By John Ballard
Despite election year politics over Obamacare, a serious national conversation is finally beginning to yield positive results. Win, lose or draw this discussion would never be happening without the two-year long struggle to birth PPACA. Having followed the debate since before it became mainstream, I have come to the conclusion that what happens with Congress, the mandate or anything else will be secondary to the discussion among the providers themselves, fueled by specialized policy wonks who have forgotten more than all the Congressional staffs and Lobbyists ever knew.
And I'm encouraged. Here are two examples.
?Dr. James Salwitz at Sunrise Rounds says in Healing medicine together...
Millions of lives and billions of dollars were saved this week and America moved a step towards a healthy new future. A new drug or surgery? Another genetic breakthrough? No, an event much more powerful. Nine medical societies (soon to be 17) and 11 consumer groups stood up together and in one voice said, �We are sick and tired and we are not going to take it any more!�
On April 4, 2012, the partners of the Choosing Wisely Campaign released their first collaborative list of unnecessary, expensive and therefore dangerous medical testing. These groups, representing well over 200 thousand physicians, AARP, industry, farmers, unions, business interests, health advocates and even Wikipedia, published a list of tests which are often unneeded and guidelines when they can be avoided. This is a national grass roots campaign without government, insurance or even AMA involvement. In this broad movement that it can be said that the people have spoken�they want costs down and quality medical care up.
Of the 2.8 trillion U.S. dollars spent on health care each year, we waste $600 billion on unnecessary tests, unhelpful treatments, and complications. We are a country that is long past the point where more money buys better health. We spend so much on medical care we are hurting ourselves. Unneeded tests lead to unneeded diagnoses which lead to unneeded treatments which lead to unneeded complications which cause unneeded suffering, all spent with desperately needed dollars. We fear that government and the insurance industry, though harsh rationing, will force a fix on the mess. It seems we have an alternative. The Choosing Wisely group is a board base of consumers and they are helping us make a stand.
In its first publication, the Choosing Wisely Campaign, organized by the American Board of Internal Medicine Foundation, dispersed five specific recommendations from each of nine specialty societies.
- Sinusitis is usually viral so do not use antibiotics and avoid CT scans
- Bone density X-rays only on women older than 65 or men older than 70
- Avoid routine EKGs unless the patient has a problem
- No routine stress tests, regular or nuclear, and reduce radiation exposure
- Reduce routine or pre-operative chest X-rays
- Avoid CT scans for routine headaches
- Colonoscopy only every 10 years, if normal
- Avoid chemotherapy in weak patients with advanced cancer
- Careful consultation with the patient and family before starting dialysis
- Reduce PET, CT scans and labs in cancer patients who are likely cured
- Use ultrasound, not CT scans for children with appendicitis
- Avoid scans for routine back pain for at least six weeks
More at the link. Go check it out.
While you're at it, bookmark Choosing Wisely for future reference. I have an idea they are just getting started.
?Why sudden death is good public policy
And you thought talk of death panes was shocking! Who knew such scary subjects would come bubbling to the top in the short space of a two or three years.
This in-your-face post is a long overdue indictment of ICDs (Internal Cardioverter Defibrillator) as one of the main contributors to the high cost of health care inasmuch as the most expensive part of the health care dollars spent are at the end of life.
This comment caught my eye.
Doctor: How do you want to die?
Patient: Suddenly, and in my sleep with no pain. You know, drop dead.
Doctor: We can fix that.
I don't expect this idea to get too much traction, but it signals an important part of the health care conversation usually avoided, and which at those rare times it comes up, is so devoid of content that it may as well be a conversation about sports or cooking.
Although we all will die, very few people have the courage to take seriously any discussion of the subject. It, forgive the expression, serious as a heart attack.