Dr. Kordonowy will now be posting his blog entries on his new blog, The Doctor's Report. Please visit and subscribe!
 
 
I just attended for the second time the Physicians' Counsel For Responsible Reform (PCRR ) in Washington DC. 

This is the second time I have had the opportunity to sit and discuss the issues of delivering health care in the present economic environment to PCRR. There are now several physician congressman in DC who, like me, understand that individuals will not get good or affordable health care if it is controlled by the central planning methods outlined in this legislative debacle.

It is only partially in effect and already the Congressional Budget Office has on record stated that the tab is already running (upward) at 1.8 trillion dollars in costs to enact this legislation.  We were told it would (only) be 998 billion when this 2000 page tome was passed- what a joke!  By tome I mean a large work, but in this case certainly not learned.  

As Americans, we have to ask ourselves "are we going to allow Executive branch designees/boards to force all of us into the activity of insurance commerce as they decide what things our forced purchases are going to cover"?  That is what this law does. It is completely absurd that we as citizens would relinquish our rights to be engaged in a free health care market in order to pay for what some appointed board decides is defined under health care.   

What if the board decides we all have to pay for each other's massages or Tylenol?  Are we all ok with having that wrapped into our "forced insurance premiums"? They already are trying to tell us we have to pay for all use of birth control -under the guise of preventive services, yet the individuals getting the pills can't pay anything out of pocket at the time of getting the service!  I guess one could define the prevention of the birth of a human being as a preventive service?!?  It doesn't matter if you might disagree with that being included in the definition because under this law, the Health Secretary has made that decision for you and me. This is much more than a religious issue, this is about Life, Liberty and the Pursuit of Happiness-and plain old common sense.  This birth control thing, by the way, is just one of the first "to be approved by the Secretary of Health" policies.  With the authority provided in this law, the Secretary of Health will be able to get into all aspects of your life, if it can be construed in any way as health related.  Is this freedom?

I am flabbergasted at the apathy of the American public and the physicians in this issue.  One of the physician attendees stated some Scottish philosopher (couldn't quote a name) had taught us that democracies tend to die out specifically because of the populous apathy that evolves over a democracy's life-cycle; I guess perhaps we are there?  If more of us, like myself, can wake out our slumber and understand what an absolute takeover this is, we can help our government retract this disaster and re-evaluate health care policy.    

The forces that need to be dealt with include: engaging true cost accounting/price disclosure in the market place, limiting monopoly and oligopoly forces that have gotten us into such an expensive, inefficient payment/contracting system and putting a stop to all the regulatory burdens that are creating provider inefficiency and increased delivery costs.   

Let me provide one example of how regulatory burdens affect efficiency and delivery costs. I can't provide you a less expensive professional visit if I am mandated to provide additional services at the behest of our government.  Before the government mandated the use of Electronic Medical Records, our group considered it a competitive advantage and thus we voluntarily purchased a system years ago.  Now the government has mandated the use of EMR.  Specifically because there is price fixing in place for Medicare, the government had to create a subsidy incentive to entice providers to buy these record systems. In order to justify getting the subsidy (and I suspect it was also a give away to the hardware and software companies), policymakers created a work list of rules that all approved EMR systems will have to be able to do. They did this in order for the providers to get a rebate (the government subsidy) on their forced/mandated EMR purchase.  The investment cost far exceeds the subsidy without including the time element that our administrative staff will dedicate to "prove we are worthy of the subsidy".

Because they decided the rules (rather than the providers and patients), our prior EMR company abandoned our product and we had to go to their newest version.  The is the one that will meet all the standards set by the federal government. We as physicians were forced by law to purchase an upgraded system at well over 6 figures for our four physician practice. It now takes more time to use the product than before and this translates to less doctor time for actual patient care. That is a drag on efficiency. Furthermore, because of our government price-setting, combined with a law that doesn't allow us to bill Medicare patients above that set price, your doctors are paying out of pocket for these upgrades (that's a direct tax on your doctor). Now patient consumers wonder why they can't find private practice physicians in the outpatient setting? If you have noticed the local newspaper ads, virtually all new doctors in the area are either Hospitalist or hospital hired physicians. Without the hospital subsidizing these infrastructure costs, new doctors can not make this financially work. Presently, hospitals can subsidize physician employees because hospitals get paid substantially more for the very same services physicians in stand alone operations get paid.  CMS, a board that advises Medicare patients, has decided to compensate hospitals substantially more than physicians. Hospitals aren't getting cut by the SGR formula, doctors are. Unless physicians can charge more than what the government is paying we will all slowly go out of business- it is that simple. 

