Obamacare: Rising Prices for Subpar Insurance?


I have avoided writing a blog entry on this subject lately, despite all of the news, both positive and negative. I have avoided it because of the mass ignorance on both sides. Talking to my Conservative friends, I hear horror stories of premiums rising 300%. Talking to my Liberal friends, I hear how the rising prices are due to getting off subpar insurance and how much better off people are.

My opting in on writing something came from an article posted by James Shore (@jamesshore on Twitter) that essentially blames the hysteria over rising prices on the Tea Party. There is no more balance in the newer article (blaming the Tea Party) than the original only stating what the letter stated and not examining other options. The question is which is closer to the truth:

  1. People are paying more for insurance
  2. People are getting better insurance

In reality, it is a bit of both.

Equivalent Insurance for the same/higher/lower price?

The first thing you have to understand about the ACA is there are no equivalent plans. When I see someone stating “people are paying less for equivalent insurance” or “people are paying more for equivalent insurance” I say “bullshit”. There are no equivalent insurance plans.

This is due to the new standards for policies. Example? Find a plan in 2009-2013 that had a deductible or out of pocket max of $6350. You can’t. Why? Because the insurance  companies uses rounded numbers. You can find a plan with a $1000 out of pocket max. You can also find $2500, $5000, $7500 or even $10,000 or more. But you will not find one ending with $350. There was no good reason to do it.

I am personally under the view the government purposefully chose off numbers for minimum standards so you could not compare. It is not in any party’s best interest to be able to compare, and politicians are human. Human beings like to work out the rules to benefit themselves. So this is not a big conspiracy, just an “it is what it is”

The end result is it is hard to compare like plans. Now, part of this is the insurance companies. They may have had a $6000 out of pocket max plan that is now $6350. So the plan is actually worse than before and if the price went up, it is true you are getting less for more.

That leads us to the topic of subpar insurance.

Subpar Insurance?

Here is an nice little clip of Nancy Pelosi stating essentially “the prices are not going up; people are, instead, getting proper insurance”. In other words, the government came in and saved us from “subpar”. You can see the mantra in the video below.

And, Pelosi is correct … according to the government. According to the government, having a policy with higher than a $6350 out of pocket max or deductible is bad. This was not the ACA directly, but the HHS, who got to determine the minimum standards of care. Do you agree with the minimum standards? Just understand, it is not an individual choice what minimum coverage looks like any more. And, from that perspective (government should decide what is par), Nancy Pelosi is right that everyone whose coverage is cancelled had “subpar” insurance. If a $6350 out of pocket max or deductible are subpar, then high deductible plans are all subpar.

If we wanted to lower healthcare costs, a stated goal of the ACA, we should have more people on high deductible plans, paying their day to day care. This would foster more competition. The government’s role should have been to ensure pricing was transparent to level the field, not ensure everyone an insurance card. Take care of those who cannot afford care? Fine. But translate that to insure everyone? This goes contrary to the stated objectives of the law that was passed.

So, high deductible plans are bad insurance for individuals buying  their own insurance, according to the government. But who is the government to decide what is acceptable for individuals? What if the government told you the minimum acceptable size of a television was 44”. You can no longer buy a $100 7” television, as it is subpar. You now have to spend $400 to get acceptable minimum television. But the law also states you have to have a minimum of 90 Hz refresh rate and 1000p. Now it is $500.

And since there are currently no 44” televisions, you have to get a 45”. Since there is no 90 Hz refresh rate, you have to get 120 Hz and there is no 1000p,so you need to get 1080p. Now, the television manufacturers turn around and create 44”,1000p, 90 Hz television and call them bronze televisions.

The Conservatives bitch that the price went up for equivalent televisions and the Liberals bitch the televisions were subpar. But if people were happy with a 7” television, who is the government to state they can’t have it?

I realize healthcare and televisions are completely different in execution, but the concept is similar. And it is more the individual that determines what is good for them. If the ACA had created bronze through platinum plans, but also allowed individuals to determine if some plan fit the, even if it did not fit the minimums,then the bitching would be less justified, as there would be a choice for those who felt they should be able to decide what works for them. But that would not have been financially viable.

Some Americans truly did have insurance that was subpar. Ignoring this fact does not allow for an honest debate. They were given few choices due to their health or wealth, or lack thereof, and the new law has given them better choices. But the choices are more expensive and some Americans did not need the new “par” standards, or want them.

On the other side, others had good or even great insurance, but it missed one or more items of what is now considered par. When I examined 2013 plans, I found some insurance plans that were actually better for some segments of society that are now subpar. For example, under the ACA exchange plans, you can get a plan that has $65 copays for the first three visits, with no copay once you meet deductible. But if you are relatively healthy, the plan that had 20% coinsurance and no copay might have been less expensive. In fact, with standard doctor’s visit costs, it would have been cheaper than the new ACA plan for most Americans. Not allowed anymore.

But weren’t some plans grandfathered in? Sure, but very, very few. Why? The HHS set rules that substantive changes voided the grandfathered plans and then called a rise in premium substantive at a very low threshold. Since the cost of healthcare went up 15% in 2010, largely due to the new fees charged the medical manufacturers, health insurers and big pharma. Back to this shortly.

