The Operating Room

Closing the divide in the Health Care Debate

noreply@blogger.com (Darkn3ss) — Wed, 20 Jan 2010 20:48:00 +0000

Congress has begun the pain staking process of interfacing the Senate's health care proposal with it's counterpart written by the House of Representatives. It seems as though those involved in the development of the bill truly do believe that it cannot fail.

California's 15th District Representative - Mike Honda recently posted on the Huffington Post explaining and commending the Health Care bill currently under review - below you can read what he had to say or you can:

Skip to the good stuff - what's this bill about? | Skip to the author's comments CMARWSQMDTHF

"This month, as Congress begins to reconcile two very different health care reform bills in the Senate and House, it is worth taking perspective on the significance of this moment. It is an understatement to say that the road to health reform has been long and difficult. The most recent attempt, in 1994, failed through a combination of scare tactics by opponents and intense opposition from entrenched and wealthy interests. Since then, the health insurance industry has staved off the threat of real reform by pledging to control costs and make health insurance affordable. They have failed to deliver, however, and do not deserve another chance to play with the lives and pocketbooks of the American people.

Meaningful health reform must deliver accessible, affordable, high quality health care. Passage of reform is critical to the economic health of our nation and for millions of chronically ill and low income Americans. It is the goal of the thousands of chronically ill Americans who come to Capitol Hill every year, and the millions unable to make the trip, who share their stories of struggling with insurance company bureaucracy, medically related personal bankruptcies, deaths, and financial ruin that result from our broken health care system. It is the goal of county and local health officials who struggle to deliver the services their communities need as the public health system across our nation struggles under the weight of the uninsured and underinsured. These voices are not the fringe of America; they are from the heart of our nation and represent the reality of our broken health care system.

Businesses small and large, their employees, the self-employed, and the self-insured all find themselves increasingly unable to bear the cost of premiums that climb 8, 10, 15, or as much as 25% per year, every year. Our bill in the House -- America's Affordable Health Choices Act, H.R. 3962 -- was specifically designed to address the needs of small businesses, middle and low-income workers, and families to expand access and quality, while creating transparency and accountability in the health care industry.

The bill allows small businesses to access, for the first time, large group provider rates through the mechanism of the health insurance exchange. It provides substantial tax credits for small businesses to provide health care for their workers. Subsidies are made available to American families from 150% up to 400% of the federal poverty line so they can afford to purchase the health insurance plan of their choice. For the very poorest families in our communities, HR-3962 expands Medicaid to 150% of the federal poverty line, and it does so without substantially burdening the states. In fact, for the first three years, the expansion is fully funded by the Federal government and thereafter, states shoulder only 10% of the expansion.

Our bill in the House ends the insurance industry practice of capping annual and lifetime payments for health care. In two years, pre-existing conditions will no longer be able to be used as the basis for coverage denials. Insurance companies will have to report and justify their rate increases and spend at least 85% of the premium dollars they collect directly on patient care rather than administrative costs. We invest heavily in preventative services because we know that chronic health conditions either prevented or caught early cost less to the system and less to the patient than only responding to acute health needs.

HR-3962 institutes basic consumer protections and requires plans to provide information and outreach in plain language, increasing consumer knowledge and power. Finally, because so much of our focus is on strengthening prevention and coordination of patient care (more efficient, cost effective, and results in better health outcomes), the House bill contains a much stronger investment in primary care physician training and education than the current Senate bill. In fact, I recently joined several of my colleagues in sending a letter to the President and Congressional leaders supporting the House language over the Senate language because of this concern.

As Congress calls upon its constituents to weigh in on health care reform during this final phase, I encourage all who are interested in health reform to visit my website and the websites of the Speaker of the House of Representatives and the Committee on Energy and Commerce to read the bill yourself, access summaries and fact sheets about the bill and its effects on different groups, and educate yourself about the substance of the bill."

- Rep. Mike Honda represents California's 15th district and serves on the House Appropriations Subcommittee on Labor & Health and Human Services

It strikes me as ironic that Medicare, Medicaid and every HMO out there has been trying to make the health care system more efficient and emphasize the importance of preventative medicine for a few decades now. Usually they claim to aim for the exact same standards outlined in Mr. Honda's speech - however consider this:

[caption id="attachment_163" align="alignright" width="300" caption="Number (in Millions) of Civilian/Noninstitutionalized Persons with Diagnosed Diabetes, United States, 1980–2006"][/caption]

Diabetes is one of the biggest problems in America and possibly even the world, 7.8% of the U.S. population is diagnosed with diabetes. Of those - 5-10% have

Type I or 'juvenille' diabetes - for which a cause has not yet been discovered. The other 90% have type II diabetes - which is directly linked to obesity and

inactivity and can controlled with diet, frequent light exercise and preventative medicine. The battle to fight diabetes with preventative medicine has been going on since it became a concern around the 1970's and 80's - and yet if you look at the data collected by places like the CDC's - Division of Diabetes HERE or HERE it becomes crystal clear that preventative medicine - hasn't done anything at all to slow the trend - so what makes anyone think that if government tries to do the same thing, it'll actually work?!

Technorati Tags: congress coverage, health care, insurance, reform, update

Thirteen percent of poison exposure calls related to painkillers

noreply@blogger.com (Darkn3ss) — Sun, 10 Jan 2010 00:28:00 +0000

U.S. poison centers answered more than 4.3 million calls in 2008, including nearly 2.5 million calls about human exposures to poison, according to the American Association of Poison Control Centers -- up from 4.2 million calls in 2007. About 13 percent of all poison exposure calls poison centers received in 2008 were related to analgesics, or painkillers.

The National Poison Data System also documented 1,756 deaths reported to poison centers in 2008. Most of these fatalities involved exposure to drugs including sedatives, antipsychotics, antidepressants and cardiovascular drugs. And most poison-related fatalities occurred among adults between the ages of 20 and 59.

Other findings in the report:

Though deaths reported to poison centers have increased since last year, pediatric deaths reported to poison centers are down. In 2007, the National Poison Data System reported 1,597 deaths, with 47 among children. In 2008, the National Poison Data System reported 1,756 deaths, with 39 among children.
Most information calls -- 1.14 million -- were for drug identification. Drug information calls increased 30 percent from 2007.
Nearly 83 percent of poison exposures were unintentional. Suicidal intent was suspected in about nine percent of cases.
Poison centers are serving a far larger population than in 1983, the first year the American Association of Poison Control Centers began documenting poison exposures. In 1983, 16 poison centers served 43.1 million. In 2008, 61 poison centers served a population of 304 million.

This is the 26th annual report issued by the American Association of Poison Control Centers.
The full report is available online at www.aapcc.org. It was published in the December issue of Clinical Toxicology.

The American Association of Poison Control Centers supports the nation's poison control centers. Poison centers offer free and confidential services 24 hours a day, seven days a week. For questions about poison or poison prevention, call your local poison control center at 1 (800) 222-1222.

SOURCE American Association of Poison Control Centers

2009 Hospital Report

noreply@blogger.com (Darkn3ss) — Fri, 08 Jan 2010 17:00:00 +0000

According to Press Ganey Associates’ 2009 Hospital Pulse Report, the Physician Perspectives on American Hospitals found physicians’ overall satisfaction with fully functioning electronic medical records (EMRs) is on a downhill slope. Many physicians actually consider the increasingly common technology to be very time-consuming. Some fear that it may compromise patient safety and the security of their information.

The report also finds that, for the third year in a row, physicians’ number one complaint is a gap in the physician-administration relationship. Physicians continue to stress a need for a much better line of communication between administrators and medical staff.

The 2009 Physician Pulse Report surveyed the experiences of 27,328 physicians practicing at nearly 300 hospitals and facilities across the country. Some other significant findings detailed in the report include:

Physicians who work in government-owned hospitals are reporting a lower satisfaction with their hospitals than peers in community-owned and teaching hospitals. The difference in the score is 6.3 points – a significant variance.
Physicians practicing in psychiatry, pediatrics and emergency medicine are those most highly satisfied within their practice when grouped by specialty. Those least satisfied include physicians dealing with cardiovascular disease, anesthesiologists, and general and orthopedic surgeons.
Physicians who have been practicing for less than five years, and those who have been practicing for over 20 years are the most satisfied.
Although many physicians would like to see improvements in EMRs, most are satisfied with their facilities’ ability to provide up-to-date medical equipment.
One of the top concerns of physicians is their confidence in hospital administration to carry out its duties and responsibilities.

“Open communication between administrators and physicians is vital not only to their relationship, but also to the bottom-line of the hospital,”

said Deirdre Mylod, PhD, vice president of hospital services, Press Ganey.

“So much of a hospital’s business is based on physician referrals, and competition among hospitals and surgical facilities continues to heat up. If administrators and physicians can improve communication, the effects will trickle down and lead to more satisfied patients and a better bottom-line.”

Findings of the survey show that physicians satisfaction level improves when hospitals put targeted programs in place, such as a monthly newsletter from the CEO, a 1-800 number for physicians to call with concerns (and a 48 hour return call guarantee), and a commitment to take simple steps like keeping physicians in updated on important issues such as hospital finances.

You can download a full copy of the report here.

Technorati Tags: electronic records, EMR, hospital, physician, report, survey

Medical Miracle? or Moral Abomination?

noreply@blogger.com (Darkn3ss) — Fri, 01 Jan 2010 19:53:00 +0000

"In California, voters authorized spending $3 billion over 10 years for embryonic stem cell research. A bipartisan Congress voted to ease federal restrictions, legislation which Bush vetoed. And opponents continued to push for a total ban on the research."

