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August 06, 2010

Myths of ObamaCare

A physician explains why ObamaCare's "preventative care" provisions are oxymoronic:

To apprehend the folly, it is necessary to understand what is meant by "preventive."

...devoted to or concerned with prevention :precautionary : as a : designed or serving to prevent the occurrence of disease

It is clear that preventive care should "serv[e] to prevent the occurrence of disease."

...Here are a couple of the "preventive services" that "beginning on or after September 23, 2010, ... must be covered without your having to pay a copayment or coinsurance or meet your deductible, when these services are delivered by a network provider."

HIV screening for all adults at higher risk

Syphilis screening for all adults at higher risk [bold in the original]

There is an inherent conflict: "The objective of medical screening is to identify disease[.]"

Unquestionably, for a disease to be "identified," it must be present, and therefore, its "occurrence" was not prevented.

It's astonishing how many of this administration's promises depend on verbal trickery like sweeping redefinitions of commonly used words like "preventative" and "affordable".

Another of Obama's repeated promises has been that involving government in health care delivery will somehow increase the availability and use of health services. Anyone who has experience with the military health care system realizes how ridiculous that claim is.

For the past few months I've watched with bemusement as my husband fights the system to get the physical exams required for retirement after 30 years of service. Keep in mind that he is an active duty officer who - by virtue of his employment status - supposedly has top priority in getting appointments.

For 3 or 4 weeks prior to going on leave, literally every time he called or went in person to schedule medical or dental appointments, he was told to "come back later". The "system" was down. Meanwhile the clock keeps on ticking. We're talking about initial consults, each of which will entail one or more follow up appointments... all of which must be completed before he retires. Earlier this week he drove in for a scheduled appointment only to be informed that it had been mysteriously canceled with no notice.

I have never, in over 10 years of going to civilian doctors, had that much trouble getting an appointment. That is no accident - a private physician who routinely treats patients that way will soon find that his patients have deserted him for a provider who understands he's being paid to provide a service. Unfortunately, when health care becomes "free", the usual for-profit incentive structure (provide good service or go out of business) doesn't apply. Such experiences were so common during the years when my boys were growing up that I gave up on military medical care and got a doctor out in town at my own expense. Fortunately, unlike patients in countries like the UK, I was free to seek care at my own expense without jeopardizing my military coverage.

I heard a term on the radio the other day that describes this situation perfectly: rationing by inconvenience. Being "entitled" to benefits means little when you have to fight an entrenched bureaucracy every step of the way. It means even less when the justification for that entrenched bureaucracy is dishonest on its face:

The sick care industry is a repair and rescue industry. It springs into action after an infraction (bodily damage) has occurred. (Review ICD and CPT codes for proof.)

This is similar in some respects to the police. They ticket after an infraction has occurred -- e.g., someone runs a "STOP" sign. They do not counsel drivers to obey the rules of the road before the fact. They don't screen persons randomly to test them for safe driving knowledge or whether they know the meaning of octagonal red signage.

Preventive care failure is the most probable result of the PPACA lie.

Learning how to drive is up to the individual, and he/she is supposed to learn that someplace other than traffic court or the back of a squad car. Once in custody, an infraction has (likely) occurred.

Preventive care is similar. It is what you are supposed to learn outside of the sick care system. Once you are in the sick care system, a disease has (likely) not been prevented.

Going to a sick care worker to learn preventive care is like going to the body shop to learn how not to get a fender-bender.

There is virtually nothing that the sick care system or anyone can do to teach the means to prevent some illnesses since so few factors are under the control of an individual and there are myriad illnesses unrelated to prevention by known learned behaviors.

Read the whole thing, as the saying goes.

Posted by Cassandra at August 6, 2010 01:11 PM

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It's astonishing how many of this administration's promises depend on verbal trickery like sweeping redefinitions of commonly used words like "preventative"

Obama prevented a child from being born by making sure it died in "partial birth abortion", which was backed up by the far more guaranteed "post-birth" abortion.

Posted by: Ymarsakar at August 6, 2010 02:12 PM

I will note one perfectly valid preventive care issue where I believe the government SHOULD step in and even provide outright free shots, would be vaccinations. I'll grant that they're a) not THAT expensive, and b) almost any doc-in-a-box can get you in and back out the door faster and more conveniently, but this is one area where: a) the current number of shots needed is relatively finite over a lifetime b) The COST is fairly low, c) It actually is for PREVENTION of diseases at the population level (unlike, say , screening) and d) requires near-universal administration to be effective.

It's one of the very few aspects of healthcare that truly approaches the common (population level) good.

Posted by: Darius at August 6, 2010 02:18 PM

When I was in grade school, certain tests were free of charge. TB tests come to mind.

