The Contraception Mandate: Obama’s Latest Trojan Horse

Unfortunately, controversy over the Obama administrations recent “contraception mandate” has virtually consumed the presidential primary over the past several weeks.  This is the mandate that states that virtually all employers, including Catholic and other religious institutions, would be forced to pay for free preventive services, including sterilization, contraceptives and drugs that cause abortion, and that all insurers would have to cover these services without additional cost to the patient. 


It’s not that the topic is unworthy of discussion and outrage, but conservatives have quickly allowed the arguments to go precisely where liberals directed them – to a perceived Republican assault on contraception itself, and a frenzied uproar about attacks on “religious freedoms”.  As a woman, a physician and a Catholic, I find this both disingenuous and absurd. 

There is nothing about contraception that is a pressing “women’s health issue”. Pregnancy is not a disease.  And without detailing the obvious, there are adequate ways to prevent it with absolute certainty.  Furthermore, multiple big-box pharmacies sell contraception for less than $10/month, rendering this hardly a “healthcare crisis” demanding the kind of national outrage that many Democrats and at least one outspoken Georgetown law student have suggested.

And try as they might, Democrats would be hard pressed to find more than a handful of conservative Christians whose stance is that access to contraception, in and of itself, should be limited or banned – Theirs is simply an issue of who should be expected to provide and pay for that contraception.

The outrage over the contraception mandate is well justified – But the focus should be on the real issues at hand: Firstly, that it is part of the government’s bigger plan to control healthcare costs by engineering healthcare guidelines and implementing social programs that meet that goal, independent of the overall impact on health and wellness; and secondly, that it represents yet another egregious intrusion of the federal government into the affairs of private companies and private citizens, and reflects a highly concerning level of control over our private lives, extending far beyond an affront to religious freedom. 

Consider first the Democrats’ contention that contraception is a “women’s health issue”. Health and Human Services Secretary, Kathleen Sebelius, told the House in mid-March that contraception is "a critical preventive health benefit for women and for their children."

This argument is particularly interesting given that at the same time Democrats are claiming that contraception is a “critical women’s health issue”, and are attempting to paint Republicans as cold and heartless in that regard, the Obama administration’s Preventive Services Task Force has come out with new recommendations that women should not start regular breast cancer screening until age 50 rather than the previous recommendation of age 40. The new guidelines came out in November 2009, from the group that has significant influence over doctors, insurance companies and policy makers. The Task Force’s new recommendations also state that women between ages 50 and 74 should only have mammograms every other year, rather than every year. And it recommends that doctors stop advising women to do breast self exams.

The Task Force’s stated reasoning behind these new guidelines is that that only one person was saved for 1,900 screened – A conclusion that has been heavily contested by a number of groups, including the American Cancer Society. The panel felt the cost of all these screening mammograms and the potential for false positives outweighed the impact of early detection.

For years both self-examination and mammograms have been essential parts of regular preventative breast care for women.  According to the American Cancer Society "death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50." A combination of early detection and improved treatment regimens are cited as the primary reason for improved survival rates.

U.S. government-run insurance plans and companies will now likely use these new federal Task Force guidelines to eliminate coverage for yearly mammograms. In addition, the Task Force has released new guidelines on cervical cancer screenings suggesting that women should wait until their 20’s to have their first pap smears and that they should be re-screened less often.  After years of educating women and the public to participate in early detection screening, the Obama administration has just done an about-face when it comes to breast and cervical cancer.  Many on the right have correctly concluded that the changes in guidelines are nothing more than rationing intended to save healthcare dollars.

When asked who will pay for the new HHS contraception mandate, Secretary Sebelius finally showed her hand: She replied that a reduction births will compensate employers and insurers for the cost of complying with the new requirements.  “The reduction in the number of pregnancies compensates for the cost of contraception,” Sebelius said. She went on to say the estimated cost is “down not up.”  In other words, it’s important that we provide contraceptives because pregnancy is more expensive to the federal government than the cost to prevent pregnancy.

This all begs the critical question: “Who is really the strong proponent of women’s health, and who is simply trying to cut healthcare costs with rationing of services and social engineering maneuvers?”  Just imagine how much money we will save when we stop diagnosing breast and cervical cancers when they’re still early enough to treat!

Now look at point number two -- The over-reaching impact of the mandate on our personal liberties: While many are focusing on the contraception mandate as a violation of religious freedom -- which is real -- and the associated affront to our constitutional, First Amendment guarantee of religious liberty, the bigger issue is being obfuscated: when the government takes over control of our health-care system, it takes control over our most private, personal decisions.  It also assumes control of everything that private companies and organizations – religious or otherwise -- can do.  Business models, plan designs, revenue streams, and customer relationships are totally at the whim of the government. This is about ultimate control of very aspect of society: religious, social and economic.

One of the first critical steps to implementing the single-payer government healthcare system that President Obama and so many on the left promote, is to force consistency in coverage and homogeneity in plan design; in other words, to force removal of all customization and personalization.

In a free market, insurers are able to customize plans and tailor coverage to meet the needs of employers and individual buyers vs. the government dictating a one-size-fits-all plan. Amongst other things, free-market competition and the ability to provide a better product drives innovation and keeps costs down.

If the government can now dictate that employers and insurance companies have to provide contraception for the prevention of pregnancy, what’s its next mandate: Car seats for infants?  Bicycle helmets?  Football pads?  Perhaps sun screen?   In this way, the contraception mandate defines the proverbial “slippery slope” in the take over of healthcare, and ultimately in controlling society.

 At what point does the relationship between the insurer and the insured, the employer and the employed, the doctor and the patient, lose all semblance of humanity and become a prescribed set of governmental rules and mandates aimed at driving the populace to the lowest common denominator?