There is no question that embryonic stem cells have remarkable properties. They can grow indefinitely in the lab, and they can turn into any cell type in the body. But to obtain them, a human embryo must be destroyed.
Scientists first showed that it was possible to grow embryonic stem cells in 1998.

The line has been drawn on a million planes, and still the world is torn apart on this subject - why?

Under normal circumstances, other scientists would have rushed to study the new cells. But because of congressional restrictions, federal money can't be used for research that harms an embryo.
President Bill Clinton decided it was OK to use federal money to study embryonic stem cells once they were growing in the lab, so long as private money was used to create them.

President George W. Bush considered the idea of stem cell research only to announce that he would support the research but only under strict guidelines. In essence this was a fatal mistake as it succeeded in angering both parties - the opposition was mad that he would support it at all while the supporters were frustrated by the strict regulations.

With the election of President Obama, the tide swung toward the scientists. In a White House ceremony in March, Obama said,

"With the executive order I am about to sign, we will bring the change that so many scientists and researchers, doctors and innovators, patients and loved ones have hoped for and fought for these past eight years. We will lift the ban on federal funding for promising embryonic stem cell research."

So where does the science of embryonic stem cells stand after a decade of political wrangling?

Politically - undecided
Scientifically - very promising - and yet; still a topic of debate

It seems we may never come to terms with the ugly reality we live in. Society would much rather uphold it's religious views than anything scientific that might actually challenge their beliefs. A massive flaw, a big mistake - but to each his own.

-Darkn3ss

Feel free to join in over at HealthCareNut.com

Thanks for your support

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Happy New Year! May 2010 bring wisdom to the masses!

noreply@blogger.com (Darkn3ss) — Fri, 01 Jan 2010 11:54:00 +0000

Happy news years and may 2010 bring wisdom to all!

And boy are we going to need it! With all the backwards decisions being made, and all the craziness that 2009 embodied that is now (thankfully) in the past - what will 2010 bring?

Will health care reform actually get passed into legislation?
or
Will it rob this country blind of all it's worked for?

Will even one corrupt politician feel the slightest bit of guilt when selling us out to the highest bidder?
or
Will the cycle continue?

How many more celebrities are going to die?

Whatever it brings 2010 is sure to be a very interesting year - well all know how 2009 went, and personally I'd say it was the worst year in quite awhile. Common sense would tell us that it's almost got to be better - or can it get even worse?

Guess time will tell, I'll be paying attention that's for sure!

My New Years Resolution: To be more social, get out more, have more fun, meet more people, live my life more!
-Whats Yours?

* UPDATE: IMPORTANT *

This blog is being migrated to HealthCareNut.com it's own registered domain powered by WordPress! The next few months will be double posted and when all traffic stops here this URL will be permanently redirected to the new domain.

Obama's christmas gift - Health Care reform gets through the Senate

noreply@blogger.com (Darkn3ss) — Thu, 24 Dec 2009 17:30:00 +0000

President Obama got his Christmas gift a little early as the Senate voted through the health care legislation in it's third and final procedural 'test run'

- Republican senators sought to frame the bill as a tarnished product of backroom deals, with some going so far as to declare it illegal. Despite strong opposition in the Senate and from a large part of the American citizens - Democrats were able to scrape together the 60 votes needed to "win" the vote, while not a single Republican supported the bill.
With final approval of the bill all but certain, Republicans on Wednesday focused on diminishing it in the eyes of the public. In particular, GOP senators questioned a deal struck by Sen. Ben Nelson (Nebraska) - who agreed to support the legislation in part because a provision was added exempting his state from paying part of the cost of expanding the Medicaid program.

It seems to be a never ending circle of lies and pay-offs that keep this country in the pit that it has fallen into as Senators are nothing more than a price tag to the Insurance lobbyists and drug companies. All they really have to do to get exactly what they want is pony up the cash and the vote is theirs.

Those who are looking at this bill with any realistic point of view can clearly see that this is not the case, it simply is not possible to mandate more spending on health care (or anything for that matter) and not spend more money. How the president is able to fathom the concept of spend more to save money - is beyond me. In fact the current bill even provides special provisions for some states; Nebraska in particular, is to be completely excluded from paying their fair share of the cost, which is estimated by some to be nearly $1 TRILLION over the next several years.

The South Carolina state attorney general stated that he plans to investigate whether the "Nebraska compromise" was unconstitutional. He estimates the deal struck with Sen. Nelson is estimated to cost the federal government an additional $100 million over 10 years.

David B. Rivkin, a conservative lawyer and constitutional expert in Washington, said he believed the claim of illegality was valid. Rivkin cited Article I of the Constitution, which says Congress can only use its power to tax and spend to benefit "the general welfare."

"This is the antithesis of the general welfare. It's about the welfare of one particular state,"
"This is worse than an earmark. This is money to buy the vote of one senator. It's not the way to use public funds." - David B. Rivkin

The proposed bill as it stands also includes a regulation to mandate that every citizen pay for health coverage whether they want it or not. At the same time the insurance won't be provided by Medicare, Medicaid or the U.S. government at all - but still private insurers; which to me - seems to point the finger once again, that someone - somewhere got a HUGE payoff for this bill.

Senators have also removed the possibility of importing cheaper prescription drugs from Canada which would have saved us billions - anyone have a guess why that was tossed out? Could it have anything to do with - the millions of dollars that greedy American drug makers shell out in 'donations' to our senators to buy their votes?

The urgency with which this bill has been crammed through the senate is astounding and is due entirely to President Obama's commitment to save face before his next election campaign begins. He is unwilling to approach the situation with any strategy or plan of action but at the same time is dead set on not giving up a fight (even if to just gather a better plan) and that has now set us further behind then we already were.

Comments anyone?

Feel free to email me at tango17@gmail.com or follow me on twitter @Darkn3ss87

Technorati Tags: health care reform bill senate government obama president drug companies lobbyist payoff taxes taxpayer vote news lawyer illegal constitution democrat republican conservative David Rivkin protest legislation
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Health Care reform may have been defeated by the Drug Companies

noreply@blogger.com (Darkn3ss) — Thu, 17 Dec 2009 21:30:00 +0000

Senators may have been paid off

Nobody on Capitol Hill takes kindly to a spreadsheet that lines up their campaign contributions with their floor votes. But that's what Maplight.org, a nonprofit database operation, has just done, producing a mashup with the tally from the Senate's vote Monday on drug importation and 6 1/2 years of campaign finance data.

SENATOR	PARTY	PHARMA. $$	VOTE
Max Baucus, MT	Democrat	$261,020	NO
Richard Burr, NC	Republican	$301,898	NO
Orrin Hatch, UT	Republican	$262,950	NO
Joe Lieberman, CT	Independant	$199,540	NO
Mitch McConnell, KY	Republican	$225,900	YES
Arlen Specter, PA	Democrat	$353,550	YES

Importation of prescription drugs is currently illegal. Advocates of legalizing it say that American consumers would save $100 billion over 10 years, as competition would force prices down for prescription drugs. The pharmaceutical industry and the Food and Drug Administration say drug safety would be jeopardized, however many who can see through smoke and mirrors can clearly see; the pharmaceutical industry simply has big influence on our own government and does not want cheaper drugs allowed into the country.

When importation was proposed as an amendment to health care overhaul, the Senate rejected it -- 51 for importation and 48 against, with 60 needed to approve.

And if you look at the Maplight analysis, you'll find--little surprise here--that senators voting nay have averaged 66 percent more in campaign contributions from Big Pharma than senators who voted yea. The difference: $85,812 vs. $51,803, spread over the period Jan. 1, 2003, to Aug. 12, 2009. Not a lot of dollars if you prorate it, but it is consistent.

Maplight earlier ran the numbers on a couple other pharma-related votes--a Senate Finance Committee vote on Medicare drug prices three months ago and, in a less refined analysis, a 2007 Senate vote on an earlier prescription drug bill.

Political scientists have devoted years to debating the potential links between votes and money. The predominant wisdom: money doesn't move votes, it follows them. Donors tend to give to lawmakers who already are on their side.

The Maplight data doesn't settle that debate. What it does point out, however, is the enduring relationships between lawmakers and interest groups, and the monetary cement that helps them bond.

It seems as if this entire health care bill is not only dead - but heading in the complete opposite direction. It was very sound in concept at first -- it was proposed to help an ever struggling health care system and it's victims (aka patients) from strangling this country with an iron grip. Now however, it is moving in the direction of giving the insurance companies more power! The pharmaceutical companies MORE POWER, and since the medicare extension is now out of the question - why the hell are they still debating? Instead of just leaving our country to be torn apart and allowing the people to go broke paying for health care they propose to make it even worse by giving the companies that created this mess - even - more - power. I for one am disgusted with this country please feel free to comment.

For some good reading on the pharmaceutical companies and how they influence our lives - checkout:

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Studies show that Physicians are happy with Medicare

noreply@blogger.com (Darkn3ss) — Tue, 15 Dec 2009 00:00:00 +0000

Physicians may not be enamored of Medicare, but they like it much better than private insurance plans

according to a survey by the Medical Group Management Association (MGMA).
The association’s Payer Performance Study of more than 1,700 group practices showed that physician groups ranked Medicare Part B well ahead of six of the largest private insurance companies in terms of overall satisfaction, based on data released at the MGMA’s annual meeting.

The survey asked participants, all of whom were MGMA members, to rank seven of the largest payers--Medicare Part B, UnitedHealthcare, Aetna, Cigna, Humana, Coventry, and Anthem--on parameters including payer communications, provider credentialing, contract negotiation, payment processing, systems transparency, and overall satisfaction.

