President Obama has mentioned many times that the health reforms he is proposing will not alter the health care of those who already have health insurance and want to keep what they have. But this is NOT the view of most practicing physicians — myself included. I may be one of the most vocal, but I am not alone.

1.  First of all, there is a critical and growing shortage of primary care physicians. Only about 2 percent of the current medical school graduating class is going into primary care. Those of us who already practice primary care are overwhelmed and many are quitting. The public insurances have the most trouble. Surveys show that 50 percent of doctors don’t take Medicaid, and in 2008, the Medicare Payment Advisory Commission found that 28 percent of Medicare patients looking for a primary care physician couldn’t find one. This problem will only get worse under any Obama plan. You may have new government-provided insurance, but you may not be able to find the doctors who take it. And if you do, they may be buried under a pile of paperwork, or be too busy changing over to the new Electronic Medical Records system to spend time with you.

2.  More than 150 million Americans have employer-provided health insurance. But if there is a public option, your employer may stop providing you with insurance. You may be compelled to take the public option, which will probably provide you with less real health care choices.

3.  If the public option grows bigger, because private insurers find they can’t compete, expect care to be rationed, as the government makes choices to try to contain costs. Reimbursements to doctors will be cut, as they have been under Medicare and Medicaid, but also, you may not be able to get dialysis if you are over a certain age, or you may have to wait on long lines for procedures, as they do in Canada.

4.  Bottom line — extending a system that already has too few primary care doctors who are overworked to the entire population does not bode well for prevention or quality of medical care. The costs will continue to spiral upward, and access will decrease rather than increase. A better approach would be to work on re-organizing the health care system towards prevention rather than intervention BEFORE expanding it. One way would be to pay for the education of primary care doctors and create a task force to treat the uninsured.

For more on my take on public health insurance and how doctors view it, check out my oped in Monday’s NY Post.

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 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

A recent story about a 17-year-old Boy Scout who died suddenly during a 7.7-mile hike in Florida has everyone wondering what went wrong. Every time I see a story like this, where an unexplained death occurs in a young person – especially an otherwise healthy teenage athlete – it makes me wonder whether it’s a good idea to have in-depth annual physicals performed on adolescents contemplating participating in high-endurance sports.

Most children get an annual physical as required by state law to attend school or play sports. I have three children, and for the most part, their physicals constitute a review of systems, blood pressure, weight and height documentation, vital signs and maintenance of vaccination schedules.

So the question is: Should adolescents have more in-depth assessments done to evaluate the status of their cardiovascular health?

This of course is a controversial question to ask because doctors can’t seem to agree on what tests should be done. And with the swelling numbers of uninsured Americans and the escalating costs of preventive medicine not covered by insurers, we’re immediately challenged with the dilemma of who’s going to pay for cardiac testing, and what happens if we do find something wrong?

A perfect example of this is the current criticism of prostate cancer screening. Many studies are now suggesting that these screenings may lead to unnecessary procedures and negative side effects — that ultimately are ineffective in changing the course of the disease.

Now I can understand evaluating the effectiveness of prostate cancer screening versus cost and quality of life issues – especially because of the nature of the disease and the age group that it typically affects.

But when it comes certain heart diseases in the adolescent patient population, we’re not looking at quality of life issues – but often, the difference between a life saved and a life lost.

One condition in particular that I think that teenagers should be screened for, is hypertrophic cardiomyopathy (HCM). This is a genetic condition that affects one out of 500 people and is the leading cause of heart-related sudden death in people under 30. And unfortunately, if it goes undetected, most parents only find out about HCM after their child dies on the field or court.

Hypertrophic cardiomyopathy is a condition in which the heart muscle becomes abnormally thick, making it harder for the heart to pump blood and sometimes interfering with its electrical rhythms. HCM tends to run in families, and children of parents with the genetic mutation for the disease have a 50 percent chance of inheriting it.

The reason HCM often goes undiagnosed, is because it rarely presents any noticeable symptoms. And while it can lead to severe cardiac problems at any age, but I would argue that if the condition is identified in the teenage population, proper monitoring could lead to a decrease in sudden, unexpected death among athletes.

Many states are looking into mandatory cardiovascular assessment of young athletes in an effort to identify patients at risk. Still cardiologists are not sure what the best method of screening should be — whether routine electrocardiography or echocardiograms prior to the start of the sports season would provide the most cost-effective, comprehensive data to aid in identifying athletes at risk.

I know that this debate will go on for quite a while, but I think that any parent with a teen or child participating in sports should have a conversation with their pediatrician.