The points that are important are

  1. The HHS rules were adopted after the law passed, and voided insurance plans that might have been fine if the standards were decided differently. These are the plans we can firmly blame on the ACA.
  2. The minimum standards included standards in pricing and healthcare, so we are not just talking minimums for healthcare.
  3. The minimum standards are an “all or nothing” proposition. It does not matter if you have better insurance on all points but 1, you still have a cancelled policy.
  4. The government is deciding for you what minimum coverage looks like. This may be fine with you and may not.

Rising Prices

The prices are rising, at least in most states. Since you cannot compare ACA plans to 2013 plans directly, as , it is difficult, if not nearly impossible, to determine exactly how much. Are they rising 2-3 times the amount? Yes, in some cases keeping the same insurance with change provisions is 2-3 times the amount. But, to be fair, people can find less expensive options on the exchanges.

But the promise of Obamacare does not really come in unless you make somewhere between 138% and 400%of the poverty rate, as you get all, or a portion, of your premiums paid for you. And if you are at the lower end up the range, you might get your deductible and out of pocket max lowered for you, as well. In fact, if you are low enough, you can get plans with no deductibles and an extremely low Out of Pocket max.

The sad part here is 400% of the poverty level is well into the middle class, making the middle class a new entitlement class. I don’t think most of the middle class wants to be on programs like welfare, but they are now on the dole if they get the subsidies. But the exchanges are set up to make this less obvious, as you never see the full price of the insurance and may not even see the subsidy amount.

NOTE: Connecticut’s site shows “you are eligible for a subsidy up to $X” but does not show the subsidy amount on the page where you pick policies. I use this site, as you could shop, from the beginning, without putting in any of your information until you checked out.

The media currently heralds 2013, through October, as a banner year for healthcare, with the lowest rise in the cost of healthcare in decades. They also state 2012 was on track with other years, down from 2010 and 2011. This is stated to be proof the ACA works. But does it? In 2010 premium prices went up in the double digits and in 2011 it was up almost 10%, the highest rises in decades. Is 2013 proof the ACA works, or an overly pessimistic market responding. When the new ACA fees went into effect, perhaps the insurance industry panicked?

I predicted the fees would drive up the cost of healthcare when I read the bill(unlike some of our Congress Critters?). The fees, in the billions, had to have an impact. I now see a big rise in 2014, as well. Why? Because we have pushed so much of the law into 2015.

Here is something to consider. Insurers set 2014 prices in 2013, with the idea 7 million would sign up on the rolls by the end of March. But the provision they sign up or be fined has been pushed to 2015. And the provision the insurance companies must fit the framework is also pushed to 2015. The insurance industry has a lot of leeway in 2014 and you may even see mid-year hikes in premiums, ala this year.

Better Insurance?

We then come to the question of whether moving up to par gives you better insurance. If you truly had subpar insurance, as determined by you, not the government, then you may have a better written policy. But it may not truly be a better policy.

One of the unintended consequences of this law was the lengths both the medical providers and insurance companies would go to make money. Many medical providers have opted out of ACA exchange plans, deciding to only take employer plans (and other group plans) at this time. They are willing to forgo less than 5% of the populace as their plans pay less for medical services.

What this means to exchange plan holders is they may not be able to see their doctor, as he is not taking the plans. This does not sound too bad until you look at places where the best hospital for their type of care has opted out of exchange plans. Or worse, as in the case of Seattle Children’s Hospital, which was dropped from exchange plans, they have to travel hundreds of miles to get cancer care for their children, or choose care in an adult hospital, which is not skilled in pediatric cancer, thus lessening care. This is not critical in all areas, of course.

Since I mentioned Seattle Children’s Hospital, I should note that not all limitations in choice are being made by the provider choosing non-exchange plans. In the case of Seattle Children’s Hospital it was the insurance company. This means some of us may get our care lessened even if we are still covered by group plans, as a  reaction to the exchange plans.

Either way, the policy is better on paper, but not necessarily better in the real world. And tightening networks is not the only way the insurance might have gotten worse.

Under the ACA the playing field is leveled quite a bit. On the positive side, it means those unable to get insurance now can get insurance. But the price has to go up for the healthy to pay for the sick adding to the rolls, sometimes significantly. There is a push to get young people on the rolls, as they are healthy and paying a large portion of the bill. In fact, a 40 year old will have better rates than a 26 year old. Don’t believe me? Run the same plan for two males, one 26 and one 40, both with zero dependents. Nice, huh?

Affordable Insurance?

The ACA has made insurance more affordable for some.Those, for example, who have their entire premiums paid and deductibles and out of pocket max lowered, have more affordable insurance. If they also have a pre-exsiting condition, they have a major win.

But since the average American, even with our horrible diet, does not fit these cases, are we not setting the rules for the exception rather than the rule?

I know a great many cancer moms (see note) that saw the ACA as a godsend. Many are now seeing it is going to bankrupt them more unless they lower their income significantly. Under the ACA, unless you have a good portion of your insurance paid, you are going to pay more per year in 2014 for your serious illness than in 2013. I am not stating this is true for all, just a large number of people. With the minimum standards, it is easy to see why.

