Tuesday Voice: A seventh red herring of the healthcare biz

A cartoon

By Jim Rix

After “Risk factors,” my previous red herring, was published, the editor suggested in retrospect that I might have used this cartoon, which he saw on his doctor’s bulletin board and thought sounded pretty healthy:

Tuesday Voice: A sixth red herring of the healthcare biz

Risk factors

By Jim Rix

The idiom “red herring” is used to mislead, to distract, to obscure the truth. And the truth, sad to say, is frequently not profitable for some businesses. And businesses that do not make a profit do not survive. The healthcare biz is no exception. Curing patients all too often is not profitable, while treating patients forever is. After all, it’s called “healthCARE” not “healthCURE.” As a result, many red herrings abound in the healthcare biz.

Tuesday Voice: A fifth red herring of the healthcare biz

Milk

By Jim Rix

The impetus for this red herring is the commercial I saw this morning on the Today Show. “Start your morning with the power of protein – MILK.” Really? Does protein provide the power/energy for the human body? I think we all know that the body gets its energy from carbohydrates and not proteins. After all, do marathon runners protein-load or carbo-load before a race? Protein builds our muscles but it’s carbohydrates that provide the energy that powers them. In fact, the human brain operates exclusively on carbohydrates. That’s why under periods of starvation the human body will convert its protein (muscles) into carbohydrates to keep the brain and hence the body alive. (This process is called gluconeogenesis.)

Tuesday Voice: A fourth red herring of the healthcare biz

Calcium

By Jim Rix

In the last episode, protein (specifically protein deficiency) was identified as a red herring, because any diet, whether animal-based or plant-based, contains sufficient protein for humans to thrive. Protein deficiency obscures the real problem, which is excess protein. For example, as the discussion of that article revealed, kidney failure is a consequence of excess protein. Are there others?

Tuesday Voice: A third red herring of the healthcare biz

Protein

By Jim Rix

Not infrequently when friends notice that my dinner plate is devoid of animal products and I tell them that I eat a plant-based diet, they ask “Where do you get your protein?” I look over at their plates, observe, say, a nice juicy piece of meat, and answer their question with this question: “Where did the cow that donated your steak get its protein?” Sometimes they figure it out but if they present a dumbfounded look, I reply, “That cow, as well as all large land mammals, like elephants and giraffes, is a vegetarian.” If they still don’t get it, I say “If there’s enough protein in plant foods to build these large animals, there must be enough to build a puny human being, don’t you think?”

Tuesday Voice: Another red herring of the healthcare biz

Sugar

By Jim Rix

The healthcare biz does little to correct the common misperception that “sugar makes you fat” and identify the real culprit because it’s not profitable to do so. While sugar is not a health food and should not be the bulk of caloric intake, a little bit of sugar on oatmeal to make it more enjoyable does little harm, while a Diet Coke with a greasy cheeseburger does little good.

Tuesday Voice: A red herring of the healthcare biz

Salt

By Jim Rix

It is obvious that for a business to stay in business for any length of time it must be profitable. This fact is true for the healthcare industry, which encompasses several entities: health insurance companies vying for your or your employer’s dollars; pharmaceutical companies anxious to push pills upon you; the meat and dairy industries promoting their unhealthy products; government agencies like the USDA setting health policies influenced by the above special interest groups; and last and least the medical doctor, also a puppet of all of the above, anxious to treat you ad infinitum to make a profit rather than to cure you with the truth. To obscure this truth, red herrings abound in the healthcare biz.

Health Care Reconciliation Bill

"Obama Plans to Sign Health Care Reconciliation Bill on Tuesday," according to Robert Pear and David M. Herszenhorn in today's New York Times. Why not "read it"? It's only 153 pages, of which over two pages are devoted to the table of contents:

AMENDMENT IN THE NATURE OF A SUBSTITUTE TO H.R. 4872, AS REPORTED

Strike all after the enacting clause and insert the following:

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
2 (a) SHORT TITLE.—This Act may be cited as the
3 "Health Care and Education Affordability Reconciliation
4 Act of 2010."
5 (b) TABLE OF CONTENTS.—The table of contents of
6 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—COVERAGE, MEDICARE, MEDICAID, AND REVENUES

Subtitle A—Coverage

Sec. 1001. Affordability.
Sec. 1002. Individual responsibility.
Sec. 1003. Employer responsibility.
Sec. 1004. Income definitions.
Sec. 1005. Implementation funding.

