There are several reasons why I believe that most doctors are unhappy with the direction that health insurance reform is taking. I address several of these reasons in my oped in today’s NY Post (September 23rd, 2009). I will also outline them here. Suffice it to say that adding more patients to the health care turnstiles and promising them access to quality physicians when there is a growing doctor (and nurses) shortage and a growing doctor (and nurse) discontentment is problematic at best. The blanket of health insurance that Congress and the president envision is not long enough to cover the body of health care. If we pull it down to cover the toes, the head will be exposed. If we stretch it to cover the uninsured without dealing with cost or the doctor shortage, we will end up taking care away from those who currently have it and need it (the elderly and the disabled to name two groups who are endangered). Remember, physicians who aren’t functioning well have a negative impact on health care.

Reasons for doctor discontentment:

• No meaningful tort reform is included in any of the current bills under consideration in Congress. No shared liability with insurances or the government, no caps on pain and suffering, no review boards to limit nuisance suits, no “loser pays” allowance, despite the fact that physicians win the vast majority of suits.
• No significant subsidies to primary care education, despite the fact that there has been a decline in those choosing primary care of over 50% over the past decade.
• Big cuts to Medicare and Medicaid payments to doctors and hospitals of hundreds of billions of dollars in the bills, despite the fact that doctors are already cut to the bone in terms of increasing expenses and decreasing reimbursements.
• Cuts in payments for procedures and mechanical devices will put more pressure on doctors as patients express their (deserved) discontent, and there is nothing a doctor can do.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

I read an interesting article today reporting the findings from a poll that seriously contradict what the White House and the AMA have been suggesting about the way medical professionals feel about the proposed bill to overhaul the health care system. And while I can’t say I’m surprised at the overwhelming negative response to the plan – the statistics speak volumes.

An IBD/TIPP poll found the following:

– 45% of doctors polled said they would consider leaving their practice or retiring early if the proposed health care bill was to pass

– 65% or 2 out of 3 practicing physicians polled say they oppose the plan

– 72% of doctors polled disagree with the administration’s claim that the government can cover 47 million more Americans with better quality care and at a lower cost

Click here to read the full article

I think there’s some truth to this study – and here’s why…

Right now, doctors are caught between a rock and a hard place and we have very few alternatives – many doctors have already started moving to other parts of the country where there is less government regulation on how they run their practice. What we are finding – and will continue to find with this health care bill looming – is that doctors have already started dropping their private practices and taking hospital jobs. Many are changing specialties or plan on not offering certain procedures because of strict government regulation once we move toward a universalized health care system – and for those doctors to perform procedure using local hospital facilities, well, that costs money, too. We’ve been facing a primary care doctor shortage for years now, and the numbers continue to drop. All of these things have a negative impact on the quality of care patients receive.

So I want to do a little research of my own. I want to hear what YOU think – especially if you’re a doctor or in the medical field. How do you feel about the proposed bill and do you think that it will cause doctors to leave the medical field?

Make your voice heard! I’ll be reading some of your comments on FOX & Friends tomorrow morning at 6:30 a.m. E.T., where we’ll be discussing this report in more depth.

During the past three decades, obesity in America has been on the rise, in part due to increased calorie consumption and portion sizes. Did you know about half of this increase can be attributed to sweetened beverages? A recent study in the American Journal of Clinical Nutrition showed that around 37 percent of our total daily liquid calories come from sugar-sweetened drinks. Not only has the number and variety of calorically dense drinks been on the rise, but the average soft drink portion is now 20 ounces, a whopping 50 percent greater than the 12-ounce portion of thirty years ago!

So what exactly does this mean for our waistlines? One 20-ounce soda has about 250 calories and 68 grams of sugar — with no nutritional benefits. That’s like eating 17 teaspoons of sugar, much more than you would add on your own to your morning coffee or tea. Adding an extra 250 calories every day will lead to gaining 25 pounds in just one year!