Medicare led the pack with a mean aggregate satisfaction score of 3.59 on a 6-point scale (1 = totally dissatisfied, 6 = completely satisfied). Aetna took second place with a score of 3.14.

The big loser? UnitedHealthcare, with a score of 2.45.

Medicare scored particularly well on the amount of time it takes to respond to questions from physicians or practice managers, the accuracy of its responses, and transparency in disclosing fee schedules and reimbursement policies.

Respondents were much less satisfied with Medicare’s provider credentialing processes. On that measure, Medicare ranked last, with Aetna and Anthem taking first and second place. “The Medicare credentialing process is completely out of synch with that of the private payers, and it is a problem,” said Dr. William Jessee, president and chief executive officer of MGMA.

Dr. Jessee said that the data show particularly strong member dissatisfaction with the private insurers on the matter of negotiating contracts. “MGMA members feel there is disproportionate power on the side of the payers.”

Although Medicare may have scored better than the private insurers, the scores suggest there’s much room for improvement in the federal program. Dr. Jessee said that the MGMA survey deliberately did not ask about satisfaction with actual reimbursement rates, but he anticipated that Medicare’s relatively favorable ranking could drop considerably if the federal government goes forward with its proposed 21% physician fee cuts next year.

The fee-shearing is among a number of federal-level issues on which MGMA is taking action. “We have three major tasks: repeal the sustainable growth rate [SGR] formula as outlined in HR3200 and most other bills; create a reimbursement formula that accurately reimburses physicians for their actual costs; and simplify administrative transactions,” he said.

Medical group operating costs have been increasing at a rate of 6.5% per year, on average, for the last decade, yet Medicare reimbursement has been flat. That, said Dr. Jessee, is making it difficult for many groups to stay in business. Any further cuts in fees will likely discourage many doctors from continuing to participate in Medicare. MGMA is committed to fighting the cuts and repealing the SGR formula, and has made some progress in Washington, but “there's a lot more game to be played,” he said.

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Link (FACS PDF)

Obama Health Care plan turns into Medicare extension?!

noreply@blogger.com (Darkn3ss) — Mon, 14 Dec 2009 17:56:00 +0000

Obama announces: Public option - dead, new plan - Medicare extension!

Wednesday December 9th,

President Barrack Obama's health care reform plan that originally involved a 'public option' that would have potentially covered all citizens of the U.S. went out the window.

Instead of the so called 'public option' Obama intends to change the eligible age of Medicare beneficiaries.

The U.S. Senate is now weighing the option of expanding the program to people aged 55 to 64. But many may not be eligible, and those who are probably won't get as great a bargain as seniors enjoy currently, after all - expanding the over fed hog that is government spending can't do anything but raise the cost to the taxpayers!

The idea of expanding Medicare has been a sleeper throughout this entire health care argument. It emerged Tuesday as part of a compromise plan to pacify liberals who wanted a government-run public option as part of reform. President Obama embraced the new plan Wednesday.

Senators are also working on an idea to start a privately run, nonprofit version of the health plan enjoyed by Congress to offer affordable coverage to the uninsured.

But details remain incomplete until federal number crunchers add up the costs, which will take several days.

Currently, Medicare rates range from $110 to $353 a month, depending on income, but those are subsidized. The government actually spends about $9,000 per year for each beneficiary, said Tricia Neuman, an expert with the Kaiser Family Foundation.

But those in the 55-64 age bracket would have to pay more - a lot more - especially if the program is launched in 2011, as the Democratic senators' plan envisions.

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Senate Rejects Abortion Ban

noreply@blogger.com (Darkn3ss) — Wed, 09 Dec 2009 19:30:00 +0000

Senate Rejects Abortion Ban

The Associated Press reported yesterday that by a vote of 54-45 the U.S. Senate actually rejected an amendment by Democratic Sen. Ben Nelson of Nebraska and Republican Sen. Orrin Hatch of Utah that would ban insurance plans funded by taxpayer dollars from offering coverage for abortions.

^{President Obama delivers a speach on Health Care Reform}

As it stands currently the proposed legislation calls for insurance plans that would receive any federal subsidies in a new insurance marketplace to strictly separate all public funds from private dollars that to be used to pay for coverage of an abortion. However the current proposal does not ba coverage of abortions. In essence instead of flat out denial of coverage the legislation would only mandate where the funds to cover an abortion would have to come from.

The Senate vote is taken as a victory by abortion rights supporters, however it could complicate prospects for President Obama's health care overhaul plan in the long run.

Personally this comes as a bit of a shock; I was beginning to believe this country had been completely consumed by religion and frankly expected anything covering abortion to be prohibitted almost wihout question. Maybe the corruption in the U.S. hasn't completely taken over yet!

It's unclear whether Reid can pass his bill without the votes of Democratic abortion opponents. Seven Democrats supported the stiffer restrictions, while two Republicans — Maine Sens. Susan Collins and Olympia Snowe — voted with the Democrats. In the House, anti-abortion Democrats have threatened to vote against any final bill that dilutes the restrictions already approved in their bill.

Abortion opponents say the restrictions simply extend current federal laws that prohibit taxpayer funding of abortion except in cases of rape, incest or to save the life of the mother. But abortion rights supporters said the restrictions would have the effect of denying women coverage for a legal medical procedure already covered by many insurance plans, even if they use their own money.

"This amendment would place an unprecedented restriction on a woman's right to use her own money to purchase insurance coverage that includes abortion," said

Sen. Dianne Feinstein (D-CA).

But Nelson called the separation of funds in the bill an accounting gimmick. "The reality is federal funds would help buy coverage that includes abortion," he said.

The vote came as Senate Democrats remained at odds on the issue of creating a new government insurance plan with time running out to pass Obama's health care remake by Christmas.

Moderates cheered a move away from the so-called public option and liberals demanded an expansion of the federal Medicare program in exchange. The public plan is now in the bill, but supporters acknowledged Tuesday that it may not have the votes to pass.

"My worry is the public option is disappearing, or it gets very much weakened," said

Sen. Jay Rockefeller (D-WV)

In exchange for giving up on a new government plan, liberals are demanding a major expansion of Medicare and additional aid for low-income uninsured. Medicare would be opened up at least for a few years to uninsured people age 55 to 64. A bid to expand the Medicaid program for low-income people failed to win support.

"That's an example of not getting what you want," Rockefeller said. Other alternatives to help low-income Americans are still on the table.

Democratic negotiators

- Five liberals and five moderates are under pressure to reach at least a tentative deal by Tuesday. The bill now includes a government-run plan that states can opt out of, unacceptable to moderates whose votes Reid needs to overcome Republican delaying tactics and move the bill to final passage.
Moderates welcome the idea of replacing a new government plan with private insurance offered under the supervision of the Office of Personnel Management, which oversees the federal employee health benefits system, but questioned expanding Medicare, and they flat-out objected to broadening Medicaid.
Snowe — one Republican who may vote for the Democrats' bill also raised a warning flag. "I'm not sure ultimately what is the purpose" in expanding Medicare coverage, she said. The American Hospital Association, which supports the broad goals of the legislation, sent an alert to its members urging them to contact lawmakers in opposition to the Medicare expansion. Medicare pays hospitals less than it costs them to provide service, the group said.

Overall the latest public plan idea bears not a single shred of resemblance to the original proposed by liberals, and embraced by Obama, during the 2008 presidential campaign.

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Why Obama is right about health care

noreply@blogger.com (Darkn3ss) — Mon, 07 Dec 2009 19:45:00 +0000

Sicko

I am not a movie critic therefore it is out of character for me to recommend you sit down and watch a movie for any purpose other than entertainment but here I will make an exception - no matter how much I disagree with Michael Moore on any of his other views, in Sicko he makes a great point.

Take a good look at some of the stories of health insurance horror and fiscal nightmares brought about by our current health care system.

Even though it came it a little over 2 years ago, I still recommend everyone watch Sicko.

Whether you are; young, old, rich, poor, democratic, republican, liberal or conservative – it makes no difference at all, we all need health care and this movie will open anyone’s eyes to some of the problems with our healthcare system.

To be honest I am not generally a fan of Michael Moore at all!! I find him to be quite obnoxious at times as a matter of fact, but this movie was done well. This particular creation of his is a very good representation of the big issues that Obama is attempting to solve with his reform plan.

I am also not a huge fan of president Obama, I find it hard to trust in any of his plans, efforts or promises thus far and he has made so many in his brief period in office I don't believe I will ever find any sort of faith in his leadership - BUT I do agree with the general idea that this country's health care system is in desperate need of reform; if we do not face it soon - it will drag this country to the ground eventually.

On a separate note

– Here is a very well put together post about Obama’s plan I found earlier today.
p.s. - his plan is not all that impressive or ingenious

What do specialists think of the Senate Health Legislation?

noreply@blogger.com (Darkn3ss) — Sat, 05 Dec 2009 07:43:00 +0000

Twenty surgical organizations, led by the American College of Surgeons, sent a letter to the United States Senate in November stating that they are prepared to oppose the Senate’s reform because it will threaten patient access and harm quality. Surgeons state that as the legislation currently stands, it fails to address some of the fundamental problems that plague the system.

“We strongly support health care reform that will expand access to quality surgical and medical care to as many Americans as possible, but we cannot support legislation that puts at risk both quality of care and patient access”

“Our system is badly in need of reform but if the legislation does not address these concerns, it will do little to fix its underlying problems and may make it worse.”

A. Brent Eastman, MD, FACS

chair of the American College of Surgeons’ Board of Regents and chief medical officer, Scripps Health.

