with….).

So, in the end, what is the Health Care Reform Act?  I think the following video will probably do a better job of explaining than I can.  So view and enjoy.

© Yvonne Behrens, M.Ed  2013

 

 

Obama Care Part 3 – 2009: The Battle

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In my previous entries, I shared the history of the whole universal health care debate, a debate that has been going on for almost a hundred years in our country.

President Obama rolled out the details of the Health Care Reform Initiative in the summer of 2009.  As you may recall, there was an unbelievable amount of acrimony around the topic.  This was where older folks, who really did not know what was within the 906 page document, were encouraged to come to Washington, D.C. (free bus ride and free lunch) and hold up placards that “yelled out” such lines as “Don’t kill Grandma.”  This phrase, it turns out, was referring to a clause, somewhere in the middle of the 906 page document in which every patient would have a right to talk with their doctors about end of life issues and it would be covered by insurance.

Ah, yes.  It was quite a period of time, back then.  Representatives, who backed the President’s health care initiative, would hold town meetings, facing really angry voters, who, quite frankly, did not fully understand how this health care initiative would benefit them.  I remember our representative in the Fifth District of Virginia, Tom Perriello, one of the finest politicians I have ever met.  He was a straight shooter and he had the most impeccable manners.  He held town meeting after town meeting after town meeting, where angry folk would challenge the initiative. In fact, it was known that the opposition sent in individuals with prepared questions on specific, if not, obscure points within the document.  Congressman Perriello had such a grasp on what those 906 pages contained, that he was able to answer most every single person’s question, no matter how obscure.    On the rare occasion that  he was unfamiliar with a clause that was brought up, he took the person’s name and address and promised to get back with him/her within the 24 hour period with an answer.

In spite of his efforts, not only did he loose re-election because he stood firmly behind the health care reform initiative, but the anger and fear that had been stirred up to such a frenzy, made his answers fall on deaf ears.  The people were not there to learn, but rather to try and trip up or embarrass the Congressman.

During a June 2009 speech, President Obama  outlined his strategy for reform. He suggested seven steps that would bring down the costs of our exhorbitant health care costs:  1)  electronic record-keeping; 2) preventing expensive conditions; 3)  reducing obesity; 4) refocusing doctor incentives from quantity of care to quality; 5) bundling payments for treatment of conditions rather than specific services; 6) better identifying and communicating the most cost-effective treatments; and, 7) reducing defensive medicine.[8]

In September of 2009, the President added a a few more points to the original plan: 1)  by having everyone be part of the insurance plan, the plan would be deficit neutral; 2) implementing laws that would prevent insurance companies to discriminate based on pre-existing conditions; 3) individuals would have a cap on how much they would have to spend out-of-pocket;  4) the creation of an insurance exchange for individuals and small businesses so that these entities would not be unfairly penalized for not having the numbers that larger companies have and thereby lack the means of equal coverage; 5) tax credits for individuals and small companies; 6) the creation of  independent commissions to identify fraud, waste and abuse; 7) in order to lower insurance costs for doctors to protect themselves against malpractice suits, the President added malpractice reform projects to the package.   [9][10]

Atul Gawande, a surgeon, writing in The New Yorker, further distinguished between the delivery system and the payment system.  He argued that reform of the delivery system is critical to getting costs under control, but that payment system reform (e.g., whether the government or private insurers process payments) is considerably less important yet gathers a disproportionate share of attention. Gawande argued that dramatic improvements and savings in the delivery system will take “at least a decade.” His recommendations were to address the over-utilization of healthcare in our country.  That the focus of healthcare needs to move back to keeping people healthy rather than making profits.  He also suggested that a comparative analysis system of the cost of treatments and outcomes across various healthcare providers be initiated.  Gawande argued:

this would be an iterative, empirical process and should be administered by a “national institute for healthcare delivery” to analyze and communicate improvement opportunities.[13]

When I read these points, they certainly make sense to me.  So why all the anger?  Why all the hostility?  Why all the emotion?