In addition, studies suggest that when people consume more calories in the form of beverages, they do not compensate by eating or drinking less. This is because the calories are often “empty,” or nutrient-poor, and do not get your metabolism moving the same way a nutritious meal or snack would. Especially with these jumbo portions, it is easier to drink more than eat a greater amount of solid food, which would offer more satiation than the liquid calories.

With the increasing obesity rates, even the government is taking action on this matter. According to the Wall Street Journal, Senate leaders are considering new federal taxes on soda and other sugary drinks to help pay for an overhaul of the nation’s health care system. Its unclear how much the tax will be, but even at a proposed 3 cents per can, about $24 billion would be generated over the next four years. What would the government do with the money? Expand health insurance coverage to all Americans. Whether or not this would help decrease soda consumption is unclear, but it might make Americans think twice about what they are drinking.

The bottom line is if you’re just starting out on a weight loss plan, the easiest way to cut calories is to eliminate liquid calories from soda, juice, and sweetened teas. Stick to water, unsweetened teas/coffee and other zero-calorie beverages. Every pound is equal to 3500 calories so if you cut out that 250-calorie drink every day, you’d lose at least 2 pounds every month. And that’s without any other change in your diet!

Tanya Zuckerbrot, MS, RD is a nutritionist and founder of www.Skinnyandthecity.com.    She is also the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com.

As President Obama tries to remake the American health care system, the gutting of psychiatry by insurance company policies and other administrative forces is a good lesson in what to avoid. 

The endless red tape inherent in dealing with many insurers and the loss of professional autonomy to insurance company “reviewers,” has led many of the best and brightest psychiatrists and psychologists to accept no insurance reimbursement at all.  Psychiatrists have, if you will, acted out Atlas Shrugged, Ayn Rand’s cautionary tale of what can happen when institutions throttle individuals.  They’ve walked away and taken their gifts as healers with them.  In fact, when I refer patients to other mental health care professionals, it’s very challenging for me to find clinicians I consider in the top echelons of my field who will accept third party reimbursement of any kind.  A brain drain has siphoned off access to some of the wisest counsel available in psychiatry, except for those willing to pay cash, and I believe the same could happen (or greatly accelerate where it already is happening) in other medical specialties.

The influence of insurance company policies has also led to the public being served by professionals from allied health fields, such as clinical nurse specialists.  The need or desire for these companies to save money, which will only be accelerated by the current Obama plan, means social workers and nurses are the preferred providers of psychotherapy and medication evaluations to those battling depression and schizophrenia and bipolar disorder.  This phenomenon could find its reflection in the firm ground of internal medicine and endocrinology and obstetrics and other specialties yielding to intellectual quicksand, in which the knowledge and skills of physicians often disappear from the landscape entirely.

There’s nothing inherently wrong with getting your health care from physician assistants and nurses.  But these folks didn’t go to medical school, and didn’t complete residencies, and if I were confronting a serious condition I’d want to be treated by people who had.  I’d pay for it out of my own pocket.  And my guess is that we’ll end up having to.

Oh, one more thing:  Not only did many psychiatrists walk out on the system, lots of the ones who stayed let their practices be shaped by insurance company reimbursement policies that pay them more to prescribe medications than to talk to people.  So there are a whole bevy of shrinks who’ll see you for ten minutes once a month and just write you a prescription.  It actually pays pretty well, even if it leaves them out of seventy percent of what can restore patients—effective, expert psychotherapy.  That medical art is in danger of extinction.

See, Obama’s eight principles for overhauling health care address economics, access, prevention, safety and cost.  They don’t address how to preserve the core of the world’s most successful, powerful, inventive health care system ever:  the contributions and creativity and commitment of America’s physicians.

With more and more women starting families later in life, and the use of fertility treatments becoming more common, the rate of multiples has risen in the last 20 years. As these pregnancies become more commonplace, doctors, parents, and educators continue to learn more about the health and development of these children.