NOTE: My youngest daughter is a 5, almost 6, year cancer survivor.

The Bottom Line

Some of the people that are getting notices truly had what all of us would agree was subpar insurance. But some did not. Some just had insurance that missed one of the provisions the government states makes insurance par. They  actually had better, more affordable insurance.

The picture is not all doom and gloom, but there were other ways to solve this. And here are a few facts that may shock some of you, as you may be hearing things to the contrary. First, the Republicans did have alternatives to parts of the plan. You may wish to debate on whether or not they were good alternatives, but to say there were none is patently false. It takes a bit of a Google search to find other voices, but they are there if you search hard enough. Second, the Republicans are not balking against the ACA now that it is being put into action, as not one voted for it. You can look at the rollcall and find this out (and please don’t comment back with the action in the house to suspend debate, which some Republicans voted for, as that was not a vote for the bill – in fact, the original house bill had NOTHING to do with healthcare – the Senate stripped 100% of the wording from the bill and started over, something that, by the spirit of the law, is illegal, but apparently not by the letter of the law).

The ACA was voted in as soon as the Democrats had a filibuster proof majority between them and Independents. This would not matter today as Reid changed the rules of the Senate so a filibuster can be broken by a simple majority. It was not a compromised bill; it was one that fit one parties view of what is good and bad, without debate from the contrary side.This does not mean the law is wrong, only that there is a greater chance at least some of the provisions are flawed, if not downright bad, as no ideology is right 100% of the time. There is both good and bad in the law, and, from my reading of the law and HHS provisions, a lot of it is bad, as it does not meet its objectives and serves to drive up prices.

The author of the article, Maggie Mahar, is almost assuredly right that the woman could have gotten cheaper insurance than the $1000 she was quoted on the cancellation notice option(s). But the case is anecdotal. What is factual, from a scientific standpoint, is insurance rates are going up rather significantly in most states for individual policy holders.  Not significantly, as in 300%, but at a rate much higher than rates went up prior to the ACA passing.

But Greg,you might say,I see plenty of examples where the rates are much lower. Do you? Or do you see the total amount lowered? The total amount, in case I have seen that are lowered, is after subsidies. If the American taxpayer is paying a large portion of your premiums,of course the total cost, for you, is lower. But the actual costs, which the rate is based on, is higher. There are only a couple of states where this is currently not true.

To put this in perspective, let me consider my daughters.Suppose one wanted a new toy that costs $200 and I decided to buy it for her, so her out of pocket costs were $0. Did the price go down from $200 to $0? No. The cost remained the same. Let’s say the toy went up in price to$250 and I still decided to pay all of it. In that case, the price did not even remain the same, but from her perspective, the cost was$0, despite a $250 price. Much of the talk I see on the Internet about lower premiums is not lower premiums at all. It is lower out of pocket costs for premiums due the American taxpayer footing part of the bill. What gets me is some people are paying more even with subsidies.

My point here is this:

  1. Naming the Tea Party boogie man is a red herring
  2. While stories out there may be exaggerated (300% increase in premiums), it does not mean higher than average increases are not happening. And, by looking at facts, you can easily find the rates in many states are going up far more than the average.
  3. Insurance under the ACA is not necessarily cheaper. Even if we have cheaper premiums and better policies, cost of deductibles and out of pocket maxes may bankrupt families. Add on shrinking networks and it could be worse.
  4. Anything is less costly to you when someone else is footing the bill.

Peace and Grace,
Greg

Twitter: @gbworld

FTC Nails Pomegranate Juicemaker for False Claims That Don’t Appear False


I found this one interesting. From the beginning of the press release … er … article (could not be a press release, right?):

“Administrative Law Judge D. Michael Chappell ruled on May 17, 2012 that some POM Wonderful ads are deceptive. The company’s ads claim that POM Wonderful 100% Pomegranate Juice and POMx supplements can ‘treat, prevent, or reduce the risk of heart disease, prostate cancer, and erectile dysfunction.’ ”

So the background is POM made a claim that their products can treat, prevent or reduce the risk of heart disease prostate cancer and erectile dysfunction. The FTC sued them for deceptive advertising and the standard they needed to uphold their claims was “competent and reliable scientific evidence”. Sans this, the complaint would be upheld and the FTC would win.

POM has conducted 10 clinical trials on their pomegranate juices and supplements (http://clinicaltrials.gov/ct2/results?term=POM+Wonderful).  Of course, these might be bogus, since they used hack institutions like John Hopkins, UCLA, University of Michigan, etc. And additional studies by the National Cancer Institute, MD Anderson, Sloan Kettring, etc. are also obviously slanted and cannot be used as proof (even though these institutions also study the seems to have a great case here.

If I move to peer-reviewed journals, there are only tens of thousands of hits, with thousands for heart disease and prostate cancer (along with other cancers) and quite a few hundreds on erectile dysfunction. Obviously, there is not enough evidence, cause an effective food or supplement would have millions of studies. After all, Zytiga, a new FDA approved drug has a bit over 700 scholarly articles (roughly the same as pomegranate and erectile dysfunction) and roughly 2500 if the word abiraterone, the chemical name for Zytiga (significantly less than the number of hits for Pomegranate and Prostate cancer, but who’s counting).