Because a group would stand to loose quite a bit if the Health Care Reform Act were to become law.  What group?  The Health Care Industry which is made up of the insurance companies, the pharmaceuticals, and the hospitals.  Oh, and then the investors in this industry.  (To be continued)

© Yvonne Behrens, M.Ed  2012

“Obama Care” – Part 2, The History

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On February 6, 1974, President Richard M. Nixon proposed a comprehensive health insurance plan to Congress.

How the times they have changed! Following is the first sentence of President Nixon ‘s address:

One of the most cherished goals of our democracy is to assure every American an equal opportunity to lead a full and productive life.
In the last quarter century, we have made remarkable progress toward that goal, opening the doors to millions of our fellow countrymen who were seeking equal opportunities in education, jobs and voting.

Now it is time that we move forward again in still another critical area: health care.

Without adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial and social barriers not stand in the way of good health care as it is to eliminate those barriers to a good education and a good job.

It is hard to believe that nearly 40 years ago, it was a Republican President speaking like this.

I will continue to quote President Nixon because he says it all:

Three years ago, I proposed a major health insurance program to the Congress, seeking to guarantee adequate financing of health care on a nationwide basis. That proposal generated widespread discussion and useful debate. But no legislation reached my desk.

Today the need is even more pressing because of the higher costs of medical care. Efforts to control medical costs under the New Economic Policy have been Inept with encouraging success, sharply reducing the rate of inflation for health care. Nevertheless, the overall cost of health care has still risen by more than 20 percent in the last two and one-half years, so that more and more Americans face staggering bills when they receive medical help today:

–Across the Nation, the average cost of a day of hospital care now exceeds $110.  {!!!]
–The average cost of delivering a baby and providing postnatal care approaches $1,000.
–The average cost of health care for terminal cancer now exceeds $20,000.

For the average family, it is clear that without adequate insurance, even normal care can be a financial burden while a catastrophic illness can mean catastrophic debt.

Beyond the question of the prices of health care, our present system of health care insurance suffers from two major flaws :

First, even though more Americans carry health insurance than ever before, the 25 million Americans who remain uninsured often need it the most and are most unlikely to obtain it. They include many who work in seasonal or transient occupations, high-risk cases, and those who are ineligible for Medicaid despite low incomes.

Second, those Americans who do carry health insurance often lack coverage which is balanced, comprehensive and fully protective:

President Nixon then shares how his health care plan would be organized:

The plan is organized around seven principles:

First, it offers every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits;
Second, it will cost no American more than he can afford to pay;
Third, it builds on the strength and diversity of our existing public and private systems of health financing and harmonizes them into an overall system;
Fourth, it uses public funds only where needed and requires no new Federal taxes;
Fifth, it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the Federal Government.
Sixth, it encourages more effective use of our health care resources;

And finally, it is organized so that all parties would have a direct stake in making the system work–consumer, provider, insurer, State governments and the Federal Government.

Unfortunately, President Nixon’s health care initiative never went further because of the Watergate affair.  In the end, President Nixon resigned the presidency and the question of health care once again was pushed aside. 

In his memoirs, “Seize the Moment” Nixon reiterated his views on why health care is such an important topic:

“We need to work out a system that includes a greater emphasis on preventive care, sufficient public funding for health insurance for those who cannot afford it in the private sector, competition among healthcare providers and health insurance providers to keep down the costs of both, and decoupling the cost of healthcare from the cost of adding workers to the payroll,”

Next came President Jimmy Carter, but he had alienated the Congress so badly, that he had very little sway over them and the question of health care floundered.

Under Ronald Reagan, a health care mandate  was passed.  This turned out to be a compromise that ended up taxing the wrong people, that is the hospitals, with no stipulation to be repaid for their services.

The law requires hospitals to treat patients in need of emergency care regardless of their ability to pay, citizenship or even legal status. It applies to any hospital that takes Medicare funds, which is virtually every hospital in the country.