Subtitle B—Medicare

Sec. 1101. Closing the medicare prescription drug "donut hole."
Sec. 1102. Medicare Advantage payments.
Sec. 1103. Savings from limits on MA plan administrative costs.
Sec. 1104. Disproportionate share hospital (DSH) payments.
Sec. 1105. Market basket updates.
Sec. 1106. Physician ownership-referral.
Sec. 1107. Payment for imaging services.

Subtitle C—Medicaid

Sec. 1201. Federal funding for States.
Sec. 1202. Payments to primary care physicians.
Sec. 1203. Disproportionate share hospital payments.
Sec. 1204. Funding for the territories.
Sec. 1205. Delay in Community First Choice option.
Sec. 1206. Drug rebates for new formulations of existing drugs.

Subtitle D—Reducing Fraud, Waste, and Abuse

Sec. 1301. Community mental health centers.
Sec. 1302. Medicare prepayment medical review limitations .
Sec. 1303. CMS­IRS data match to identify fraudulent providers.
Sec. 1304. Funding to fight fraud, waste, and abuse.
Sec. 1305. 90-day period of enhanced oversight for initial claims of DME suppliers.

Subtitle E—Provisions Relating to Revenue

Sec. 1401. High-cost plan excise tax.
Sec. 1402. Medicare tax.
Sec. 1403. Delay of limitation on health flexible spending arrangements under cafeteria plans.
Sec. 1404. Brand name pharmaceuticals.
Sec. 1405. Excise tax on medical device manufacturers.
Sec. 1406. Health insurance providers.
Sec. 1407. Delay of elimination of deduction for expenses allocable to medicare part D subsidy.
Sec. 1408. Elimination of unintended application of cellulosic biofuel producer credit.
Sec. 1409. Codification of economic substance doctrine and penalties.
Sec. 1410. Time for payment of corporate estimated taxes.
Sec. 1411. No impact on Social Security trust funds.

Subtitle F—Other Provisions

Sec. 1501. Community college and career training grant program.

TITLE II—EDUCATION AND HEALTH

Subtitle A—Education

Sec. 2001. Short title; references.

PART I—INVESTING IN STUDENTS AND FAMILIES

Sec. 2101. Federal Pell Grants.
Sec. 2102. Student financial assistance.
Sec. 2103. College access challenge grant program.
Sec. 2104. Investment in historically black colleges and universities and minority-serving institutions.

PART II—STUDENT LOAN REFORM

Sec. 2201. Termination of Federal Family Education Loan appropriations.
Sec. 2202. Termination of Federal loan insurance program.
Sec. 2203. Termination of applicable interest rates.
Sec. 2204. Termination of Federal payments to reduce student interest costs.
Sec. 2205. Termination of FFEL PLUS Loans.
Sec. 2206. Federal Consolidation Loans.
Sec. 2207. Termination of Unsubsidized Stafford Loans for middle-income borrowers.
Sec. 2208. Termination of special allowances.
Sec. 2209. Origination of Direct Loans at institutions outside the United States.
Sec. 2210. Conforming amendments.
Sec. 2211. Terms and conditions of loans.
Sec. 2212. Contracts; mandatory funds.
Sec. 2213. Agreements with State-owned banks.
Sec. 2214. Income-based repayment.

Subtitle B—Health

Sec. 2301. Insurance reforms.
Sec. 2302. Drugs purchased by covered entities.
Sec. 2303. Community health centers.

No sanity clause

Could Paul Krugman have produced Christmas's best pun, not only for its pertinence to our politics but also to Christmas itself? In his opinion piece, "Tidings of Comfort," in today's New York Times, he's explaining why so many people are complaining about "the legislation that passed the Senate on Thursday and will probably, in a slightly modified version, soon become law [and] make America a much better country":

There are three main groups of critics.
    First, there’s the crazy right, the tea party and death panel people — a lunatic fringe that is no longer a fringe but has moved into the heart of the Republican Party. In the past, there was a general understanding, a sort of implicit clause in the rules of American politics, that major parties would at least pretend to distance themselves from irrational extremists. But those rules are no longer operative. No, Virginia, at this point there is no sanity clause.