I had the unique experience of babysitting male triplets from the time they were 5 years old. They are now 16, and still a part of  my life — though I no longer have the task of supervising them. As they grow into young men, they continue to teach me the joys — and stresses — of raising multiples. In addition, I have two friends who had the pleasure of giving birth to triplets. Using my interaction with all three families as a source for inspiration, the tired and proud parents and I created these tips for parents of multiples.

Establish routines.
This is your number one stress-minimizing strategy, and should remain a priority throughout your multiples’ lives. Establishing a routine means you must be prepared. This comes in many forms: Having clothing, bottles and diapers always available is a necessity. Establishing feeding, bedtime and daily routines creates a sense of structure and security for your children, as well as allowing you time to get things done around the house. Without structure, you will quickly feel you are either bathing or feeding your children 24 hours a day.

Ask a friend or family member to document important events.
When you are caring for multiples, your main concern is the children’s primary needs such as food, clothing and sleep. You are less likely to worry about taking pictures of them coming home and documenting all the important “firsts” that parents like to record. Asking a close friend or family member to keep baby books or photo albums will help take the stress off you to organize those cherished memories. When asked if she thought this was a good tip, one mother of multiples said “I wish I thought of that! I barely have any pictures of their early years!”

Bond with each of your children.
This may be tricky, considering you are still working on establishing a routine. Use feeding and bath time as a good opportunity to connect with your children individually. They will no doubt feel a close connection to each other as multiples, but establishing individuality and unique bonds with you and your spouse is equally as important.

Take care of yourself.
A recent study in the April issue of Pediatrics showed that women who give birth to multiples are 43 percent more likely to suffer from postpartum depression than women who give birth to a single child. Talk with your spouse about how you can both stay healthy before and after the babies are born. A friend of mine who has 16-year-old triplets says a woman stopped her in the hallway at her last doctor’s visit before the boys were born. She said “Always feed yourself first.” She went on to explain this meant physically, emotionally and spiritually. “Feeding” yourself is necessary in order to provide for the other members of your family.

Ask for help.
It may mean asking for help establishing breastfeeding routines in the early days or asking family members or friends to help with rides to soccer practice when they are eight. You are going to need help with multiples! Do not be ashamed to say you need a helping hand — your family and friends will most likely understand and be willing to switch your laundry, drop off a meal or listen to your concerns in order to be there for you and your children.

Preparing for and raising multiples is a unique experience, one that only another parent of multiples can truly understand. Look online for local support groups to find guidance from those who have been through this experience before or are living it now. These parents may be able to tell you where the best playgrounds for multiples are in your area. (As one parent of multiple describes: The best playgrounds for multiples are ones that are completely fenced in!) You may establish close friendships with other parents that last a lifetime!

Finding a babysitter or caregiver for multiples can be challenging. If you don’t have family or friends that can help out, you will need to look for someone who is energetic and organized — the two main features of a successful caregiver to multiples. This is also where a support group comes in handy — references are a must!

Your pediatrician or neonatal specialist will be an important source of information and guidance for you. Multiples may have specific health care needs that singletons don’t. Make a list of questions prior to appointments so you don’t forget what you wanted to ask. You may need to bring along an extra friend or family member to document the doctor’s responses, as you will surely have a lot on  your plate, and may not be able to remember everything he or she says.

But the most important thing to remember when raising multiples: You are multiply blessed!

Jennifer Cerbasi teaches at a public school for children on the autism spectrum in New Jersey. As a coordinator of Applied Behavioral Analysis programs in the home, she works with parents to create and implement behavioral plans for their children in an environment that fosters both academic and social growth. In addition to her work both in the classroom and at home, she is also a member of the National Association of Special Education Teachers and the Association for Supervision and Curriculum Development.

Infuriated by a deteriorating economy and blatant abuse of American taxpayers, the public is taking a strong stand to prevent banking executives from getting away with fiscal robbery. What many have failed to realize is that another industry — the health insurance industry — is getting away with murder, perhaps literally, by putting their bottom lines above your welfare, and this time it could be hazardous to your health.