Zytiga is the obvious safe choice for discriminating patients, as the only major complications are hypertension (high blood pressure), fluid retention, weight gain, adrenocortical insufficiency (problems with adrenal glands) and hepatotoxicity (kills your liver). The non-safe choice, drinking pomegranate juice, is far worse, as drinking it in higher amounts might cause weight gain, according to various sites. Weight gain is far worse than heart attack in my book.

Here are a few links to journals with research on pomegranate (hack journals , of course):

A Google scholar search reveals more than 51,000 hits for pomegranate. If you go to more specific searches on pomegranate reveal more than 4,600 hits for cardiovascular, more than 3,000 for pomegranate and prostate cancer, and more than 700 hits for erectile dysfunction. Of course, since many, if not most, of these are peer reviewed journals and studies by government agencies, so they MUST be biased and unreliable (bad science like all peer-reviewed journals).

Let’s dig a bit deeper into our government, okay? Certainly they have something to say about how bad Pomegranate juice is for you. I mean, they couldn’t be saying something like pomegranate juice helps with medical conditions, right?

From the National Cancer Institute: 

“A study of 13 pomegranate compounds showed some were able to slow the growth and spread of prostate cancer cells and to cause cell death. Higher doses were found to be more effective.”

“Three types of prostate cancer cell lines were treated with either pomegranate extract, pomegranate juice, or two of their bioactive compounds. ALL (emphasis mine) pomegranate treatments were shown to increase cell death and decrease the spread of cancer cells, with higher doses found to be more effective.”

“Other studies in cancer cell lines found that the anticancer activity of pomegranate included effects on certain enzymes and pathways involved in cancer, such as the insulin-like growth factor (IGF) system.”

But this is the National Cancer Institute (NCI) and not the Federal Trade Commission (FTC) and agencies should only trust their own research, even if they don’t research medicines or food. Unless, of course, the research they are trusting is about claims on medications, then they should trust all research, right?

So who is Administrative Law Judge D. Michael Chappell? He MUST be an independent legal authority with no ties to either the FTC or POM, right? If not, he might be biased in one direction or another, which would seem almost unfair to opposing side. Well, a bit of investigation reveals him to be a completely unbiased employee of the FTC, so I am rolling with him all the way … just like the media that published the FTC press release as an authoritative source of information. Hey, if it is press released, it has to be right? And there is no bias against farmers, food, etc. in the government, right?

If it seems like I am a bit underwhelmed by our government, you hit the nail on the head. With the revolving door between various agencies and the industries they watchdog, and the history of going after food while giving “medicine” a relatively free ride (could be due to many federal employees being former {drug, food, ?} company executives/researchers/etc.), I am a bit leery when I see the FTC going after a food for false practices (at least they did not state “water can prevent dehydration” was a false claim, as the European Union did last year), so they have that going for them.

As an aside, here is a particular egregious revolving door case:

In order for the FDA to determine if Monsanto’s growth hormones were safe or not, Monsanto was required to submit a scientific report on that topic. Margaret Miller, one of Monsanto’s researchers put the report together. Shortly before the report submission, Miller left Monsanto and was hired by the FDA. Her first job for the FDA was to determine whether or not to approve the report she wrote for Monsanto. In short, Monsanto approved its own report. Assisting Miller was another former Monsanto researcher, Susan Sechen. Deciding whether or not rBGH-derived milk should be labeled fell under the jurisdiction of another FDA official, Michael Taylor, who previously worked as a lawyer for Monsanto.

Really? She writes a paper to get recombinant growth hormone approved for use in cattle and then gets to approve the research? Obviously no conflict of interest there, right? And I want the fox to guard my henhouse and should have a bridge to sell you later on today. Bleh!

Am I stating you should drink lots of pomegranate juice? Certainly not! Am I stating you should not take drugs if you have heart disease, prostate cancer or erectile dysfunction? Not at all! I am stating that POM’s “false claims” appear to have plenty of evidence behind them. And I would rather drink pomegranate juice than take a load of drugs (one for the cancer, another for the hypertension caused by the cancer drug, and another for the erectile dysfunction caused by the previous 2 drugs, and others to halt the liver damage, etc.).

And, yes, I am being a sarcastic snit at this moment.

Peace and Grace,
Greg

Twitter: @gbworld

Working with Relative Numbers (AIDS vaccine, Cancer Drugs)


I finally got a chance to sit down and read a bit more about the AIDS vaccine trial. The major media has proclaimed that the vaccine has a protective effect of 31.2%. What this supposedly means is that 31.2% fewer people will contract AIDS when taking the vaccine relative to those not taking the vaccine.

The problem with these numbers is they really don’t mean much. Let’s look at the real numbers.

The trial had approximately 16,000 participants broken into 2 groups:

  1. People given the cocktail of 2 AIDS vaccines (ALVAC-HIV and AIDSVAX B/E)
  2. People given a placebo

Of the participants in the trial, 51 of the vaccinated group got AIDS/HIV, compared to 74 who got the placebo, which is where we get the 31.2% figure. Since the publishing of the paper, they found that 7 tests subjects already had HIV, so the new number is 26.4%.