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

In these uncertain economic times, it is not unusual for many patients to postpone their regular preventive care. Often viewed as unimportant if there are no obvious problems and “nothing hurts,” the routine dental checkup and cleaning are put on hold in the interest of saving some money.

Unfortunately, nothing can be further from the truth. To begin with, the checkup examination can often help you avoid or detect a dental problem early before it becomes painful both physically and financially. Regular dental care helps ensure healthy teeth and gums, which in turn strengthen a healthy oral immune system.

Good oral health is essential to maintaining total body health as research continues to emerge showing a strong correlation between dental disease and many systemic problems ranging from Alzheimer’s disease to pancreatic cancer. If you are a pregnant woman, you have a seven times higher chance of having a pre-term baby. You also have up to a ten times greater chance of heart attack or stroke, and a seven times higher chance of developing type 2 diabetes. Basically, gum disease is a major source of chronic low-grade inflammation which can have ravaging effects on many body organ systems.

Several recent studies, including one completed with 145,000 patients at Columbia University’s dental school, went even one step further. They found that maintaining or restoring good oral health actually reduced total health care costs up to 21 percent for the management of patients with various systemic diseases. A study performed in Japan concluded virtually the same. The actual potential health care cost savings could easily be in the trillions of dollars if this is considered on a large population scale.

So if you’ve considered putting off your last checkup, think again. There’s a lot to be said about being “penny wise and dollar foolish.”  Now is the time to be more preventive and proactive about your health as a healthy smile is also healthy for your wallet.

Dr. Gerald P. Curatola is a renowned aesthetic dentist and pioneer in the emerging field of rejuvenation dentistry, which improves patients’ overall health and appearance by integrating total wellness with cutting edge oral care and restorative procedures. In addition to his private practice, research, and work as a Clinical Associate Professor at NYU College of Dentistry, he is an internationally sought after speaker, author and expert who has been featured widely in print and broadcast media. For more information, go to DrGerry.net

The Institute of Medicine, a prestigious body, has released a new report building on previous reports issued between 2001-2004 which have all concluded that the lack of health insurance in our society is putting a lot of pressure on our current health care system and leading to skyrocketing costs. The current report concludes that when local rates of people without insurance are relatively high, even people with insurance have difficulty obtaining needed care.                                                      

According to the report, the number of people who have health insurance continues to drop, while employment-based coverage — the principle source of insurance for most Americans — is failing. The average amount of money that employees paid for year for family coverage has doubled in the past decade to $3,354 in 2008. The IOM committee concludes that if there is no intervention, the decline in health coverage will continue, costing the health care system more money down the line in terms of delayed diagnoses and poor outcomes.   

My take is somewhat different.  Here’s why:
 
*  I don’t assume that increased health coverage automatically leads to improved health outcomes. Our system is currently clogged with insured patients who overuse their coverage precisely because they don’t feel the pain in their pocketbooks. Recent studies have shown that it is these folks who unnecessarily fill our ERs, often with minor ailments.
*  There is a great and growing shortage of doctors, especially primary care doctors. Current medical school graduating classes average only 2 percent going into primary care. So who is going to practice all the preventative medicine that IOM has in mind by extending insurance coverage?
*   The current system of health care is far too intervention-oriented. This means that we wait until people get sick and then use our insurance coverage to absorb the cost of disease-modeled intervention. Did you know that over $460 billion – that’s right BILLION – was spent last year in the U.S. on cardiac and vascular interventions. Until we transition to a real preventative-oriented model, where hospitals are NOT the focus, extending coverage will only extend the problem.
*  Making the system more prevention oriented is not a function of extending a generic disease model to more people. Instead, it means disruptive innovation, altering the system itself, with a new focus on prevention through the use of genetic technology, biotechnology, personalized medicine, and most importantly, increased development and use of screening tools that lead to catching a cancer or heart disease before it occurs, or at least before expensive chemotherapy or elaborate stenting procedures are required.
*  With the current managed care/employer-driven health model, there is no way to protect the patient/consumer from shoddy care. Extending that will only extend the shoddy care.
 
 
Let me give you an example of how the current system doesn’t work – (as if you don’t know it already from your own health care difficulties):

A producer here at Fox had an earache – he wanted to see his primary care doctor, but the doctor was all jammed up with patients. So he went to a mini-medicine mart, a doc-in-the-box, and was quickly given an antibiotic, and his ear has started to improve.