Under President Bill Clinton, a comprehensive health care system was devised based on universal coverage.  Although the added coverage would be expensive, the cost of non-insured and the poor in emergency room procedures was more.  Hillary Clinton headed up the task force to provide the proposal.  Clinton’s plan, like Nixon’s, called for building on the existing private-sector health-care system and using government subsidies and tax credits to get all Americans under an umbrella of health coverage. Like Nixon, Clinton said her plan “is not government-run. There will be no new bureaucracy.”

In 1993, 23 Republican senators, including then-Minority Leader Robert Dole, cosponsored a bill introduced by Senator John Chafee that sought to achieve universal coverage through a mandate that is, a mandate on individuals to buy insurance. Nearly every major health care interest group had endorsed substantial reforms–grandiose ones, in fact. The American Medical Association (AMA) and Health Insurance Association of America (HIAA), the two great, historic bastions of opposition to compulsory health insurance, both went on record in support of an employer mandate and universal coverage. Even the U.S. Chamber of Commerce endorsed an employer mandate, as did many large corporations. Other groups came out variously for reform options that ran along a spectrum from Canadian-style, single-payer programs on the left to managed competition and medical savings accounts and radical changes in tax policy on the right. Under the circumstances, it was easy to believe the country was ready for substantial reform and that a market-oriented, consumer-choice approach to universal coverage, positioned in the center, could become a platform for consensus.

But, once again,  politics got in the way, and thus this health care initiative came crashing down. And every year, the health care costs have gone up.

These days, a day stay in the hospital costs at least $1,700, sometimes more, depending on which hospital.  Back to the history and onto…..

George W. Bush signed into law the Medicare Modernization Act.  This was supposed to provide all 40 million Medicare beneficiaries with a voluntary prescription drug benefit. This drug benefit gave seniors their choice of various plans to help them afford the cost of their medicines.  Of course what was not taken into account were the pages and pages of documents that these seniors were expected to go through.  And then there was the donut hole, that place wherein which the senior would fall when they reached a cap of $2,250 in their prescription drug costs.  In an environment where a pill can cost as much as $1,000, that hole could reach the senior fairly quickly.  And thus, something that looked like it was giving, ended up giving nothing.

So, the picture looks a little bit like different administrations offering a cake and being shot down for political reasons and some administrations getting crumbs through but with consequences that somehow undermine the crumbs thrown at the public.

Meanwhile, the law makers who keep negotiating and fighting against the idea of a universal health care system have the best healthcare system provided them for life.

(to be continued)

© Yvonne Behrens, M.Ed 2012

“Obama Care” Part 1, The History

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Since President Obama has been re-elected, I decided that I had better educate myself on the question of the Health Care Reform Act and find out what is really at stake.  I do believe that the only way the President will get the support he needs to make this initiative successful is if he and his Administration educate the public with the same energy and coordination that they used for his election and re-election.  For my part, I will begin with the history of the universal health care question in our country and move forward.

Many people think that the whole question of universal health care was “pushed” on us  by “this” president.   Untrue.  Universal health care has been a topic of discussion since the turn of the century — the 20th century.  Yes, since the early 1900s.  Why is it that the idea of universal health care has not been embraced by our country, the only advanced nation in the world not to have universal health care?  The answer to that question has many components.  Jill Lepore, in an article  she penned December 7, 2009 for the New Yorker, wrote that a group of economists which included Louis Brandeis, Jane Addams and Woodrow Wilson formed a committee they called the Committee on Social Insurance.  By 1915, the committee had drafted a bill to provide universal medical coverage.  At the time, the American Medical Association enthusiastically supported the idea and by the end of 1916, the idea was presented to Congress for their approval.

According to Lepore, part of their presentation lauded Germany as the great example to be emulated.

“Germany showed the way in 1883,” Fisher [one of the committee members] told his audience. “Her wonderful industrial progress since that time, her comparative freedom from poverty . . . and the physical preparedness of her soldiery, are presumably due, in considerable measure, to health insurance.”