The surgical groups said they plan to oppose the Senate reform if a number of provisions that were included in the Senate Finance are retained. In addition to failing to permanently fix Medicare’s broken physician payment system and to include any meaningful proven medical liability reforms, the surgical community opposes a number of the ’s provisions including:

The legislation establishes a Medicare Commission that would shift the responsibility for making difficult Medicare payment and coverage decisions to an unelected Executive branch agency without appropriate checks and balances.

The legislation includes mandatory participation in the seriously flawed Physician Quality Reporting Initiative (PQRI) – a program through which CMS is still attempting to address systemic problems dating back to 2007.

The legislation attempts to improve patient access to certain physician services through reimbursement changes, but funds these changes through payment cuts to all other physicians – thereby exacerbating workforce shortages, including general surgeons.

“The result of these serious deficiencies will make it more difficult for the American people to receive the surgical care they will need in the future. We will work with the Senate to improve the legislation, but if these shortcomings remain in the final Senate bill, we will have no choice but to urge Senators to vote no”

A. Brent Eastman, MD, FACS

The American College of Surgeons met with policymakers over the past year to educate them about programs that would improve quality, reduce costs and increase patient access. One such program, the ACS National Surgical Quality Improvement Program (ACS NSQIP), is helping to prevent thousands of surgical complications each year. Each hospital in the program, on average, is seeing 250 to 500 fewer complications and thus an annual reduction of $3 million in costs. Nine of the top 10 private hospitals in the nation, along with more than 240 additional hospitals, use ACS NSQIP. The ACS believes that these types of quality programs, if supported by Congress, could save the system a minimum of tens of billions of dollars over the next decade.

“There are ways to improve quality, cut costs and increase patient access – but the Senate isn’t hearing those of us who are closest to the patient and work in the system every day”

A. Brent Eastman, MD, FACS

The surgical groups that signed the letter include:

American College of Surgeons
American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Ophthalmology
American Academy of Otolaryngology-Head and Neck Surgery
American Association of Neurological Surgeons
American Association of Orthopedic Surgeons
American College of Obstetricians and Gynecologists
American College of Osteopathic Surgeons
American Osteopathic Academy of Orthopedics
American Society of Anesthesiologists
American Society of Breast Surgeons
American Society of Cataract and Refractive Surgery
American Society of Colon and Rectal Surgeons
American Society for Metabolic & Bariatric Surgery
American Society of Plastic Surgeons
American Urological Association
Congress of Neurological Surgeons
Society for Vascular Surgery
Society of American Gastroitestinal and Endoscopic Surgeons
Society of Gynecologic Oncologists

Technorati Tags: surgery,surgeon,college,news,update,american college of surgeons, ,reform,debate,medicine,doctor

Health Care Reform - A new idea

noreply@blogger.com (Darkn3ss) — Tue, 01 Dec 2009 04:25:00 +0000

Do we really have a right to health coverage?

Think about it - why do people believe they have some right to free health care? No body else pays for our cars, our houses, or our groceries. Why is it any different when it comes to medical care? Maybe if we cared about the cost involved we as a society would actually care about what it all cost, maybe we would actually look into alternatives and conservative treatments for our problems rather than rushing into the most expensive tests possible at the slightest hint of a cough.

If we all paid for our health care and insurance didn't cover anything but emergency services, providers would have to lower prices and compete like any other business. This is one way to make sure that not only the prices are kept in check but also that the quality is also maintained.

As it stands today in America, no one ever really questions the prices of any medical care unless they are paying out of pocket with their own money. The mutual thought process among providers and patients alike is essentially -

'Why do I care - the insurance is picking up the tab?'

That kind of mentality is the reason we are in the situation we are in right now with health care. The insurance companies have tightened down on spending, increased premiums and run the system through the ringer because of the over spending on medical care that is not medically necessary and yet thousands of us throw caution to the wind on a daily basis because someone else is paying the bill.

That mentality hasn't gotten us anywhere so far...maybe that is what needs to change.

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Baritatric Surgery - Weighing the risks

noreply@blogger.com (Darkn3ss) — Fri, 27 Nov 2009 19:00:00 +0000

Bariatric Surgery

- It's the newest craze in surgery today. Some surgeons net up to $16,000 each for the Lap Band procedure and other surgical weight loss options, most of which take only a few hours to complete. The staggering demand for these procedures has led to abuse of the system - patients eager to jump straight to surgery without going through the proper channels and greedy surgeons hounding after patients who are willing to pay cash like blood thirsty animals will tell them anything they want to hear if they think it will convince the patients to go under the knife.

If you or anyone you know is undergoing preparation for bariatric surgery - take a real look at the medical guideline criteria that is supposed to be met before surgical steps are taken. The reason the guidelines exist is to ensure that before a patient goes into any surgery that he or she has exhausted ALL other realistic options and the surgery is merely the final resort to achieve a healthy weight. By the way – weight watchers does NOT count!

1. The Risks -

The risks are one of the first things your surgeon should discuss with you, in fact if they were truly responsible – they wouldn’t even discuss bariatric surgery without discussing the risks first. As with any abdominal surgery the risk for post operative complications like incisional hernias, infection, or non-healing wounds is very high. Specific to bariatric surgery; other post-operative risks include:

Peptic ulcer
Esophageal stricture
Kidney stones
Anemia
Chronic dehydration
Gastric dumping syndrome
Malabsorption of nutrients
Severe depression
Vitamin B12 deficiencies
Neurologic complications
Other personality disorders

The intra-operative risks are even more severe. Intra-operative risks in any abdominal surgery (whether laparoscopic or open) apply here.

The surgeon could nick the intestine, then a bowel resection would be necessary possibly leaving the patient with a permanent colostomy.
Open abdominal operations lead to a very high risk of leaving instruments or surgical sponges inside patients (forgotten instruments)
Improper handling of laparoscopic instruments can damage any number of organs within the abdomen.

2. The Planning -

When going by clinic guidelines agreed upon by both the American Medical Association and The American Society for Metabolic and Bariatric Surgery your pre-operative workup would generally require at least 6 months of planning and that is a conservative figure, some patients need up to 1 year of pre-operative workups and dieting before they meet guidelines for bariatric surgery (if they meet the requirements at all).
The following is typically required pre-operatively of anyone below a Body-Mass Index (BMI) of 49.0:

Psychiatric evaluation
6 months of physician supervised weight loss counseling/therapy
Documented evidence of treatments tried/failed for any and all co-morbidities related to your planned surgery – meaning if you have arthritis due to morbid obesity you need documentation of failed treatments for the arthritis, if you have obstructive sleep apnea secondary to your obesity you need a documented sleep study and documentation of failed treatments for the sleep apnea.

Understand that bariatric surgery is not going to solve your weight problem in and of itself. The surgery is a pre-cursor to the extremely strict diet, and strictly controlled exercise program that is a necessity to maintain for up to 15 years after your surgery. You will also be required to be closely followed by your psychiatrist to make certain you are not showing signs of suicidal thoughts or depression.

Your surgeon will (should) require regular follow ups at least once a year sometimes for the rest of your life to track and follow you progress, and if you have a Lap Band you will at some point require a saline injection or “fill” to make sure the band has not loosened up over time.

3. The Reasons -

With the heavy advertising done by up and coming bariatric surgery clinics and even the suppliers of the Lap Band system – it is of no surprise that a large portion of people suffering from obesity are clamoring into surgeons offices by the thousands to talk about bariatric surgery options. I would warn you that this is only good for the surgeons and not you as a patient. Your surgeon is sure to be a great talker – he could probably convince you of anything (as most doctors can after so many years) but you should do your homework before hand as regardless of what the surgeon said – you may need to try more conservative options before considering any surgery to help you lose weight!

Bariatric surgery is clinically indicated for the following situations:

Patients with a BMI >35 **

At least one of the following *

Type II diabetes

Dyslipidemia

Poorly controlled hypertension (must be documented)

Significant cardiopulmonary disorder (e.g. coronary artery disease, cardiomyopathy, pulmonary hypertension)

Obstructive sleep apnea (must be documented)

Severe arthropathy of weight-bearing joints (treatable but for the obesity)

Pseudotumor cerebri

Severe venous stasis disease (e.g. with lymphedema of morbid obesity)

Obesity related hypoventilation

Non-alcoholic liver disease or steatohepatitis

AND

Attempted and failed at least 4-6 months of physician supervised weight loss counseling and therapy
Been alcohol and drug free for at least 1 year

*Depending on your insurance you may need to have 2 or even 3 co-morbidities related to morbid obesity to qualify for coverage

**Some insurance will not cover bariatric surgery for patients with a BMI under 40.0

Note: Not all insurance companies cover bariatric surgery

I urge you – take a step back and look at the situation objectively (for real). Bariatric surgery is a relatively new concept and as such it should be utilized only in severe cases where patients have put forth a very determined and focused effort to lose weight and it truly has failed. If one is considering bariatric surgery – do your research first and be honest about it’s applicability to yourself – and do not take it lightly!

4. The after care -

As previously stated – surgery is not the end of your journey. There is extensive aftercare and follow up needed if you actually expect bariatric surgery to help you lose that weight.

Post-operative Diet

Nothing about your diet after surgery will be pleasant, flexible, or negotiable! You will fail in every aspect if you do not follow the diet assigned to you after surgery.

You will be eating nothing solid for upwards of 4-6 weeks after your surgery. For the first 4 weeks you will likely be gradually moving from clear liquids only to light juices and protein drinks.

You will more than likely be slowly moved to semi-solid foods like apple-sauce etc. and then you will be eating blenderized foods almost exclusively for a period of time. Some doctors standard post-op diet plans even include blenderized fish, pizza, and hot dogs! You honestly NEED to be prepared for this – it is not pleasant at first (if at all) almost anyone who has at any point in life needed to eat blenderized fish or meat will tell you so.