But ears are tricky, and are easy to misdiagnose or mistreat. I send many of my patients so afflicted to ear specialists. The producer may not have needed the antibiotic or he may need more care than just an antibiotic. Either way, I am wary of the care he received, and am concerned that in the end he could end up costing the health care system more money, and himself more aggravation, than if his primary doctor had been available. And keep in mind that his doctor WAS not tied up with the uninsured, but with the kind of coverage that IOM thinks should be extended to more people.

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

If you are suffering from a toothache, chipped tooth, loose filling or other dental emergency, it’s important to call your dentist as soon as possible. Toothaches may be an indication of a cavity or other serious problem — such as a bacterial infection — that will need to be addressed quickly and should not go untreated. Until a professional treats you, here are some at-home tips to calm oral pain and what to do when an unexpected emergency arises.

With most dental emergencies, severe pain may be a factor. Aspirin or aspirin substitutes should be avoided as they can slow clotting. If you cannot manage the pain without assistance, you may consider ibuprofen or naproxen sodium — but only if you have no previous allergies or medications that can interact with these painkillers. Be sure to check with your doctor or pharmacist and carefully follow your doctor’s and label instructions.

Cavity Calming Solutions
Applying ice (on and off) to the affected area or to the cheek may help sooth irritated nerves and reduce swelling. Oil of cloves (from the pharmacy), or even fresh cloves from the spice rack, have been known as an aid in relieving pain naturally. Never place an aspirin directly on a painful area inside the mouth. Very gentle massaging and flossing can help to remove irritants, while rinsing with a tepid crystal salt water solution will help reduce swelling and detoxify the mouth. Real vanilla extract placed on a cotton ball and then dabbed around an irritation may also help relieve pain.

Broken Tooth
Rinse your mouth with a warm crystal salt-water solution and get to your dentist as soon as possible. Bleeding may be stopped with gentle pressure to the gums, not to the tooth. Remember to bring any tooth fragments to the dentist with you and keep them hydrated in a solution such as milk or salt water. A soft piece of wax or a temporary filling material from the pharmacy may help to prevent further irritation.

Knocked-out Tooth
Hold or place your tooth in the socket if possible or wrap in clean, wet gauze until you can see a dentist. A tooth has a better chance of being saved and re-implanted if you can get to a dentist within 30 minutes. Call an emergency room or 24-hour dental service if you can’t reach your dentist in time. Biting down on a moistened tea bag may help sooth and slow bleeding.

Crown or Bridge Fell Out
Use a little petroleum jelly or denture adhesive available from the pharmacy under the crown to hold it in place — as a very temporary fix — until you can see a dentist. Do not chew on the crown or bridge.

Bitten Tongue or Lip
Apply a cold compress and gentle pressure to help stop bleeding. If bleeding does not stop, go to an emergency room.

Object Caught Between Teeth
If you cannot remove an object with gentle flossing, do not cut your gums or use any sharp objects to remove the obstruction. You should rinse with warm crystal salt water solution until you can see a dentist.

We often say the mouth is the gateway to total wellness. Treat your mouth with respect and care, including eating a healthy, antioxidant-rich diet, and exercising and brushing three times a day. Visit your dentist regularly for cleanings and oral health exams. Your dentist may be able to prevent a possible emergency by catching dental problems before they begin — saving you a lot of discomfort and a potential emergency visit later. And common dental issues, such as gum disease, may be precursors to other, more serious illnesses. Studies from Harvard and other major medical institutions have proven that poor gums can put you at high risk for diabetes, heart disease and other illness.

Many people see their dentist more than they see any other doctor. If you are like many who are afraid to see the dentist regularly, ask about “pain free” dental care. In fact, many of our patients find our treatments and procedures soothing and even comforting. Today’s dental science has come a long way — and patients should not be afraid to seek good oral health options. If you are concerned because you do not have insurance, talk to your dentist about possible payment options or other forms of help that may be available.
Dr. Gerald P. Curatola is a renowned aesthetic dentist and pioneer in the emerging field of rejuvenation dentistry, which improves patients’ overall health and appearance by integrating total wellness with cutting edge oral care and restorative procedures. In addition to his private practice, research, and work as a Clinical Associate Professor at NYU College of Dentistry, he is an internationally sought after speaker, author and expert who has been featured widely in print and broadcast media. For more information, go to DrGerry.net

BOSTON —  Blue Cross Blue Shield of Massachusetts says it will become the first health insurer to participate in Google Health, a medical records initiative by the online search engine.

Massachusetts’ Blues plan said Thursday that it expects to begin offering the free electronic service to its roughly 3 million members this fall. Members will have the chance to open a Google Health account and authorize sharing of their medical claims data with the online service. (continue)