But, let’s look at the real numbers, rather than relative numbers. Of the 16,000 people on the study, I assume roughly 8,000 got the vaccine and 8,000 go the placebo. If true, then we have the following stats using the original study numbers:

Group Number in Group Number Infected % of total Group
Vaccine 8,000 51 0.64%
Placebo 8,000 74 0.93%

Results:

  • With a Thai heterosexual lifestyle, and a vaccine, I have less than 1% chance of getting HIV
  • With a Thai heterosexual lifestyle, and no vaccine, I have a .29% higher chance of getting HIV than with a vaccine

Statistically, this is not a good absolute number. If you take this to its natural conclusion, it breaks down like this. For every 1000 people, the number getting AIDS is 9, but this is reduced to 6 if you get a cocktail of vaccinations. Statistically speaking, the 3 extra people could be a fluke, as the numbers are too small to be statistically significant when you look at absolute numbers. It is only through relative numbers that the percentages appear significant.

You see the same relative numbers in cancer.

Consider Tamoxifen, which showed a 49% reduction in occurrence amongst high-risk participants. Here are the numbers:

Group Invasive Breast Cancer
Tamoxifen 89
Placebo 175

When you run this against the numbers and run some other calculations, you end up with a 49% less likelihood of getting breast cancer. When you look at real numbers, the incidents of invasive breast cancer is 6.76 per thousand with the Placebo group and 3.43 with the Tamoxifen group (page 6 in study). In real numbers, this means 641 additional women will not get cancer this year if they take Tamoxifen over those who do nothing.

Group Invasive Breast Cancer Endometrial Cancer Stroke Embolism
Tamoxifen 89 36 38 18
Placebo 175 15 24 6

And when you look at the totals, they stack up like this:

Group Cancer Non Breast Cancer Non Cancer Negative Event
Tamoxifen 125 92 56 181
Placebo 190 45 30 220

Net result: Less breast cancer, more endometrial cancer, more strokes and more pulmonary embolisms. While you are less likely to develop invasive breast cancer, you are more likely to get something that could kill you.

Here are some real numbers, based on incident rates:

Tamoxifen Placebo Difference
2009 estimates Rate/1000 Total Rate/1000 Total Rate/1000 Total
Breast Cancer 192,370 3.43 660 6.76 1,300 3.33 641
Hip Fracture 243,200 0.46 112 0.84 204 0.38 92
Endometrial Cancer 42,160 2.3 97 0.91 38 -1.39 -59
Stroke 301,000 1.45 436 0.92 277 -0.53 -160
Pulmonary Embolism 234,000 0.69 161 0.23 54 -0.46 -108
In Situ Breast Cancer 42,250 1.38 58 2.68 113 1.30 55
Deep Vein Thrombosis 720,000 1.34 965 0.84 605 -0.50 -360
Total 1,774,980 102
Percent Diff: 0.0058%

 

The net result is 102 women less per year get a serious disease using Tamoxifen as a preventative than those who do nothing. One question I have, however, is what were the numbers for other types of cancer (brain, lung, liver, colon, breast) between the two groups, as it may actually put Tamoxifen on the negative side of the equation. Oh, and one more thing, the study was choosing women with a higher risk of breast cancer. If we were to re-run these figures with all women, what would the numbers look like. As a side note, Tamoxifen is horrible on the liver and is known to increase the risk of liver cancer by a large factor, yet that is not included in this study (it was never tested).

End Result: Tamoxifen was approved as a preventative drug in high-risk patients because it reduces the relative (low) risk of breast cancer by 49%, despite the fact that the real benefit, spread across diseases and medical conditions studied is extremely low. Even if we examine it myopic, the benefit, in real numbers, is very, very low.

Another way of using relative numbers is in survival. Examine this study of Sorafenib. The pill increases survival by 44%. What this means, in real numbers, is the median life expectancy without Sorafenib was 8 months. With Sorafenib, the median survival was 10.7 months. Three extra months of life is all you get with this miracle pill, but these are also 3 extra months of pure chemo hell.

If you, or a loved one, has been diagnosed with cancer, make sure you understand what the real numbers are, so you can make an informed decision.

Others in this series:

·         The Caroline Pryce Walker Conquer Childhood Cancer Shill Game

·         Childhood Cancer Statistics (13,712 estimated diagnosed in 2008)

·         Understanding Appropriations – The Carolyn Price Walker Conquer Childhood Cancer Act

Peace and Grace,
Greg

Twitter: @gbworld

Letter to the Editor


I saw this letter to the editor posted with much praise on a forum I belong to.

Every day we consume public options
I stood in line at the post office and, as usual, someone commented about the long
line, small number of clerks and the government-run operation. Curious, I asked why
didn’t he go to FedEx or UPS. His answer: "They charge too much." Oh, I see; he
chose the public option over a private company because it’s more affordable. This
conversation made me wonder what other public options we use every day.

There are many fine private education facilities available, but the majority of
students attend tuition-free public schools. There are numerous places to buy books,
but the community uses the public library by checking out books, taking children to
story time, or using computers – all free services. So, why the aversion to a public
option in health care reform?