You will be moved to solid foods (obviously in small portions) eventually.

It is typical for your dietician or nutritionist to recommend that you eat very very small portions every hour or two as opposed to the normal 3 meal a day diet most of us are used to. Fluid intake is recommended in small portions – in some cases, every 30 minutes.

Your diet will almost always include a set minimum amount of protein (your choice of powders, drinks etc.) that you must intake every day.

Follow Up visits

Every member of your bariatric team needs to be someone you are comfortable with because you are going to be following up regularly with all of them – in many cases you will for the rest of your life.

Your psychiatric follow ups in some cases are not necessary after a few years, however in the case that you develop depression or other psychiatric problems after your surgery – the follow ups will continue until you are cured of them.

5. The Doctor -

As I have stated in previous posts – there are a lot of doctors out there so hell bent on getting patients to agree to surgery that they will tell them whatever sounds good. NOT ALL DOCTORS but there are many of them out there. If after considering and discussing the options and risks you decide to not jump to surgery right away – do not let them try and convince you other wise. In fact if they do continue to try and cite reasons you should go ahead with it after you stated you did not want to – I would recommend you not go with that doctor at all. It may be a hassle to find another doctor, it may have cost you a co-pay but do you really think a doctor who wants to operate on you after you said “no” is worthy of your trust?

I really hate to stereotype anyone however there is a big trend among the newest generation of surgeons (like the ones who just got out of residency and are really energetic and enthusiastic) to be way too quick to jump straight to surgery. A lot of them tend to boast about how they were trained on robotic surgery and they love the latest technology and so on, or how many hundreds of surgeries they did in their residency etc. As a general rule I would recommend you lean away from any surgeon who brags about anything – most of the truly skilled surgeons (or any doctor really) won’t feel a need to brag about anything. If you specifically asked them about their previous experience they would usually offer up the information gladly.

Doctors in general and surgeons in particular are as human as everyone else. As such they are subject to the same mental tendencies as the rest of us. For example when it comes to bariatric surgery – many surgeons who are not directly involved in the field of surgical weight loss will recommend against it at all costs because of the risks involved. Whereas many who specialize in bariatric surgery exclusively will recommend it to (literally) 9/10 patients they see. Some have even falsified their own records in order to facilitate payment for surgery where the patient did not actually meet the criteria.

In short – be aware that some doctors become better at making money than making medical recommendations after awhile. Read between the lines on that one!

The doctor you chose may also have influence over whether or not your insurance company will pay on your surgeons claim. Almost all insurance companies base their policies on Medicare Guidelines, the fair majority use parts of it word for word. Medicare guidelines state: “Coverage is provided only if the bariatric surgery is performed at a medical center designated a Center of Excellence by the American Society for Bariatric Surgery (ASBS) or certified a Level 1 Bariatric Surgery Center by the American College of Surgeons.”

If the surgeon who is to perform your bariatric surgery is not affiliated with such a facility then obviously he or she won’t be performing the surgery at an approved facility – which in turn will most likely end up in the claim being denied leaving you stuck with the bill; and it will be a very large bill.

You can to some degree avoid this by making sure you are going to a Medicare approved bariatric facility. Even if your insurance is one that does not require that the facility meet those guidelines – it is still a good idea to go with with one anyways as they have gone through proper measures to prove that bariatric surgery was successfully preformed their before.

Conclusion

As a patient you may be inclined to believe that you absolutely need bariatric surgery – but you need to take your time considering the real world risks and truly huge commitment necessary for a good result. If you have tried your hardest (and really REALLY tried) and have failed at losing weight, and it’s effecting your medical well being – then by all means, talk to your doctor and make sure you are choosing the right one.

DISCLAIMER

This article is not intended to be the only basis on which anyone bases a decision to have surgery. I am in no way saying you should or shouldn’t have or consider having surgery – I am merely warning of some of the risks you may or may not be taking. Some of the content within this article is based on my personal experience in working with doctors and surgeons.

References

ASMBS – Post-operative concerns

ASMBS – General guidelines for surgical weight loss

ASMBS – Patient Resources

Medicare – Bariatric surgery criteria

Medicare - Approved bariatric facility Search

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Vascular Surgery

noreply@blogger.com (Darkn3ss) — Thu, 26 Nov 2009 08:44:00 +0000

Just finished the Vascular Surgery Knol

Check it out and let me know what you think! Most especially if you just so happen to be a vascular surgeon reading this post...but then again I doubt that would happen.

Don't let him fool you

noreply@blogger.com (Darkn3ss) — Wed, 25 Nov 2009 09:05:00 +0000

Don't let his teleprompter fool you, President Obama is spreading a very clear message in this video but in the end his actions were opposite his very own words. It's beginning to become clear what his push for health care reform is really all about - money, and not the kind he claims to want to save the patients either.

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Health Care Bill moves forward 60-39

noreply@blogger.com (Darkn3ss) — Mon, 23 Nov 2009 02:50:00 +0000

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Republicans, eager to defeat Obama were handed a punishing defeat of their own last night. The health care bill was passed with a vote of 60 for the bill to 39 against. This has cleared the way for a monumental, full-scale debate set to begin after Thanksgiving on the legislation. The bill is designed to extend coverage to the 31 million Americans who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.

Whether or not any of the goals are achieved if and when the bill passes legislation and takes effect is anyone's guess. In recent years the trend of inconsistencies and misjudgments on the governments behalf would point to a grim road lying ahead if in fact it does pass legislation.

I have said it before - I will say it yet again: Reform is absolutely essential - but this may not be the way to do it. Handing over control of anything to the government has not exactly turned out well in the past.

Video - Senator Reid's remarks shortly after the bill passed the vote.

Mitchell Bard: It's Too Early to Celebrate the Senate Health Care Vote

noreply@blogger.com (Darkn3ss) — Sun, 22 Nov 2009 09:04:00 +0000

Mitchell Bard of the Huffington Post shared these thoughts on health care

Mitchell Bard: It's Too Early to Celebrate the Senate Health Care Vote:

I swear, I find no no joy in being Debbie Downer. I really wish I could celebrate the Senate's 60-39 vote to begin the debate on health care legislation, narrowly holding off the blocking tactic of the Republicans. I am 100 percent in favor of health care reform (I'm a fan of Rep. Anthony Weiner's proposal to extend Medicare to everyone). But a realistic view of what happened (and what has happened leading up to the vote) reveals far more things to be concerned about than to cheer for.

For starters, to get to an up-or-down vote on the final bill in the Senate, this 60-vote procedural hurdle will have to be jumped over again to close debate, and Sen. Joe Lieberman has already promised to join the Republicans in filibustering any bill that contains a public option. There are also several other centrist Democrats in the Senate who may not vote for cloture if there is a public option in the bill. Since the Democrats were only able to secure the minimum 60 votes to get past the Republicans this time, without Lieberman's vote (and all of the centrists'), if no Republican jumps ship, a bill containing a public option cannot get to the floor.

Also, it is easy to forget that a health care bill only barely made it through the House (220-215), and did so only after Democrats agreed to pass the bill despite the inclusion of the anti-abortion Stupak Amendment, which wouldn't just prevent the government from funding abortions, but would actually have the effect of making it harder for many women to exercise their constitutional right to choose under health care reform than it is today. True, the Senate's version has a less onerous anti-abortion provision, but if the House anti-choice Democrats stand firm again, even if a bill gets through the Senate, when it comes out of conference, the House will have two options, neither of which is good: pass the bill with the odious Stupak Amendment intact, or watch the bill go down to defeat at the hands of the anti-choice Democrats.

So what am I supposed to celebrate, exactly? That a health care bill will be debated? Even though, to get past a 60-vote cloture motion, it will have to be gutted even beyond the shadow of a bill it is now (the current bill has a weak public option, no other mechanism to really cut costs, and hands billions of dollars to the insurance companies who are a big part of the original problem)? I'm not saying I don't support this weak bill (it's better than nothing), but if it gets any weaker and cuts into the constitutional right of women to choose, really, does the good still outweigh the bad?

And the whole notion that there will be a debate is really hard to take seriously. There has been no honest health care debate up to this point. There has be a flood of outright lies from the right (two words for you: 'death panels'), and if you think it's getting any better, as the vote neared, Sen. Kit Bond compared health care reform to one of the biggest Ponzi schemes ever: 'Move over, Bernie Madoff. Tip your hat to a trillion-dollar scheme.' This is the level of debate. Paranoid ramblings about government takeovers and hidden agendas of doing the bidding for insurance companies, hospitals and pharmaceutical companies that line the pockets of those opposing reform. The nonpartisan Congressional Budget Office can report that the Senate health care bill will cut the deficit by $130 billion over the next ten years without raising taxes on the middle class, but Republicans will still scream about expanding deficits and massive tax increases. Some debate.

You know, there is one thing I really like about the health care legislation that will now be debated in the Senate, and, oddly enough, it's something that most of my fellow progressives oppose: the ability of states to opt out of the public option. Honestly, I think this part of the bill is spectacularly brilliant. Why? It's simple, actually. It's democracy at work.

Consider that in the last months since the health care debate took off, we have been treated to the following:

- Rep. Joe Wilson of South Carolina screamed 'You lie!' during President Obama's health care address to a joint session of Congress.

- Sen. Mitch McConnell of Kentucky said that passing health care reform with a public option could 'cost you your life.'

- Rep. Paul Broun of Georgia, who, by the way, is a physician, said that health care reform with a public option 'is gonna kill people.'