I'm not sure how I feel about free vaccinations though. What government provides for free tends over time to become mandatory. Given that my husband was nearly crippled by free flu shots from the military, I view mandatory vaccinations with considerable skepticism :p

But perhaps you really meant, "free" and not "mandatory"? If so, please disregard!

Posted by: Cassandra at August 6, 2010 02:25 PM

Or taking SIX months to schedule surgery on cancerous tumors after taking TWO months to get an appointment to diagnose.

Cutting FOUR INCH chunks out of the chest vs what a small invasive procedure it would've been when the size of small peas upon diagnosis.

FOUR years of mysteriously "cancelled" appointments to prove disability and then requiring the process to begin again even when it was the VA's fault by not providing notification?

Can't find the cure? Drug 'em!

I can't wait for Obamacare! You said a mouthful with rationing by inconvenience! Thank you for serving your country. Unfortunately you have now become an inconvenience by your survival. Do the right thing and fall on your sword please! *growl*

Posted by: JHD at August 6, 2010 02:41 PM

One thing I keep thinking about is that my father in law complained several times during his retirement physicals of changes to his digestive tract (staying away from specifics here).

He was told it was "nerves" and not to worry. It turned out to be colon cancer and it killed him.


I don't actually fault the providers for the sorry state of military medical care. Working in an entrenched bureaucracy where every day tasks become difficult and there's little incentive to solve problems takes its toll on even the most dedicated professionals.

I've told you before how long it took me to get Imitrex (long the standard of care) for my migraines. No such troubles once I migrated to a civilian provider. There's something wrong with a system that can't handle even routine issues efficiently, but I don't need to tell you that.

Posted by: Cassandra at August 6, 2010 02:49 PM

We're talking about initial consults, each of which will entail one or more follow up appointments... all of which must be completed before he retires.

That's another lie they told you.

I'm still waiting for *two* initial consults, and I've been retired for five years. All the Actives did was pass me off to the VA, which, after I reported in, wouldn't schedule me because -- wait for it -- "You should have had them done before you retired."

Posted by: BillT at August 6, 2010 03:08 PM

All the Actives did was pass me off to the VA, which, after I reported in, wouldn't schedule me because -- wait for it -- "You should have had them done before you retired."


That's why I said they must be completed before retirement :p

Posted by: Cassandra at August 6, 2010 03:11 PM

The community clinics they are opening help but that's probably only until the medical staff get burned out and overwhelmed. Still, the clinic idea has worked much better for the routine or minor stuff. The new one we have here is awesome. Where the bureaucracy rears it's ugly head is between the old "entitled" VA hospitals and the "upstart" clinics. Turf wars and it is unbelievably maddening. You wanna' get your panties in a twist just watch bureaucrats fight over their turf. To hell with the patient. Turf is much more important than some dumbass kid dying.

The VA is and has been broken for as long as I can remember. If I only got a nickel for each 1/4 hour spent dealing with these asshats I'd be a wealthy man. Hours and hours and hours and hours! Trust me though, I'm well versed in dealing with the system. And they do not like that worth a damn! Heh!

Posted by: JHD at August 6, 2010 03:11 PM

That's why I said they must be completed before retirement

I wish you the best of luck with that, darlin' girl -- and that's with sincerity, not sarcasm.

Posted by: BillT at August 6, 2010 03:19 PM

I've said before here that if the government wants to fix health care, to start by fixing the Indian Health Service, and the military and veteran health care system (as a systems designer I hate to call them a system!) I had good care while I was in, good care at the VA, and battles with the bureaucracy in both.

It was especially infuriating when the DMV revoked my driver's license because the VA wouldn't break the law concerning medical records -- and neither told me they'd done so! I found out when I stopped to give first aid at an accident scene, and the cop ran my license as a witness. He came back with his supervisor and asked me why my license was revoked. "Huh? It's not." "Well, it is, but strangely, there's no reason given. You don't seem to be the kind of guy that ... never mind. You live over there?" "Yes sir." "OK. Drive home, then park it for the weekend, go down to DMV Monday morning -- don't you drive! -- and get this straightened out. Some kind of computer glitch, I suspect." The supervisor then chimed in "The ambulance crew says you did well and thank you, and gave me these to give to you to replenish your first aid kit, and something you didn't have you might need someday." (A box of sterile pads, some tape, and a pair of SAMI splints.) "Sorry about the license thing."