"But," Krugman continues, "given the way the Senate rules work, it takes 60 votes to do almost anything. And that fact, combined with total Republican opposition, has placed sharp limits on what can be enacted.
    "If progressives want more, they’ll have to make changing those Senate rules a priority...."
    Krugman's opinion piece on Monday ("A Dangerous Dysfunction") focused on the need for that change. May it happen.

About those dead cats

It's cold and dreary in Mebane. There's even a possibility of snow (our always-reliable and hardly-ever-wrong weather forecasters tell us). What better sort of day for reading Gail Collins, who is even more reliable and right than our weather forecasters? I recommend her op-ed piece, "The Lost Weekend," in today's New York Times. Excerpts:

The Senate is going to be in session all weekend, debating the big health care bill and arguing about which direction the cost-curve is heading. This is a positive development on two counts. It keeps senators off the streets while providing much-needed employment in the chart-making sector of our economy.
    ...
    Is that perfectly clear? Good. Now we will return to our regularly scheduled conversation. Did you see that hot reality show “Hoarders” on A&E the other night? What about that lady who hoarded her dead cats? If “Hoarders” gets superpopular, do you think lots of people will start putting dead cats in their living room just so they can get on TV and be famous? Maybe somebody will try to bring dead cats to a state dinner at the White House! Does the Secret Service have a plan to avert this?
    Sorry. I’ll behave. Back to the health care bill.
    ...
    In fact, G.O.P. senators appear to have amendments aimed at wiping out virtually all the cost-cutting the Democrats have put in the bill, including productivity adjustments and incentives for innovation in health care delivery.
    If they can’t kill the bill completely, Republicans who are not from Maine seem intent on raising its price tag....
    There is no sane explanation for all this other than crass political calculation....
    Now, about those dead cats.

Enjoy today's weather.
    Or, as my friend Fred says:

McCain's not crazy. He's just performing stunts that he thinks will help him get re-elected. Unfortunately, there are no end of people (they're called politicians) who are quite willing to screw up the country as long as they can continue to enjoy the spotlight and perks of public office.

Michael Moore's funniest movie to date, not

It may be too late for a Must See (MS) recommendation for a 2007 documentary, but if you still don't know (but care) what are some of the salient issues in the "health care debate," then Michael Moore's "Sicko" is a film you must see.
    However, I don't get the blurbs on the Special Edition DVD. "You'll laugh till it hurts"? (Peter Travers) "Michael Moore's funniest movie to date"? (A.O. Scott)
    Not. Not.
    No, I agree with D. Maass, who wrote on November 6, 2007:

"Sicko" is about shame. The shame we should all feel as a country for allowing a health care system where profit's made by not providing care. The shame we should all feel for not standing up to it, for shrugging off the tremendous influence insurance and pharmaceutical industry lobbyists swing and wield with our elected officials. The shame we should all feel for not caring for every human being within our borders. And perhaps, the most American shame of all: the shame of falling far behind the rest of the Western world.

Knowing the film's main conclusions from other sources, except for some of its squeamy details (like the man who sawed off two of his fingers and had to choose which finger he could afford to have reattached), I found the documentary a challenge to watch. Funny it's not, except possibly some of the shenanigans gotten up to by the liars who have been bought off by insurance or pharmaceutical companies. But these portrayals incite more to anger than to laughter.

I said some of the salient issues. One Moore overlooks is the question of America's being "overtreated," to borrow a phrase from the subtitle of Nortin M. Hadler, M.D.'s indispensable book, Worried Sick: A Prescription for Health in an Overtreated America (2008, University of North Carolina Press).
    If you have to choose between a Must See movie and a Must Read book, read Worried Sick. You'll learn infinitely more to your own personal advantage. And it's an enjoyable read, Hadler's right there with you, mind to mind.