Across the health care community from doctors to pharmaceutical companies to hospital organizations, steps have been taken to implement ethical standards. Codes of conduct are hardly a new idea. Most are self-imposed by professional organizations or trade groups on their members, often in an effort to voluntarily level up their members’ general behavior, especially in the wake of legal or political scrutiny. For example, the pharmaceutical industry substantially revised its code governing interactions with health care professionals after public and professional criticism. Managed care organizations, however, are the only remaining hold-outs that have not adopted a Code of Conduct, leaving them highly unsupervised. Sadly, the very companies Americans often think help pay their bills are undercutting the quality of American health care in their pursuit of a fatter bottom line.

The game works like this: Health insurers’ profits increase as outlays for patient costs decrease. One such way to keep patient costs down is by prescribing generic drugs over name-brand drugs. In a practice known as drug switching, patients are switched from more expensive, name-brand drugs to generics, even if the name-brand drug was working and the patient experienced no negative side effects.

Managed care companies go to great lengths to make sure the switch appears innocent — a doctor is trying to help a patient reduce his or her medical expenses, and therefore recommends the generic. However, behind the closed doors of invite-only dinners and receptions hosted by managed care organizations, many doctors are lured into drug switching programs that offer attractive fiscal incentives, and there is no mechanism in place to regulate these practices.

Doctors are paying the price as well. In a survey done by the Toledo Blade last year among Ohio doctors, ninety-five percent of respondents said insurers interfered with decisions about prescriptions, 91 percent with testing, 74 percent with referrals, and 69 percent with hospitalization decisions. Eighty-six percent said interference compromised patient care, 76 percent said it adversely affected their patients, and 65 percent said they were unable to successfully protest denials. Most shockingly, 14 percent believed interference from an insurer had contributed to the death or serious injury of a patient.

This prompted a response from our now President:

“I am deeply troubled by The Blade’s report of how insurance companies, not doctors and nurses, are making decisions about patient care,” said Senator Barack Obama in a statement to The Blade. “Medical decisions should be made based on what’s good for your health, not what’s good for an insurance company’s bottom line.”

As managed care organizations seek to maximize profits and survive the economic downturn, the public can likely expect increasing use of cost-driven practices. These aggressive tactics must stop, and a comprehensive Health Insurer Code of Conduct must be implemented by which managed care organizations agree to abide by ethical standards such as transparency, clinical autonomy and, most importantly, patient safety and welfare.

The best Rx for every American is access to quality health care and medicine. It’s time to ensure the health insurance industry puts your safety before profits.

For more information about the National Health Insurer Code of Conduct go to: www.insurepatientaccess.org.

Fox News Health Tips:

• Know your medicines. Talk to your doctor about your prescriptions. Are they generics or brand names? What are they supposed to do? Are there less-expensive options? What are the risks and benefits of taking the drug?
• Be on guard. If anyone wants to switch your prescription, ask why. Will the new drug interact with existing medications?
• Appeal. With your doctor’s help, use your health plan’s appeals process to seek coverage for your desired medication.

Last week, I published an oped in the Wall Street Journal where I pointed out that extending health insurance (especially with a government option) to the entire population would be problematic unless the problem of doctors opting out of insurance under the current system is addressed.

In other words, health insurance doesn’t automatically mean health care, especially if you lack the caretakers to accept it.

This oped produced a firestorm of responses, from  letters to the Journal to hundreds of responses to the WSJ blog which published an abbreviated version, to hundreds of emails to my personal account. I discussed my oped on Fox News and Fox Business. Most of the responses were positive, and Rush Limbaugh read my oped on his radio show and praised it. The NY State Commissioner of Health is going to meet with me to discuss ideas.

Among my critics, some people lost sight of the point that I have not dropped Medicare myself, in fact I pointed out in the article that I take care of many Medicare patients who have left other doctors they were happy with because they dropped out.