So Monday morning, down to the DMV on the bus. Waited until just before lunch, I overheard the guy before me had his request for reinstatement after his 11th DUI conviction granted, I watched him walk out of the office and get into a red pickup and drive himself away (is it unreasonable for me to assume he drove himself there?) So I was not in a cheery mood when I was called in, and it was explained to me that I was responsible for keeping my address correct in their database. They'd mailed the notice of revocation to an address in the middle of a local lake. No record of when or by whom the change was make. No explanation of why my current license (which they took) had my correct address, and that the then six year old expired license (which they also took), had the same address. In any case, I was revoked because the VA had refused to provide details of my treatment for epilepsy in a fashion they desired -- that is, my bringing my original medical records to them. I tried to explain that this was forbidden -- and stupid -- but that made no difference. It was all my fault and I was revoked; if and when I brought, in person, the required documents, I might be reinstated. So I said "Fine. Noticing that the previous person gets a reinstatement after committing a voluntary crime, and my revocation is because I'm following the law, refusing to break the law, and being treated for an involuntary, service connected, disability, I'll take myself home, and drive when I feel like it, too." and left. (There was no door to slam.)

The next morning, Special Delivery, I had a new license.


It's not going to get any better. Sorry The Unit had problems with the flu shots; I think of them (and the pneumonia vaccine) as having saved my life several times by now. I'm inclined to think that a nominal charge is acceptable, an hour's pay, free for those unemployed or retired. The obesity thing ... depends on how they measure. Body fat, ok. BMI is a joke, designed for populations, not individuals.

Posted by: htom at August 6, 2010 03:45 PM

Darius, vaccinations are not that cheap for physicians, because of the liability costs added to the price of the vaccines. You pretty much HAVE to go to a doc-in-a-box or the County Health Service to get shots around here, especially for childhood diseases.

I do not want the federal government requiring vaccinations, because of the mess with the HPV for teens (no proven benefit in non-adults, and very limited carryover) and hep for newborns whose parents are not carriers. I do believe that schools can and should require some vaccinations, and I believe very strongly that if you choose not to get your child immunized against measles, mumps, whooping cough and polio, your child should not circulate with the general population. There have been polio outbreaks in Minnesota because of this, mumps swept through a couple of colleges in IA and KS, and measles is very, very bad news for pregnant women.

Posted by: LittleRed1 at August 6, 2010 04:23 PM

But didn't the Left say that military medicine was good or something...?

Military doctors may be good, but bureaucracy is bureaucracy. It can make even the sun dim in comparison in shock wave.

Posted by: Ymarsakar at August 6, 2010 04:24 PM

But didn't the Left say that military medicine was good or something...?

Now it's good. Two years ago, it was bad, and was bad all the way back to 2000. But before 2000, it was good, all the way back to 1992, and before that it was bad. And that's as far back as most of them can remember.

Posted by: BillT at August 6, 2010 06:55 PM

I guess we were lucky wherever Daddy was stationed. We weren't ever at a really big duty station, so there (generally) weren't a whole lot of people to be using the services. I do remember having to sit and wait one time when I got strep here in Austin while still in college - my parents took me to the clinic at Bergstrom AFB. When Dad was at Ft. Hood, I was away at school most of the time, and not sick when I wasn't. Too young to remember wait times in San Antonio.

Yeah, I sure a heck hope we can get Obamacare stopped in its tracks... and I say that as a currently uninsured (due to underemployment) person.

Posted by: Miss Ladybug at August 6, 2010 08:42 PM

Prevention also entails educating people about high-risk
behaviors such as diet,lifestyle, and avoiding those
behaviors, actions, etc. that pose arisk to your health.

Posted by: Cricket at August 6, 2010 10:52 PM

Cricket, you racist, unenlightened homophobe, you!

Posted by: BillT at August 7, 2010 08:26 AM

I can buy HIV screening as disease prevention in the sense that being diagnosed may lessen the chance that the patient will spread the disease to others. It doesn't mean I think the government or anyone else should mandate coverage for that or any other preventive measure. As always, I favor catastrophic coverage that kicks in when ordinary expenses top a certain level. All ordinary preventive care is what I expect to pay for myself.

"Rationing by inconvenience" is exactly right. I believe it's what kicks in any time prices are fixed by anything but the free market.

Posted by: Texan99 at August 7, 2010 10:34 AM

I can buy HIV screening as disease prevention in the sense that being diagnosed may lessen the chance that the patient will spread the disease to others.

Since drug users and homosexual men will be predominantly represented in the sample, you have a whole slew of Leftist lobbies that will use "privacy" to lock the results.

Government of this variety isn't absolute power used on everybody. People get "special dispensations" based upon their loyalty to the Regime.

Posted by: Ymarsakar at August 7, 2010 11:13 AM

@ BillT: *blush*

Posted by: Cricket at August 7, 2010 12:14 PM

Y, yeah, that's why I hedged and said "may lessen." For some people, it will have this effect, so it's at least somewhat preventative.

Posted by: Texan99 at August 7, 2010 02:16 PM

Texan, I left a comment on your blog.

Posted by: Ymarsakar at August 7, 2010 03:46 PM

HIV screening and Syphilis screening won't prevent anyone from getting the disease unless the people diagnosed act reponsibly. Is the government going to ask them to act responsibly or force them to?

Posted by: tyree at August 10, 2010 09:07 PM