Now with the mess Medicare is in, we are ok with the Patient Protection and Affordable Care Act?  This Act is nothing more than attempt to force a Medicare type (price fixing) model on all citizens.  It is such a predictable disaster that the Obama led legislation created an authoritative overreach by mandating we all buy this bill of goods (hogwash is a better word). That is why the federal government is mandating we all purchase health insurance from birth to death.  No rational person would buy this crap otherwise.

While on the plane to DC on Monday morning, I read Congressman Michael C. Burgess, MD's book titled 'DOCTORx in the HOUSE, a Physician-Turned-Congressman Offers His Prescription For Scrapping Obamacare... And Saving America's Medical System'. " 169 pages of a very readable book that explains what happened in Canada after it nationalized its health care system and how what is happening now is very similar. He is credible because he is a third generation physician who's father left Canada and whose grandfather thrived there as a physician before the government started running the health care system.  He was in Congress as a Texas member of the House of Representatives when the Obama administration decided to force this Healthcare agenda on America.  President Obama and his administration did this while the nation was dealing with one of the worst and expensive financial crises in our history.  Dr./Congressman Burgess very calmly explains the politics behind what happened.  He explains what insurance really is and why it is financially impossible for the President to make the claims he does. The President says that he can give us all more while it will cost us all less.  Only an apathetic or ignorant society could believe such panhandled hogwash.  I ask that you read his book so that you aren't ignorant to this most important modern issue. I learned a lot from reading this well written book. Besides being a 30 years in practice OB/GYN doctor, he has a Masters degree in Medial Management from the University of Texas at Dallas, which further adds to his credibility. He finishes the book with 9 common sense, doable policies that would go a long way to changing health care for the better, and bolstering the patient physician relationship, not abolishing it as the Patient Protection And Affordable Care Act will do.

Hopefully, the Supreme Court realizes the unconstitutionality of the Patient Protection And Affordable Care Act this whole thing will be deemed unlawful and thus clawed back. The executive branch (yes folks, that's the President) needs to be handily told that forcing individuals into commerce is not a power our constitution gives the President or the Federal Government/Congress.  Hopefully when we vote for the President in November and hear further debates in health care, we are all mindful of this Act and the lessons to be learned surrounding its history.

Respectfully,

Raymond Kordonowy MD
Internal Medicine Of Southwest Florida
 
 
         Its too early to know if this will work but it does appear promising.  Tying in a protein found on HDL cholesterol (known as Apo E) with amyloid has resulted in a basic science experiment which shows real promise for Alzhiemer's disease treatment.  The Wall Street Journal featured an article showing that a compound known as bexarotene (safe for treating skin cancer) stimulated mice genetics to increase Apo E production. This was associated with increasing dissolving amyloid plaque in a mouse Alzhiemer's disease model and a sustained improvement in cognition function. Prior to the compound being given to the mice, they couldn't smell or make a nest (loss of smell is frequent in Alzhiemer's patients). Within 3 days they were making organized nests (normal behavior lost when they are demonstrating Alzheimer's disease). This research will lead to human dosing trials according to the article.
         This summer I attended an HDL class sponsored by the National Lipid Association and learned that there is a metabolic pathway whereby HDL cholesterol does affect amyloid and other neuroprotein metabolism. This article suggests that the Apo E protein found in HDL may be what regulates this.  I predict that we will learn over time that HDL cholesterol has many more functions than our current simplistic understanding about returning cholesterol from cells back to the liver--which in and of itself is very important for treating and preventing atherosclerosis. 
 