Another criticism was that I don’t provide solutions. That is a fair comment, though my father always taught me that a person’s first responsibility is to identify a problem before considering solutions. In any case, here are some preliminary ideas that could help primary care doctors and keep them from opting out of an expanding system:

* Subsidize education and provide incentives for choosing primary care medicine as a career.
* Provide tax incentives for seeing Medicaid and perhaps Medicare patients.
* Do NOT take Medicaid funding away from hospitals to increase reimbursement to private physicians because this will have little impact and because taking care of Medicaid patients – who are often the sickest due to poverty – requires the kind of network you only find at the hospital and associated out-patient clinics.
* Increase physician reimbursement and decrease paperwork.
* Consider a system where insurance is less pervasive and is focused more on prevention and emergencies, with high deductibles to discourage overuse. The middle ground between prevention and emergency intervention can involve negotiated prices between doctor and patient, the way it used to be. Health Savings Accounts should also be considered.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

By Melanie Schuman Rattigan

If you’re under the weather or facing a more serious illness, you go to your local doctor or perhaps an urgent care clinic. Maybe even an emergency room. Insurance might be an issue. Frankly, sometimes even getting an appointment can be a challenge. Now imagine you don’t have any of these options. That’s what most Guatemalans face. 

Click here to see pictures from Melanie’s trip.
 
The highlights of my five trips to Guatemala often come from our general medical clinics. You see how people live in mud-and-stick fabricated homes to how they pass the time without television, Internet, school or even unfortunately a job. Sometimes it’s a 3-hour road trip through mudslide-ravaged villages. Other times, it’s 25 minutes off the main transcontinental road. There are clinics where we see 75-100 patients and then those that easily reach in to the hundreds. Parasites are a common problem, as is malnutrition.  For many, this is their one chance to be seen by a health care professional even if they might not have an ear infection or exhibit symptoms of disease. Vitamins, a little ibuprofen for an aching back or antacid for recurring heartburn often does the trick.  Sometimes parents of children born with cleft palates come seeking assistance and we arrange for them to be evaluated by our plastic surgery team that visits each March.
 
While the providers — pediatricians, registered nurses, general practitioners and even emergency medicine professionals — are the stars, there are plenty of jobs for the non-medically trained such as myself. We handle head count, people flow — getting families to the next available provider; we’re runners for refills from those dispensing the meds and most fun of all — we hand out toys or clothes when the patients are finished. I even learned how to make balloon animals, which was just as entertaining for the kids as it was for me.
 
This February, I translated for a pediatrician who himself has adopted four children from Guatemala and wanted to “give back” to the country that has given him so much. A man in his 40s recovering from a stroke came in with his family. (It’s not often we see men at these clinics except on Sundays.) After a brief examination, we referred him to a local neurologist in addition to regular physical therapy at the clinic Hearts In Motion built in the nearby city of Zacapa. 

The surprise of the trip was a 9-year old boy with hydrocephalus who came with his grandmother. His head was enlarged and his eyes shifted constantly left-to-right, up-and-down from the pressure of accumulated fluid on his brain. At birth, doctors told the family he wouldn’t live long. With a physical disability like this (he is also blind in his right eye) he does not go to school, but has already lived longer than anyone imagined. 
His family was told he needed surgery to live beyond age 12, but it is cost-prohibitive and not an option. The doctors recommended a shunt to relieve the pressure — an operation which would have done by a local doctor — and then began examining his ailing grandmother. It was then that I gave him a toy from my backpack — a blue truck that was 74 cents on clearance at my local drugstore. His face lit up and, for the next 15 minutes, he laughed as we played. He was better at getting that truck to cruise across the room than I was and when he left, I was in tears. What did his future hold? We have volunteers that live in-country year-round who can monitor the situation and provide assistance when possible.
 
On average, clinics see about 200 general medical patients each day. There are also clinics specifically for dental care (extractions, cleanings), eye care and ob/gyn care (more on that next week.) And while it’s not a clinic, the most-eye opening experience for many volunteers is visiting the local garbage dump where many people live.  We make sandwiches of bean puree and cheese and fill plastic bags with horchata — a rice milk drink. The residents come running when our yellow school bus makes it way in and line up waiting for a meal and the clothes and shoes we bring.  It’s probably the one hour of the trip that most reminds you — even on a bad day, life is good.