- Sen. James Inhofe of Oklahoma said, regarding the health care bill: 'I don't have to read it or know what's in it. I'm going to oppose it anyways.'

- Sen. Richard Shelby wrote to one of his constituents that health care legislation would 'directly subsidize abortion-on-demand,' 'rations health care so that our citizens are withheld important and potentially life-saving treatments,' and 'requires taxpayer dollars to fund health benefits for illegal immigrants,' all scare tactics that he knew (or, as a U.S. senator, should have known) is patently false.

Unfortunately, I could go on a lot longer, but you get the point. All of these politicians have many things in common, but there are two I would like to point out here: 1) They represent states that would likely opt out of a public option, and 2) they were duly elected by their constituents to serve in Congress.

Item 2 is really something important to remember. These men did not stage coups d'etat. No, they were elected by the majority of the voters of their states or districts. They were chosen by their constituents in democratic elections. And now it's time for democracy to do its job, so that the citizens of these states get exactly what they voted for. Why should we, as a country, spend taxpayer money to improve the health care of citizens who would send to Congress men capable of uttering baldfaced lies, all in the name of politics (trying to prevent the president from getting a 'win') or protecting the special interests that fill their campaign accounts? And if they are telling their lies in defense of some kind of pure ideology that abhors the government's involvement in anything (except the bedrooms of its citizens, of course, but that's another issue for another day ...), well, then, let's give their constituents what they want. Hell, Shelby went after Medicare in his constituent letter, so I would be happy to let the states opt out of Medicare and Medicaid, too

In Shelby's state, Blue Cross Blue Shield controls 83 percent of the health insurance market, with more than 600,000 people living without health insurance and another more than 175,000 who cannot obtain group coverage and are forced to buy insurance on their own. Under health care reform, most would have access to health care, more than 400,000 Alabama residents would be eligible for government subsidies to help pay for health insurance, and the 175,000 plus not on group plans could get more affordable insurance. But these people also voted for Shelby. I respect the democratic process, and the people of the good state of Alabama should be free to get exactly what they voted for. I wouldn't dream of stjanding in their way. And the same can be said for the folks in South Carolina, Kentucky, Georgia, Oklahoma and all the other states who have sent representatives to Washington to obstruct health care reform.

This is the country in which we live now. This is what passes for debate. So you will forgive me if I am not optimistic that a worthwhile health care reform bill will make its way past another cloture vote in the Senate, past an up-down vote in Senate, through a post-conference vote in the House, through yet another cloture vote in the Senate, and finally through a final up-down vote in the Senate, all while the Stupaks, Liebermans, and Lincolns of the world are standing in the way, not to mention the stop-at-nothing lies and scare tactics employed by the right. I am sorry, but I am firmly in I'll-believe-it-when-I-see-it mode.

The bottom line is that I don't want to be the messenger of doom. I would love to celebrate a health care reform victory. And when a real one arrives, I will.

Swine flu clinic set for Simpson Center in Hemet

noreply@blogger.com (Darkn3ss) — Sun, 22 Nov 2009 00:42:00 +0000

Swine flu clinic set for Simpson Center in Hemet:
An H1N1 flu vaccine clinic is scheduled from 2 to 7 p.m. Monday at the Simpson Center, 305 E. Devonshire Ave. in Hemet.
Riverside County Department of Public Health officials said the nasal spray and injections will be available to about 2,000 people in the following groups: children 6 months to 12 years, caregivers of infants, pregnant women, people who work in health care or emergency medical services and adults ages 25 to 64 with chronic medical conditions.

House Passes Bill To Create EHR Loan Program for Physicians

noreply@blogger.com (Darkn3ss) — Fri, 20 Nov 2009 00:48:00 +0000

Yesterday - Wednesday the 18th of November, the House of Representatives approved HR 3014, a bill that was designed to help health care providers purchase electronic health record systems and other health information technology tools, the Rutherford Daily News Journal reports.

The Small Business Health IT Financing Act would authorize the Small Business Administration to oversee a loan program for health care providers seeking to purchase health information systems. However many electronic medical records vendors are using the bill as a marketing tool - boldly claiming to practices nation wide that the government will 'pay in full for your EMR' when in fact it is more of a loan than a blank check as they would have their customers believe.

Kathy Dahlkemper (D-Pa.), chair of the House Small Business Regulations and Healthcare Subcommittee, introduced the measure
http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.3014:

Medical Insurance Dictionary - what they really mean!

noreply@blogger.com (Darkn3ss) — Wed, 18 Nov 2009 08:19:00 +0000

Health Insurance - What does it all mean?

Have you ever called your insurance company to ask a question, and only ended up hanging up your phone feeling more confused than you were to begin with? Insurance companies love to use confusing and overlapping terms and jargon like; copay, coinsurance, preauthorization, predetermination, and the list continues indefinitely. Knowing what these terms means in essential in turning that confusion into an understanding of what they really mean.

Deductible - A deductible is the amount of money you must pay into your own health care costs before your insurance will begin to pay their contracted rates. Say you have a plan that covers costs at 80% with a $400 deductible; your insurance will pay absolutely nothing until you have paid $400 out of your pocket. Deductibles can range from $0 (generally only applies to HMO or Medicare beneficiaries) Now depending on your particular deductible you may have to pay for a single doctors visit in full to meet it, or you may have to pay for several doctors visits before your insurance is going to pay their share.

Co-payment (copay) - A copay is a set amount of money you pay each time you seek out certain services. Generally anyone with a copay in their insurance plan has a separate copay for each distinct type of service; for instance the copay may be $15 for a routine doctors visit, the copay for prescriptions may be $10, and more intense services such as a visit to the emergency room may require a copay of $100. Again some beneficiaries of Health Maintenance Organizations or Medicare do not have a copay depending on their plan. Co-payments are also typically waived if the Out-of-pocket maximum for the calender year has already been met. Failure to collect a co-payment on the providers behalf can be cause for payment reduction or even claims denial.

Co-insurance - Co-insurance is the amount of the total bill that the patient is responsible for paying. Although it is often confused with a copay it is in fact quite different. Co-insurance is never a set dollar amount but rather a percentage of the total bill for services rendered. It is a way to share cost between insurer and insured. Typically patient responsibility for higher end PPO plans is 10-20% in-network and 30-40% for out-of-network care. The cheaper PPO health plans sometimes have as high as 40% patient responsibility for in-network care and 50% for out-of-network care.

Out-of-pocket Maximum - Per calender year this is maximum amount of money a beneficiary can be required to pay out of his/her pocket. After they reach this limit typically all further co-payments or co-insurance (for the calender year) should be waived. Basically it is a spending cap on your own funds.Typically this is a few thousand dollars per calender year a common limit is $4000 per year. If you seek out health care on many instances in a year and reach your OOPM limit, your insurance plan should pay for services at their contracted rate and for the remainder of the year as long as you remain in-network you should not have to pay any further co-pays or co-insurance.

In-network/Out-of-network - These terms confuse most patients because they are generally only used by PPO/EPO type health plans. Even though PPO/EPO type plans that always claim to allow patients the choice of their provider - there are limits to those choices and thats where these terms are used. Any provider who signs with your specific insurance carrier/provider network is considered in-network and any provider who does not is out-of-network. Going to any provider that is out-of-network in any insurance plan is going to cost more and in fact many beneficiaries (especially those insured through smaller employers) do not even have out-of-network coverage; which leaves them stuck with 100% of the bill.

NOTE: Some groups/plans refer to the same principal in different terms such as; participating providers vs. non-participating, in-area vs out of area, or preferred vs. non-preferred providers.

Pre-authorization/Pre-certification - Pre-cert. or pre-auth (for short) are processes through which insurance plans review services on a case by case basis to determine medical necessity and issue approvals or denials. Most PPO/EPO plans have specified guidelines that state which services do and do not need pre-auth. or pre-cert. whereas with most HMO plans almost every service requires pre-authorization.

NOTE: All insurance plans will tell you very specifically that pre-auth and/or pre-cert are never a guarantee of any payment, but simply a determination (prior to any actual service is preformed) of whether or not the service(s) are deemed medically necessary by their guidelines.

Pre-determination - Often confused for pre-auth. or pre-cert., pre-determination is actually a process of determining the estimated pay out from the insurance company and the estimated financial responsibility of the patient. Again this process does not guarantee anything. The final pay out of the insurance company will never be given until after the claim is submitted, this is how they ensure that the insurance companies cannot be blamed for any physical damages suffered by the patient while awaiting insurance approval.

If the insurance companies did not use the infamous 'claims payment not determined until services rendered' clause hospitals and doctors could simply delay your care and blame the insurance company for not responding and all damages (or death) could be blamed upon them. Using this clause ensures that determination of 'necessity' in urgent situations is the responsibility of the provider.

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10 Tips that can help you at the doctors office

noreply@blogger.com (Darkn3ss) — Fri, 13 Nov 2009 07:28:00 +0000

10 Tips that can help you at the doctors office

Health care is out of hand without a doubt but there are several ways you, as a patient - can improve the quality and efficiency of your care. Even if you are happy with the care you receive these tips can increase the efficiency of your doctors visit and even decrease the time you spend waiting around.

1. Communicate clearly - There are few things more challenging for medical office staff than patients who do not communicate what it is that they need. The reason you are in the office or calling on the telephone should be stated in as simple a manner as possible. Keep in mind that not all problems are simple and not every situation is the same and most of us do understand that - just be as clear and concise as you can. (ie. "hello my name is ________ I am calling for an appointment to be evaluated for _______ with Doctor _______")

2. Be aware of what you are there for - It is quite a burden to decipher your medical issues for you, especially if you are a new patient. Physicians' offices around the country waste enormous amounts of their time trying to track down information about patients that they really should have already known. If you are referred to a physician by your regular doctor do not call for an appointment if you do not understand why you are being referred there. This will smooth the appointment making process and help to avoid mistakes like being referred to the wrong doctor.