Health care is a moral issue, and those who espouse family values are the ones who
object the loudest. Doesn’t the woman working two jobs to make ends meet deserve
health care? Or the single mother raising her children? Or the man who lost his
factory job after 20 years of employment? Is one less deserving than another? In
this great nation, the wealthiest of nations, it’s time for all citizens to have
access to health care.

Ramona D. Marek
Vancouver

The problem I have with this commentary is it is completely based on emotion and not fact.

Public “Free” and “Cheap” Services

If we flip some of the arguments, we start to see glaring holes. For example, the free services mentioned are not really free, but prepaid. Perhaps we should be asking the question why people are actually buying books when there is a “free” or cheaper option available. The answer is rather complex, but generally breaks down to

  1. The free option is inferior. In the case of the postal service, UPS and FedEx both guarantee delivery in a timely manner; the postal service does not. In the case of public schooling, one looks at statistics. In the library, it may be in the form of out of date books (esp. in technology)
  2. The free option is limited. In the case of the library, the book is unavailable. No upfront cost, but there are opportunity costs for waiting for something that may take a long time.

One of the aversions to a public health care option is the fear of prepaying for an inferior and/or limited service. Looking at other “public” options, this is a realistic fear. In general, the government services are designed as stop gap measures. As such, they generally are inferior and limited in scope. But somehow we have the unrealistic expectation that health insurance reform will be different.

Moral Issues

The author states health care is a moral issue. How does she come to this conclusion:

Decency? As a person who supports multiple charities with my time and money, I can buy into this idea.

Out of decency, I agree that we should provide health care. I propose the following.

  1. Charitable organizations set up foundations that provide free or low cost health care to those who cannot afford it
  2. Governments add to these organizations through funding or through government sponsored health care centers
  3. Hospitals and health centers, public and private, be mandated to aid those in times of emergency regardless of ability to pay

If we are talking decency, then the current system covers the moral imperative, as it does all three of the above. Today, one can enter any hospital in this nation and be treated for illness, both life threatening and non, without proof of the ability to pay for it.

Or perhaps she sees health care as a necessity?

Air is necessary; without it we die in minutes. Water is necessary; without it we die in days. Food is necessary; without it we die in weeks. Clothing and shelter are necessary; the length of time in which we die without these necessities can be as low as minutes in freezing climates. How long can one survive without health care? This is variable, but statistically speaking, the average person will get to the age of 65 or greater (for women) without a life threatening health care issue. This means more than 80% of the average life can be completed successfully without any health care.

But suppose we approach this as we approach necessities. When we view actual necessities, like food, water, shelter and clothing, our solutions are very different than what we are proposing with health care. Food stamps offer access to the necessity of food, but give limited choices, as the vouchers are limited in value. Housing assistance offer access to the necessity of shelter, but the type of house one can choose from is limited. In most cases, charities fill in the gaps that the government programs miss. And, today, we offer the same for medical care in the form of free clinics and regulations that hospitals cannot turn away the sick due to lack of insurance.

So, morally, even if we approach health care as an imperative out of necessity, the current systems fulfills our obligation.

Access to Health Care

The author talks about people not having access to health care, but if that is the issue, people do have access to health care, when it is necessary.

If we look at the other necessities in life, we are given access, but not the access of our choice. Our government offers us clean drinking water, but if we want non-chlorinated water, we have to buy it. Our government offers food stamps to those who cannot afford food, but if they want Ruth’s Chris they have to pay for it. Our government offers housing assistance, but not at the Ritz Carlton.

But the author does want bottled water, Ruth’s Chris and the Ritz Carlton for everyone when it comes to health care. She is not arguing for access, but for access to the doctor of her choice. She is stating that this type of access is a right and appealing to class envy to bolster her argument. But she is not really thinking through the moral imperative, access to health care, or even her analogous “free” services when she approaches this issue. It is purely emotion.

Health Care in America

When looked at objectively, we have a pretty good system. In some areas, America leads the pack. Inchildhood cancer, for example, is above the rest of the world in survival statistics. We are not the best medical system in the world, but we are not the worst.

We are, however, the most expensive health care system, per capita, in the world. Waste, in the United States, accounts for more than 50% of the total costs of health care (about 1.2 billion out of 2.2 billion). Our major health care problem is not access to doctors, but the sheer amount of waste.

The solution proposed by our government is to ensure everyone has insurance. The problem with this approach is it places a middle man in every medical transaction. When a person is not paying for what they are consuming, prices inevitably go up. In addition, when there is a middle man paying the bills, and costs go up, there is no choice but to raise rates or limit services.

There is an idealistic viewpoint that making the government the middle man will solve the problem better than insurance companies as middle men. This is unrealistic. Government really has no incentive to keep prices down, as they can reach into any number of buckets (at least for the near future). There is no reason to control costs when you can simply pass them on.

There was an article in Forbes on the waste in the health care system. Of the different areas of waste, emergency room visits is the only area moving to a government option would solve, as everyone would have access to the doctor of their choice with their government insurance card. But, one of the largest areas of health care waste is in the form of paperwork. This is primarily due to programs like Medicare and Medicaid (government run programs) which have a very high amount of paperwork compared to insurance claims. If we move to a public option, the expense of this area is likely to rise. As it is one of the highest areas for waste, the expense of health care will likely rise.