 
The president of the Florida Medical Association (Dr. Miguel Machado MD) goes to the mat for Doctors and patients.  Please read the letter sent to our congress, which he cosigned with other mutually interested representatives. This letter contains recommendations for reform that will enable a more efficient and viable healthcare system. 
Read the letter here: http://www.flmedical.org/uploadedFiles/INFORMZ/LinkforPR11-18-11.pdf



 
 
For years, the FDA recommendation for annual prostate cancer screening has been digital prostate exams along with the PSA (Prostate-specific antigen) blood test annually starting at age 50.  Recently, there has been a U.S. Preventive Services Task Force draft recommendation suggesting that the PSA test not be used for prostate cancer screening.  IMSWF physicians routinely offer this test in our recommended health prevention lab profiles for men.  Up to this point, the physicians haven’t changed this general recommendation, but I do agree that there is some need for discussion regarding the necessity and utility of this test. Browse the following links for more information.  What is your opinion on the prostate cancer screening debate?


 
 

Health insurance premiums are rising far faster than inflation or wages.  Doesn't this make it obvious that things are amiss?  Perhaps there is price fixing?  The mandate forcing citizens to buy insurance (Obamacare) merely "feeds the citizens to the wolves" -shame on this position!

http://www.mcclatchydc.com/2011/09/27/125423/job-based-health-insurance-premiums.html
 
As Dr. Kordonowy has stated before, the rising health insurance premiums are "stealing employees wages".  The system continues to asks the employer to purchase insurance for employees and this translates to lost wages to the employee.  Since the employer isn't using the product and since it is considered a business expense, the employer doesn't negotiate or shop as intensely as the individual would.  The biggest fear the private health insurance industry has is that real individuals demand real products if they are going to pay for them.
 
 

Dr. Kordonowy has indicated Healh Savings Accounts's are a step in the right direction to place better personal and provider accountability into health care delivery and improve personal choice for your health care.  The following link indicates that companies are now recognizing this as " the future" for health care payments.  Dr. Kordonowy would favor eliminating requiring PPO insurance as part of the HSA option (currently required by law).  Only when the insurance industry is forced to provide consumers with less expensive insurance options (such as true catastrophic coverage) will the HSA find its true market potential.  Persons who take on higher levels of personal risk via HSA accounts and higher personal deductables should see proportionally lower insurance premiums from the industry. With the PPO rider requirement in the law, the health insurance industry doesn't have to provide the consumer with a fairly priced product.


"Lower insurance premiums will mean more take home pay for the average employee.  It is a sad state of affairs to see the past decade of potential wage increases be siffoned from employees only to feed the coffers of the health insurance industry and the fixed prices of the health care industry. Now our government wants to force us to make these payments- from birth to death! "  Ray Kordonowy MD 
 
 

Obesity is costing us a lot of money in health care costs.  The following article demonstrates that if we educate ourselves to a better lifestyle, we save a lot of money and prevent a lot of disease.  The physicians of Internal Medicine of Southwest Florida have been using a holistic approach to health such as providing our patients access to a Certified Dietitian in order to learn how to make better food choices and encourage exercise to maintain ideal health. 
 http://www.internalmedicinenews.com/newsletter/internal-medicine-news-e-newsletter/singleview40794/weight-loss-programs-could-save-medicare-up-to-15-billion/b1a1b3e132.html
 
 
Xarelto (rivaroxaban), a Factor Xa inhibitor, has recently been approved by the FDA for the treatment of Deep Vein Thrombosis. A recent trial has also shown that Xarelto is noninferior to Coumadin (warfarin) in treatment for Atrial Fibrillation.  The following article discusses studies involving this new and exciting medication. 
http://www.internalmedicinenews.com/newsletter/internal-medicine-news-e-newsletter/singleview40766/rivaroxaban-contests-warfarin-for-stroke-prevention-in-af/cb1b135f01.html
 
 
Another example of vaccination being safe and effective, the Hib (Haemophilus influenzae type b) vaccine has been used in children since 1992 to prevent infections such as pneumonia and meningitis. The vaccine has been extremely effective in preventing such infections in children who have been vaccinated. Recently, however, prevalence of Hib disease has seen an increase among adults.  According to the CDC (Center for Disease Control), adults with specific health conditions such as sickle cell disease, HIV/AIDS, removal of spleen, bone marrow transplant, or cancer treatment with immune-suppressant drugs need to be protected from Hib by the vaccine.  The following article explains the increase in Hib infections, but does not stress the fact that adults can, in fact, be vaccinated. http://www.webmd.com/healthy-aging/news/20110811/hib-disease-increasing-among-adults
 

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