I want to know what you think.

Eight states are considering passing legislation that would require random drug testing for people to receive food stamps, unemployment benefits or welfare.

Click here to read the article, “States Consider Drug Tests for Welfare Recipients”

Supporters of this legislation feel that it’s necessary in response to an ever-growing population of Americans applying for government-funded aid as a result of the economic downturn. These lawmakers feel it would help to identify the potential health risks and the probability of those receiving aid getting back on their feet when the economy turns around — and that it would also send a clear message: In America, you don’t get something for nothing.

Why not get tested? Millions of Americans are drug tested at random for their jobs every day — the same Americans whose taxes are funding government assistance programs like food stamps, unemployment and welfare. And as American citizens, we need to take responsibility for our own well-being and that of our families.

Now, I’m not getting down on the millions of Americans who may be down on their luck, or for whatever reason, must rely on government aid to help them through tough times while they try their best to get back on their feet. But then if that’s the case, a random drug test should not be a problem, right?

But there are two sides to every argument — and there may be a couple of questions worth asking when considering this proposal …

What about the unintentional effects that limiting aid to a family — especially one with children — may have in failing to provide them with necessities as basic as food on their plates? We don’t want to punish the children for their parents’ actions. But then, in some cases, with severely drug-addicted parents, how can we be sure that the money is going to support the children, rather than to support the habit?

Just last year, a contest in southern California called “There Ought to Be a Law,” yielded a disabled 16-year-old winner whose life challenges inspired his proposal of legislation to mandate random drug testing for all pregnant women on welfare. R.J. Feild was born weighing just 2 pounds, 2 ounces with traces of heroin, marijuana, methamphetamine, alcohol and cocaine in his system due to his mother’s drug use while she was pregnant.  And while the “R.J.’s Law” never made it into legislation, it brought to light an important issue.

But then what happens to people who test positive for drugs while on public assistance? Would the states flat-out refuse help forever, or would they help them get into a rehabilitation center to kick the habit? Right now, most states can’t even meet their Medicaid requirements for people to get routine health care. Perhaps a better plan might be to pump the government aid they would normally receive directly into rehabilitating them.

So I’d like to know what you think, because at the end of the day, we’re the ones funding these programs.

Are we done paying for Bernie Madoff’s crimes? Not any time soon. Bernie may get at least 20 years in prison, but it seems we’re going to have to be paying for his lifestyle — although more modest behind bars — for quite some time.

According to some estimates, Bernie is going to cost taxpayers an average of $29,000 a year — and that’s not including any extra perks that his lawyers may negotiate in court.

Things may have changed since the days of Michael Milken spending a few years in “Club Fed” only to be released to his $500 million dollar fortune, but the Bernie Madoff tab is still open.

At a time when 45 million Americans are living without the benefits of health insurance, and reform is the hot topic on everyone’s lips, it’s quite disheartening to know that the only people with a constitutional right to government-funded health care are convicts. And isn’t it ironic that in the midst of an economic crisis, where many Americans are struggling to get by, that we taxpayers are once again footing the bill for those same greedy crooks who got us into this mess?

So the question is: Should Bernie Madoff have to pay for his own imprisonment? And I think the answer is yes. Now I know many of you smart lawyers out there might tell me this is a ridiculous notion, but I can’t help but think ― if I was planning my retirement, what would I want?

Well, I think I would want secluded place to spend my time, three hot meals a day, 24/7 health benefits ― including dental and vision ― and visitors that would come and see me once in a while, but would never stay long enough for me to have to kick them out. Sounds an awful lot like Bernie’s new retirement plan, doesn’t it?

So I guess I better start saving now for my retirement at the age of 70. But I wonder if all the people that he stole from, whose lives he destroyed, are going to be able to see some the benefits that American taxpayers will provide good ol’ Bernie for the rest of his miserable existence.