To protect health care, we need to reform it

James Surowiecki's short article about health care reform, "Status-Quo Anxiety," in the August 31 New Yorker ends with the statement, "...if we want to protect the status quo, we need to reform it." His reasons for saying this would be good for people to consider who are afraid of losing what they already have. For example:

...although people tend to feel that they own their health insurance, their entitlement is distinctly tenuous. Because it’s hard for individuals to get affordable health insurance, and most people are insured through work, keeping your insurance means keeping your job. But in today’s economy there’s obviously no guarantee that you can do that. On top of that, even if you have insurance there’s a small but meaningful chance that when you actually get sick you’ll find out that your insurance doesn’t cover what you thought it did (in the case of what’s called “rescission”). In other words, the endowment that insured people want to hold on to is much shakier than it appears. Changing the system so that individuals can get affordable health care, while banning bad behavior on the part of insurance companies, will actually make it more likely, not less, that people will get to preserve their current level of coverage.

Ambrose Bierce on prayer

To try to get away from the depressing spectacle of the "health care debate" (including, alas, President Obama's unexpected weakness in attempting to achieve a political compromise by trying to appease people who won't be appeased—like Senator Charles E. Grassley, “who feeds the death panel smear, warning that reform will 'pull the plug on grandma'”¹), I'm reading an entertaining book, John Allen Paulos's 2008 Irreligion: A Mathematician Explains Why the Arguments for God Just Don't Add Up, which in passing quotes Ambrose Bierce's Devil's Dictionary (1911):

Pray, v. To ask the laws of the universe to be annulled on behalf of a single petitioner confessedly unworthy.

Mention of Bierce immediately follows Paulos's own statement:

Subjective arguments for God's existence generally claim to establish even more than a connection between God and a particular religion. They claim to establish the existence of a personal God [emphasis mine] who cares about us individually, listens to our prayers, and occasionally intervenes with a miracle on our behalf. An understandable wish perhaps, but absurd nonetheless. [pp. 80-81]

Absurd as it is, I have once or twice caught myself beginning to pray for health care reform to become a concerted, rational undertaking.

_______________

1. From Paul Krugman's column, "Obama's Trust Problem," published yesterday on The New York Times website.

The reason for my recent disappearance

To my regular readers, who may be wondering why I haven't posted anything lately, I think I owe an explanation. The simple truth is that my spirits have been rather down lately over the utter banality and craziness of one-half of the "health care debate" in this country. I don't know which depresses me more, the fact of Fox News [sic] and Rush Limbaugh and Sarah Palin, or the fact that a large number of supposedly adult Americans listen to and believe them.
    And it doesn't help that some of these bewildering (and possibly bewildered) people are my neighbors and relatives. A letter printed yesterday to the editor of a local newspaper castigated another letter-writer, saying, "I don't know where that liberal gets his information, but a recent poll on Fox News says...."
    And a cousin emailed me this morning about a conversation in his extended family:

Yesterday I visited them, and they started telling me about Hitler, and how he wanted to socialize everything. I'm like, "Whoa! Obama is nothing like Hitler. It's irresponsible to compare the two. Hitler was like the most evil person of the 1900's."
    Then they were like, "You know what would happen if the Democrats got their way? They would euthanize H----d's son because he's mongoloid."
    It's not even worth arguing with them anymore. A lot of senior citizens watch Faux News most of the day and listen to AM radio when they aren't watching their crazy propaganda "news." It's mind-boggling how irresponsible some of those crazy right-wingers are. They are scaring people into starting militias, and that shit is dangerous.

Are any of you depressed about this, too? The false rumor-starting, the fear-mongering, the hate-inciting? If you want to unburden yourself a little (as I have here), my comment box is open.

Not to be Louised again....

Let's hope that we don't get Louised again when it comes to health care reform. But did you know that the actress who played Louise in that oh-so-effective 1994 anti-health care reform advertisement was actually for reform...and almost walked off the job when she saw the script she was to perform? At any rate, so reported Judith Warner yesterday on her New York Times blog, titled "Louise’s Second Act":

Fifteen years after she starred in the infamous Harry and Louise ads — the televised spots that are generally credited with having turned the tide of public opinion against Clinton-era health reform — she and Harry are back, angling for a shot at redemption, with a new ad campaign, “Get the Job Done,” in support of the Obama plan.