3. Be polite - Whether you are calling for the first time or calling for the 3rd time in a day you can almost certainly guarantee a better outcome by simply not being rude. You are seeking medical care so it is completely without doubt that at the very best you are not feeling well - that doesn't mean you need to treat the staff like idiots before they even attempt to help you. You don't need to act like their best friends at all, you don't need to suck up to them; in fact I would personally say you don't need to be much more than a civil human being and speak calmly to really help me solve your problems or answer your questions. It is not bias so much as it is simply easier to help someone who is not treating you in a rude or disrespectful manner. The office is getting calls from extremely hostile and rude individuals all day long - if you are the one who was easy to deal with or even a pleasant person to talk to, you have a good chance of smoothing your entire care process as people are more likely to go out of there way to just to talk to someone who is a decent person. .

4. Have your questions written down before your visit - Take a few minutes; whether it be a day or two before your appointment or in the waiting for before your appointment, and write down what specifically you want to discuss with the doctor. If you leave your appointment with the doctor and think of more questions it is usually going to be a hassle for both yourself as well as the doctors staff and the doctor as he/she has certainly moved on to the next patient. This is not to say it is frowned upon, it is perfectly acceptable if you remember a question the next day or something of the sort, and the doctor may be very easily reached depending on your scenario and how busy the doctor is. However if you just walked out of the room, got the front desk and saying 'oh wait i forgot...' you are not going to help the doctor patient relationship because you are interrupting the flow of the office for something you very well should have asked moments before when you were face to face with the doctor.
NOTE: Try not to go overboard with it as I have personally witnessed a doctor walk into - and then immediately out of a room because the patient had a 6 page list of questions to ask before he even walked in, the doctor spent another 30 minutes printing out every piece of material on the patients diagnosis he could find to hand to them personally.

5. Know your facts - It should go without saying that it is your responsibility alone to know the facts about yourself, such as - what kind of insurance you carry, what tests you have had done, your prior medical history, and your allergies. Whether you think so or not - no one besides yourself is responsible for keeping track of the simple information. If you do not give the staff the correct insurance information or you change your insurance without informing them - you can absolutely be held responsible for 100% of your bill, read the contract you signed at the front desk; in my office it is in bold! If you don't mention a previous treatment, surgery or sever allergic reaction; you could suffer extreme complications or even die to not fault but your own. It's simple: you are the only one who is responsible for knowing the simple facts about yourself and omitting them is not hurting anyone but you.

6. Remember the doctor-patient relationship -This is an idea that has been mentioned less and less over the years however the fact is that the doctor-patient relationship will always be just that - a relationship. You have a role to play in the relationship as does the doctor. As with any other relationship, treating the other party poorly or communicating poorly is only harming the relationship: and since you (the patient) are the one who needs the help of the doctor, you are not helping yourself any by harming that relationship. Again as with the staff - you do not need to kiss up to the doctor. Rather you need to treat them as intelligent, decent people as most of them are when dealing with patients. The exception here is if the doctor is treating you poorly or not being respectful and polite to you - even then I would suggest you refrain from reciprocating the poor behavior and find a different doctor.

7. Follow directions - It's quite sad that this is a tip but the fact is that the vast majority of the delays in patient care we deal with most frequently are caused by the patients themselves. Almost without exception anytime a patient is scheduled for any type of test or procedure, they are given both verbal instructions and written instructions. You need to understand them completely and follow them for your test or procedure to be preformed in any type of timely fashion. If you didn't do what you were instructed to how can you expect that your test or procedure will still be done? My office in particular mails them certified to every patient we schedule and yet 90% do not follow them. If you are one of the few patients who follows directions - you are a shoe in for fit-in appointments - this makes you and your care easier to deal with.

8. ASAP does not mean at your earliest convenience - Without exception, every patient believes that their treatment should be scheduled as soon as possible (ASAP)! Hearing this a few hundred times a day takes a toll on medical staff because it frankly gets old, as most patients do not understand that ASAP means next available and that's not always convenient for them. If you are telling the office to do something ASAP and they get you the next available appointment then you as a patient need to do what needs to be done to make that appointment work, ASAP DOES NOT mean that you get the next appointment that fits your schedule! If you request ASAP you are basically saying "I will do what needs to be done to get this done soon." Now if you just so happen to have something extremely important (ie. not- your family is in town, you are going to disneyland, or you have tickets to a show you want to see) and it truly takes precedence over your own health - you would be best advised to very sincerely apologize, explain yourself, and give the office the next time(s) that you are available and hope that they are able to match your schedule.

9. Anticipate delays - It sucks but all over the world doctors are outnumbered by a huge margin, this is what almost guarantees a wait at almost any doctors office. It is typical for a doctors schedule to be booked with two patients per every fifteen minutes, in my office it is actually scheduled four patients per every fifteen minutes for every clinic we have scheduled. Why? you ask - because for a doctor (the kind who treat patients, not work administrative jobs) to be successful he or she must make the best use of nearly every minute of every day literally if they are waiting around for a patient because the last one did not show up - they are wasting their time and could be on their way to a hospital to save a life. Try to understand if they staff is telling you the doctor is delayed - if you were lying in a hospital bed in unbelievable pain, would you want them to up and leave because they had patients in their clinic?

10. Understand a doctors limits - Doctors who save lives posses a skill set that is in high demand and as such, medicine is all doctors really get to live - and that is ok because it helps them stay focused. Aside from diagnosing illness and treating their patients, doctors knowledge of things like insurance procedures and even their own schedule - is minimal at best. They are specifically taught not to worry about these things because they are nothing but clutter in the brilliant mind trying to save lives - that's why they hire staff to handle these things. However you will be reluctant to find a doctor who will admit when he does not know (for example) when his next appointment to have your surgery done is. They probably have no idea what your co-pay will be and so on. So do yourself a favor and be aware of what questions should really be directed at the staff. If you ask a doctor anything that is not directly linked to your diagnosis or treatment (ie. insurance procedures, scheduling, disability papers etc) they will more than likely give you an answer reluctantly off the top of their head, that is worth almost nothing. My doctor will tell patients he can fit in their surgery 'next week' when in fact he is double booked in the O.R. and the office for the next two weeks. Why? Because it is not his job to worry about his schedule that's why he pays a scheduler. If you ask him how to get insurance approval he will tell you he'll take care of everything. Why? Because he has no idea and he knows it will put your mind at ease and you will walk away feeling happy and informed. The fact is - medical questions go to doctors: anything else goes to the staff - if you want an accurate answer that is.

Conclusion - If you read these and thought that it was all common sense, you are right. However there is not one patient my doctors have ever treated that was actually able to use said common sense behaviors - people tend to get very emotional and lose their sense of rationale when dealing with doctors because the doctor has hundreds of people to worry about but every single patient doesn't care about anyone but themselves. Keep these in mind and you will make a positive impact in your own life. If nothing else - you will find that medical staff will treat you like their best friends if you simply a pleasant person.

Health Care bill HR-3962 passes house vote

noreply@blogger.com (Darkn3ss) — Sun, 08 Nov 2009 07:06:00 +0000

The House floor erupted in one of the loudest cheers the chamber has heard in years when Rep. Maxine Waters (D-Calif.), an hour before midnight, cast the 218th and deciding vote on landmark health care reform.

There were still six minutes and fifty-two seconds on the clock and the chair made a move to gavel the vote closed.

Democrats waived their opposition, keeping the vote open.

Almost every eye in the chamber darted to the far end of the GOP side, where the last possibility for a bipartisan bill sat wedged between Minority Whip Eric Cantor (R-Va.) and Rep. Don Young (R-Alaska), both of whom were leaning on him, both literally and figuratively.

The White House, two sources told HuffPost, had been working hard to win the vote of Rep. Joseph Cao (R-La.), a freshman in a strongly Democratic district. The pro-life Cao's vote came into play when an amendment from Rep. Bart Stupak (D-Mich.) passed overwhelmingly, greatly restricting reproductive rights.
After several minutes, Cao cast a yes vote from his seat, making the bill bipartisan. Reps. Jim Oberstar (D-Minn.) and Mike Honda (D-Calif.) waded into the Republican side of the aisle to get to Cao, rub his shoulders and slap him on the back.

Cantor stormed out as the Democrats applauded their defector.
The majority party had seen plenty of defections earlier. A stunning sixty-four Democrats joined with the GOP to pass Stupak's amendment, 240-194.
Stupak, during the vote on the final bill, didn't stick around long. He cast his vote quickly and shook the hand of Majority Leader Steny Hoyer (D-Md.), then headed over to the GOP side, where he was warmly welcomed.

Rep. Patrick McHenry (R-N.C.), a strident partisan, was the first to greet him, shaking his hand and slapping him on the back. Stupak then found Cantor and Young, shook their hands, and retired from the floor to the Republican cloakroom.
Cao's vote was a mere bonus for Democrats, whose spontaneous floor celebration radically outdid the reaction of the Yankees to winning the World Series recently. The normally stoic Pelosi had tears streaming down her cheek. Rep. Rosa DeLauro (D-Conn.) bent over and vigorously pumped her fist. Arms were thrown in the air; hugs all around.