Of course, government can mandate a fee schedule, as has been pointed out to me numerous times. The problem, however, is if (or when) costs rise, the fee schedule will still rise, or you will see smart doctors getting out of the business. But, then, some have suggested not only a single payer system, but getting rid of hospitals as we know them. In this vision, all doctors are employees of the government. I am not sure how we think this will work, as most doctors I know of that started in government service (military primarily) got out as soon as their mandated time was up.

Summary

I believe we have a moral imperative to offer necessary medical care to those who cannot afford it. I do not believe we have a moral imperative to offer an insurance card to everyone, however. Yes, we do need to improve our system, especially for those uninsured, but we should focus on the biggest problem first, which is not access to health care.

I think the only way we will see prices going down is if health insurance is treated like other insurance. If the average person paid his day to day care and held insurance for catastrophic illness (meaning making it more like car insurance or home owners insurance), we would see some changes in pricing. If this was further bolstered by transparencies in fees, fostering competition, we would see a radical shift in the cost of health care. If further bolstered by tort reform and information technology, we would wipe even more expense out. We would then be in a better position to try options other than insurance as the only solution.

During this health care debate, I have often heard people say “you of all people should understand the need for health insurance for all Americans”. They are talking about my daughter’s fight with cancer.

What I have found is this:

  • Health insurance is an industry that does not really care about the cost of health care. They care about making sure they can maintain a certain percentage of profit despite the cost of health care. Thus, they set up rules that are easy to forget, that exclude certain items. They find ways to get rid of the most expensive options. And, they fight any more expensive option unless there is adequate medical reason.
  • Those without health insurance get the same care as those with when it comes to terminal illness.
  • Most of the cost of health care is written off for those who cannot afford it. In fact, I know many parents who had no insurance who pay less than I do for health care … and I am insured.

Imperfect system? Certainly. But despite having insurance, I don’t see insurance as the answer. In fact, if I had the option when I signed up for my current policy, I would have preferred an HSA with insurance for catastrophic medical only. It would have cost me a bit more out of pocket on a normal year, but the savings in premiums would more than make up for it. Through my daughters bout with cancer, it might have been more expensive, but not nearly as expensive as it would be if HR 3200 had passed back then and we had to go on that option.

I am not stating that all arguments for health care reform are bogus. There are many good arguments out there. I just don’t see “everyone having an insurance card” as an option that solves the real problems with health care in America.

To those who state “you of all people should understand the need for health insurance for all Americans”, perhaps you should be thinking “you of all people understand the problems with health care, so perhaps I should listen to you”. It is just as logically unsound as an argument, but it balances out the equation.

Peace and Grace,
Greg

Twitter: @gbworld
September is Childhood Cancer Awareness Month: http://www.crazycancertour.com
Miranda’s Caring Bridge site: http://www.caringbridge.org/visit/mirandabeamer

Garlic and Brain Cancer, part 2


I have been doing some research on cancer lately (see last post here) due to my father-in-law being diagnosed with glioblastoma multiforme. It is not our first bout with cancer:
  • Grandmother (breast cancer) – passed in 1972
  • Two aunts (breast cancer) – recent, both in five year period
  • Daughter (non-metastatic Ewing’s sarcoma)

It is my daughter that first got me interested in cancer and during her treatment I found how woefully ignorant most doctors are of nutrition. In fact, talking to Tiffany’s cousin, I found he only had 8 hours of nutrition during his entire medical school career (that is 8 real hours, not 8 semester hours). Unfortunately, this is typical.

During Miranda’s treatment, we found that supplementing with L-Glutamine reduced mucositis symptoms tremendously. We also found that she stopped getting C-Diff infections when supplemented with probiotics. And we found that supplementing with certain minerals reversed what the rnal specialists told us was permanent kidney damage. Realize that a study of one is not scientifically conclusive and that the kidney diagnosis may have been incorrect, but it is still evident that the supplementation we fought for did wonders for our daughter. This is why I am very interested in nutrition in disease management and prevention.

What is interesting is going back and looking at just one active ingredient over history. In particular tracing back Diallyl Trisulfide (DATS), an active ingredient in garlic. It is of interest now as DATS is especially good at causing apoptosis (cell death) in glioblastoma cells. The way it works in cancer is very complex, but one interesting aspect is DATS causes cancer cells, or at least certain cancer cells, to be starved of Glutathione (GSH). Without GSH, the cell seems incapable of sustaining its "immortality" and the tumor dies.

The studies I am currently looking at are from the 1980s. With hindsight (which is 20-20), it seems someone should have noticed this before. But, I do realize that cancer was more mysterious then, doctors are trained to trust drugs, and a variety of other reasons "blinded" us to something so simple for such a long time. I also realize getting grant money is hard, especially for something that, scientifically speaking, is considered more of a "whim" than a theory.