However, in April 1917, the United States declared war with Germany,  killing, along with some German soldiers, any move towards Universal Health Care which was now being correlated as a product of Germany.

In Lepore’s article, we learn that:

In California, where the legislature had passed a constitutional amendment providing for universal health insurance, it was put on the ballot for ratification: a federation of insurance companies took out an ad in the San Francisco Chronicle warning that it “would spell social ruin to the United States.” Every voter in the state received in the mail a pamphlet with a picture of the Kaiser and the words “Born in Germany. Do you want it in California?” (“If you are opposed to a thing these days,” one frustrated health-care advocate wrote, “the cheapest way to attack it is to call it ‘German.’ ”) The people of California voted it down. By 1919, John J. A. O’Reilly, a Brooklyn physician, was calling universal health insurance “UnAmerican, Unsafe, Uneconomic, Unscientific, Unfair and Unscrupulous.”

Hm.  This certainly sounds familiar, although these days, the word German has been replaced with the word socialist.

Fast Forward to Franklin D. Roosevelt and the New Deal.  Once again, universal health care was bandied around as a right of all citizens.  But opposition came, in the form of Southern Senators (who were mostly Democrats at the time, because Abraham Lincoln had been a Republican), concerned about the implications that a National Health Insurance (NHI) might have in their segregated societies.  They aligned themselves with Republican senators and brought the American Medical Association (AMA) into the fold to put a block to this.  President Roosevelt, concerned that other New Deal reforms would not pass if he pushed too hard on NIH, dropped it.

However, after World War II ended, President Truman tried to implement the national health insurance once again. His plan proposed a single insurance program that would cover all Americans with public subsidies to pay for the poor.   Once again, according to an article published by the Kaiser Foundation:

Southern Democrats in key positions blocked Truman’s initiative, partly in fear that the federal involvement in health care might lead to federal action against segregation at a time when hospitals (in the South) were still separating patients by race. [The irony of the fact that it was President Obama who successfully brought universal health care into law is not lost on me.]

Also “an increasingly powerful AMA opposed National Health Insurance believing that physicians would lose their autonomy, be required to work in group practice models and be paid by salary or capitated methods.  In addition, business and labor groups were not supportive, nor was the emerging private health insurance industry. “

Now the opposition was becoming stronger.  The area of health care was being recognized as a potentially huge money making enterprise by the business class.  But the government continued to plug away at the idea of universal healthcare.  President John F. Kennedy presented the concept in the form of health care coverage for all those on Social Security.  This was in 1962.  President Lyndon B. Johnson was able to pass legislation creating Medicare/Medicaid programs to provide comprehensive health care coverage for people aged 65 and older, as well as for the poor, blind, and disabled in 1965.  At this point, healthcare related spending started to skyrocket.  Health care became a lucrative business.

In 1971, confronting the escalating costs of healthcare, President Richard M. Nixon backed a proposal that would require employers to provide a minimum level of health care for their employees, while maintaining competition among insurance companies, keeping medicare/medicaid for those over 65 and creating a pool insurance coverage for self-employed individuals.  Senator Teddy Kennedy at the time was promoting a universal health care coverage directed and financed entirely by the government.

In hindsight, President Nixon’s proposal might have helped to contain health care costs.  The issue that was being challenged by Senator Kennedy was that President Nixon’s program supported private insurance companies as the providers of health insurance.  Kennedy’s proposal would take health care out of the private sector.

The debate that occurred between President Nixon and Senator Kennedy probably best epitomizes the struggle our country has had throughout its existence [go back to the acrimonious exchanges between Thomas Jefferson and Alexander Hamilton].  The debate has always centered around the rights of the citizenry and the rights of businesses to thrive and keep this country moving forward economically.  What the debate never seems to quite latch onto is that there are some areas that are service areas by nature and other areas that fit under the intent of business.  Health care is a service area.  It should not be a money making enterprise.  When the focus is on making money, the focus is no longer on service.    [to be continued....]

© Yvonne Behrens, M.Ed  2012