As the clock hit ten seconds, Democrats counted down the time, finishing with an even louder cheer as Pelosi read out the tally: 220-215.
Not even the extreme pro-life amendment could dampen enthusiasm. "We'll live to fight that battle," said Rep. Louise Slaughter (D-N.Y.), a passionate supporter of reproductive freedom. "It took a hundred years to do health care. Nothing can dim that."

Majority Whip Jim Clyburn (D-S.C.) said it was the hardest vote he'd ever whipped. "We crossed a threshold tonight," he said. "This was a tough deal."
Rep. Keith Ellison (D-Minn.), who'd fought for a stronger public option, was fired up, too. "I'm ecstatic. I think it was great," he said, before adding that he wasn't happy with the Stupak amendment or the weaker public option.
As he spoke, Rep. Dennis Kucinich (D-Ohio) walked by, handing reporters a statement explaining why he'd been the only liberal to oppose the bill.
Would you have changed your vote if yours was the deciding tally?
"No," said Kucinich. He then added cryptically: "I could've been, but that would've been up to the White House." Kucinich is pushing for inclusion of an amendment that would allow individual states to implement single-payer health care without being sued by insurance companies.

His measure and others, as well as the surprisingly strong showing by pro-life Democrats and the ever-looming immigration issue, threaten the fragility of the bloc of 220. But for now, Democrats were basking in the moment. As Speaker Pelosi walked with her leadership team to a press conference, a reporter asked her how she felt as she passed by. Her eyes filling with tears, she turned and slowed her walk. "I feel great," she said.

Medical decision making

noreply@blogger.com (Darkn3ss) — Sat, 07 Nov 2009 08:19:00 +0000

All patients deserves to know exactly what goes into the decision making process when their lives are in the hands of physicians. Sad but true is the fact that it rarely is a transparent process. You see if physicians simply went by medical guidelines and ordered treatment based on what was best for the patient, their profits would soon begin to decline and for doctors all over the country money is why they got into the health care business. For those of you who think it was to help people - think again.

It's not just the crooked doctors you hear about in the news and on late night talk shows that are doing unnecessary surgeries and procedures on patients either - many of them are well respected and have well run practices. The clues are all in the framework of the doctors decision making. The thousands of cases of unnecessary appendicitis surgery can be easily explained by the vague and deceiving nature of this very common disease. Appendicitis is often diagnosed based upon unspecific symptoms which can be misleading in the process of deciding upon the correct diagnosis. Appendicitis is often mistaken for various other internal disorders that generate resembling symptoms.

There have been hundreds of cases if not thousands where patients have complained of abdominal pain alone and had an appendectomy through an emergency department only to recover with the same exact pain. Often this leas to more surgeries which is even more money for the doctor. Being that the appendix is seemingly benign and removal generally causes no 'harm' to the patient in the long term - it is usually never questioned by patients. In fact often doctors will remove a healthy appendix if a patient is having any other abdominal surgery for the bump in pay, claiming that it was a precautionary measure.

This is only one example of the many routinely preformed yet routinely unnecessary treatments that patients receive frequently. Some others include; removal of skin lesions that are non-symptomatic, the widespread misuse of ADHD/ADD medication, antidepressants, and antireflux medication.

The industry in America is overrun with reps from drug companies, medical suppliers, pharmacies, and even representatives from home health agencies - all trying to sell, sell, sell! They hand out vast amounts of sample medication, boxes of business cards, and all sorts of goodies for doctors to leave around their office. In turn the doctors will almost universally send large numbers of patients their way - and sometimes it's not even intentional: many times if the doctors wanted to prescribe say an anticoagulant (blood thinner) he would simply ask his nurse to prescribe a blood thinner, however if the doctor just met with a pharmaceutical rep who sells blood thinners he's quite likely to mention them by name simply because it's fresh in his mind.

On the other hand, there is quite a bit of intentional patient redirection - often at no benefit to the patient at all. Typical examples are: gynecologists who own ultrasound machines, surgeons who own surgery centers, and so on.

The government has picked up on this in recent years, Medicare and Medicaid have continuously decreased payments for most procedures due to the amount of unnecessary procedures and tests were being ordered on patients. By the time someone with the power to act upon this problem had put the pieces together - the problem was no longer manageable, it had spread throughout the entire health care system across the country.

The financial burden of this problem is bad enough, but worse yet is the damage to people that unnecessary treatment often causes. Perhaps the worst side of this story is the trust most of us tend to have with physicians. If we can't listen to our doctors what are we to do? My advice (for what it's worth) is to just be cautious. If a doctor is recommending treatment it is a good idea to read up as much as you can on the indications, contraindications, and alternatives that exist as well as the benefits and risks. Information is worth more than gold!

Good people are hard to come by

noreply@blogger.com (Darkn3ss) — Tue, 03 Nov 2009 05:00:00 +0000

Good people - they are unfortunately a dying breed in this age. Common courtesy, decency and even common sense having taken a back seat to iPhones and the "I am better than everyone" mentality. I observe it on a daily basis and to be quite honest usually I observe this behavior from the patients I deal with on a daily basis, I do see it on occasion in my own coworkers and even some of the doctors I work with.

Today though, I came across a genuinely kind person - a patient who came into the office who almost saved my life, or at least my hand, from an uncertain fate.

Many people can be kind on the outside but quickly turn rotten without the slightest provocation - few are actually nice as this patient happened to be. It was her first visit and she was nervous but maintained a pleasant demeanor. The doctor talked with her for quite some time, then he decided to preform incision and drainage of an abscess in the office which she handled like a champ. After he walked out of the room I came in to clean up and before I could even put on gloves the patient very abruptly warned me of the uncovered - used #11 scalpel that the doctor had just carelessly thrown in the garbage can. She told me to be careful and then said goodbye and went on her way.

For those of you unfamiliar with surgical instruments a #11 scalpel blade is about the most dangerous piece of metal under 2 inches one could find in or around a medical office. They are pointy like an x-acto knife and add to that the tempered medical grade surgical edge sometimes down to half a micron thick - and you are dealing with something that could cut through the trashcan in an instant...never mind the trash bag or my hand for instance.

Now it may come as a shock to some of you but some doctors, when it comes to anything remotely unrelated to diagnosing illness - are about as dumb as rocks. Never mind the medical training during which I guarantee they received instruction on proper disposal of instruments - how about common sense?

Razor sharp blade + trash bag = bad?

The reason I find it worth mentioning that this lady happened to mention it to me and how wonderfully kind that is - is because it has happened before! The first time this particular doctor pulled this stunt I would have sliced my hand to bits if I had not been paying very close attention to what was at the time a half visible handle in the bag of trash. I came to find out later that the patient had actually been the one to throw the scalpel in the trashcan himself! Nonetheless the doctor was to blame on this occasion as well, as there is a sharps container attached to the wall next the door of every single exam room in the office.

When approached about it on both occasions not once did he look up from fidgeting with his iPhone when he laughed, shrugged it off, insincerely apologized and walked away. This kind of behavior is exactly why patients aren't the only ones who hate arrogant doctors, their staff do too!

There is light at the end of the tunnel however because I have now come across at least one - good, kind person and for that I am thankful if only she could teach the doctor to do the same.

The Operating Room

Closing the divide in the Health Care Debate

Congress has begun the pain staking process of interfacing the Senate's health care proposal with it's counterpart written by the House of Representatives. It seems as though those involved in the development of the bill truly do believe that it cannot fail.

Thirteen percent of poison exposure calls related to painkillers

2009 Hospital Report

Medical Miracle? or Moral Abomination?

"In California, voters authorized spending $3 billion over 10 years for embryonic stem cell research. A bipartisan Congress voted to ease federal restrictions, legislation which Bush vetoed. And opponents continued to push for a total ban on the research."

So where does the science of embryonic stem cells stand after a decade of political wrangling?

-Darkn3ss

Feel free to join in over at HealthCareNut.com

Thanks for your support

Happy New Year! May 2010 bring wisdom to the masses!

Happy news years and may 2010 bring wisdom to all!

*** UPDATE: IMPORTANT ***

Obama's christmas gift - Health Care reform gets through the Senate

President Obama got his Christmas gift a little early as the Senate voted through the health care legislation in it's third and final procedural 'test run'

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Senators may have been paid off

Studies show that Physicians are happy with Medicare

Physicians may not be enamored of Medicare, but they like it much better than private insurance plans

The big loser? UnitedHealthcare, with a score of 2.45.

Obama Health Care plan turns into Medicare extension?!

Obama announces: Public option - dead, new plan - Medicare extension!

Wednesday December 9th,

President Barrack Obama's health care reform plan that originally involved a 'public option' that would have potentially covered all citizens of the U.S. went out the window.

Senate Rejects Abortion Ban

Senate Rejects Abortion Ban

Sen. Dianne Feinstein (D-CA).

Sen. Jay Rockefeller (D-WV)

Democratic negotiators

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Sicko

On a separate note

What do specialists think of the Senate Health Legislation?

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A. Brent Eastman, MD, FACS

A. Brent Eastman, MD, FACS

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Baritatric Surgery - Weighing the risks

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1. The Risks -

2. The Planning -

3. The Reasons -

4. The after care -

5. The Doctor -

Conclusion

DISCLAIMER

Vascular Surgery

Don't let him fool you

Health Care Bill moves forward 60-39

Mitchell Bard: It's Too Early to Celebrate the Senate Health Care Vote

Swine flu clinic set for Simpson Center in Hemet

House Passes Bill To Create EHR Loan Program for Physicians

Medical Insurance Dictionary - what they really mean!

10 Tips that can help you at the doctors office

Health Care bill HR-3962 passes house vote

Medical decision making

Good people are hard to come by

* UPDATE: IMPORTANT *