It boils down to this. garlic, or rather one or more of its active ingredients, causes GSH (Glutathione) starvation in certain types of cells. Conversely (perhaps paradoxically) garlic has been shown to increase GSH levels in the body. GSH, or Glutathione, is a molecule made up of three key amino acids. One of its primary "symptoms" is a charged immune system, which is a good thing. In general, raised GSH levels are good, as high levels have been shown to help detoxify the body and help in a variety of disease conditions, including cancer, allergies, alzheimers, diabetes, etc.

I would not state that garlic, by itself is a cure. In fact, I am suggesting that it is one component in a diet that can be used to complement conventional treatment for disease. I also believe that is is a decent component to avoiding disease. In that area, I would also include:

  1. Increase in physical activity (exercise)
  2. Healthy weight maintenance
  3. Diet rich in fruits and veggies, lower in meat products
  4. Diet with meat that is more balanced in essential oils (omega-6 and omega-3) – free range is generally better if you know that it is truly "ranged"

There are others, but this is a good start. Would I replace conventional medical treatment for these options alone? No. Perhaps one day, but not today. But, think if we spent as much research dollars on nutritional elements as we do drugs? That would be powerful. And, despite medical poo pooing of the idea, I think nutrition could be the key, or at least part of the key, to curing cancer and other diseases. Of course, we have to either shift our priorities or figure out how to make money off it, right?

Peace and Grace,
Greg

Garlic cures Brain Cancer?


I was looking for some information on glioblastoma, due to my father-in-law’s diagnosis. Interstingly enough, I found a study that showed massive apoptosis (cell death) of cancer cells, using active ingredients in … are you ready for this … garlic. This is big news. It appears that there is now evidence that garlic can kill glioblastoma cancer cells. You can read the study here, if you are medically inclined:
 
This is not really new news, as garlic has been shown to be effective against breast cancer (http://carcin.oxfordjournals.org/cgi/reprint/22/6/891), prostate cancer (allium veggies in general – http://jnci.oxfordjournals.org/cgi/reprint/94/21/1648), bladder cancer (http://jn.nutrition.org/cgi/content/abstract/131/3/1067S) and many others.
 
What is new is the extreme amount of apoptosis in a type of cancer with a median life expectency of about 9 months. At levels of 500 μM , there is almost complete aptosis of the cancer cells. Since this is in vivo (in a test tube), there are still questions of how to get the chemicals from the garlic into the brain (I am not sure if they pass the blood-brain barrier, still researching), so we need clinical trials. Number of clinical trials proposed for garlic on glioblastoma: 0.
 
Let’s look at a different direction. Last year, they found a new drug Abiraterone was effective on prostate cancer. Number of clinical trials for Abiraterone on Prostate cancer: 8. This is a new drug. What about "old" drugs, meaning those in studies for at least 5 years. Herceptin is in 296 studies, mostly breast cancer. Gleevec is in 355 studies on a variety of cancers.
 
Now, one might argue the efficacy of the drug versus chemicals in garlic, as the measure of what gets study money. Unfortunately, it is hard to compare apples to apples here, as one study focus on cell viability and the other on tumor shrinkage. But, let’s look at it. In the Herceptin study (Trastuzumab – http://jco.ascopubs.org/cgi/reprint/23/11/2460) study, aptosis increased by 35% with a median tumor decrease of 20% over 3 weeks. In the garlic study, viability of the cancer cells reduced from 90% to less than 10% at a level of 500 μM, with DATS (one the active ingredients: DAS, DADS, and DATS), this type of cell death was seen at 100 μM.
 
Now, I am not a researcher or a doctor, so I cannot tell you how less than 10% viability relates to 20% tumor shrinkage, but, as a thinking human being, I would gather that a huge decrease in viability equates to a large amount of shrinkage in tumor size and a great amount of tumor cell apoptosis (death). To me, this would at least warrant one study on glioblastoma and garlic.
 
Why the disparity?
  1. Brain cancer is rare. It is also a killer, but rare is why it is not studied as much.
  2. The breast cancer "lobby" is very noisy (think pink ribbons), thus breast cancer is more noticed.
  3. Drug companies fund many of the studies.
  4. Doctors are taught to use drugs as cures. Thus studies not funded by drug companies often go to drugs.
  5. Doctors are woefully ignorant of nutrition. According to the American Association of Medical Colleges, the class of 2012 (those entering med school today) will be required an average of 21 hours of nutrition over 4 weeks of study.
  6. It is hard to make money off food, as a drug.
If, in fact, garlic can be shown effective in vivo (rat studies), it would be wise to move this up to clinical trials as quickly as possible, as lives are at stake. But I do not have a lot of faith it will happen. Once I can figure out a decent regiment, I am going to pass it on to my father-in-law. I am not going to suggest going away from the radiation and chemo, but instead add garlic as a complementary treatment.
 
By the way, if you are currently diagnosesd with cancer, there are other natural chemicals that show promise in fighting cancer. I would not necessarily suggest going completely alternative, but I would look into eating more cruciferous vegetables (brocolli, kale, etc.), turmeric, garlic and hot peppers. It would also be wise to increase anti-oxidants, but I would do a bit of research as antioxidants can reduce the efficay of the active ingredients in some of the more potent cancer killers (garlic, turmeric). The positive side of natural "cures" is the reduction, if not elimination, of side effects.
 
Peace and Grace,
Greg