In one fell swoop, the United States will go from the country that has the best cancer and trauma survival rates, and has made more discoveries and advances in healthcare than any other nation on the planet, to the one that is crippled with mandates and onerous regulations that effectively stifle innovation and progress, and one where critical screenings and services are rationed based on actuarial calculations rather than medical science.

Democrats have effectively skewed the optics of the contraception argument to appear that it is about the value of protecting women’s health and whether or not religious freedom should supersede the sanctity of sexual freedom.  If we can see beyond the affront to Catholic social thought, the discussion is really about government mandates aimed at rationing healthcare dollars, controlling costs, and applying an artificial coda of social “equality”. It reflects a continued march down the path to increased intrusion and control by the federal government into the private lives of its citizens.

If we believe that the Constitution’s protection of our lives and liberty is valid, then the Supreme Court must declare the Patient Protection and Affordable Care Act unconstitutional, and ultimately stop the limitless control of the government over our lives, such that we can return our country to the path to liberty and prosperity.

                                                     blog founded by Kelly Victory
                           written by Kelly Victory MD copyright 2012 all rights reserved

Re-thinking Healthcare Insurance: A Prerequisite to Successful Healthcare Reform Kelly Victory, M.D.

It has been nearly 18 months since the passage of the Patient Protection and Affordable Healthcare Act, the single most significant legislative change to be passed in our lifetimes. Hopefully by now, most Americans are aware – and President Obama himself has admitted -- that the 2600-odd pages of legislation known as the “Healthcare Reform Bill” ultimately constitute nothing other than an attempt at health insurance reform.  The primary goal of the bill, cost containment, was an abject failure, and there are only minimal references to the pressing issues of quality and access. The resultant bill is little more than a continuation of the complex shell game we have been playing with regard to who is going to pay, who they are going to pay it to, and when they are going to pay it.

Unfortunately, a further essential flaw of the reform legislation is that it fails to address the fundamental, underlying fallacy of healthcare insurance in this country.  Insurance, as a product, is excellent for mitigating and diversifying risk, and accounting for unpredictable and catastrophic events.  It is not an economically viable solution, however, to address routine and/or maintenance issues.  In addition, insurance premiums are normally predicated on some calculation of one’s overall risk profile.  Automobile insurance, home-owners insurance, and life insurance policies all reflect these basic constructs. For reasons that are not entirely clear, however, we apply an entirely different set of expectations when it comes to healthcare insurance.

Take automobile insurance as an example; it is illegal to drive a car in most states without carrying car insurance.  We expect that the policy will off-set the costs if significant car damage is incurred as a result of an accident or an act of nature.  Yet, when one goes to fill up the car with gas, change the oil, or rotate the tires, there is no expectation that one’s car insurance would pay the bill. Likewise, one cannot obtain a home mortgage without carrying homeowner’s insurance.  The policy is meant to protect the homeowner in the event of catastrophic damage from fire, storms, vandalism, etc. -- But when you repaint the house or mow the lawn, there is no expectation that this would be covered.  So why then, should healthcare insurance be anticipated to pay for routine expenditures on maintenance items like annual physicals, routine blood pressure checks, pap smears and immunizations?   


Can you imagine what car insurance would cost if you wanted it to cover every fill-up and trip to the Jiffy-Lube?  How affordable would homeowner’s insurance be if you had a rider that covered snow plowing and routine lawn care? 

It appears that healthcare “insurance”, the way most Americans expect it to be, is a misnomer;  we want to pay the low rates associated with “insurance”, but be protected as if we have a “pay ahead” plan – one where all of our healthcare needs are covered, from the routine and expected to the catastrophic.  Such a policy can be nothing other than astronomically expensive.

Furthermore, healthcare insurance is the only insurance where risk profile is not a routine factor in the calculation of premiums. One can essentially guarantee an increase in car insurance rates after obtaining multiple speeding tickets, while  completion of a safe driving course or ice-driving school will generally result in a reduction.  Failure to install smoke detectors or buying a home located in a flood plain will most certainly result in higher homeowner’s insurance premiums.  Sky diving, race car driving and heli-skiing will generate an entirely different life insurance premium than a less aggressive risk profile.  


If we applied this same model to healthcare insurance then, shouldn’t smokers, and those who are sedentary by choice, pay a premium for those life-style choices?  We know that certain modifiable, life-style behaviors such as smoking, failure to wear seat belts, physical inactivity, etc. drive excess healthcare costs, yet this sort of “profiling”, when applied to healthcare insurance, has been seen as discrimination and anathema.   

Americans are going to need to get their heads around the concept of personal responsibility when it comes to healthcare.  Healthcare insurance, like every other form of insurance, simply cannot cover soup to nuts and remain affordable.  That model also defies the very concept of “insurance”.  On the other hand, we can promote the use of individual savings mechanisms such as Health Savings Accounts (HAS’s) that provide a way for individuals to accrue pre-tax dollars in an account that they then control to cover downstream healthcare costs. This supplemental savings, when added to standard catastrophic insurance, allows individuals plan and save ahead for routine and maintenance healthcare items.

Likewise, lifestyle choices and personal behaviors must be factored in to the determination of risk profile and therefore, premiums.  While we can’t expect people to pay more for things that are not within their control, such as a family risk of colon cancer or a personal history of congestive heart failure, we should incentivize and reward those who choose not to smoke or to remain physically fit by offering them a lower insurance premium. 

The President and Congress failed us miserably in passing the wholly inadequate and highly flawed healthcare reform legislation last year.  Much time and effort will be required to defund, repeal and replace misguided and convoluted provisions within the bill.  That said, no healthcare reform, whether presented on behalf of conservatives or liberals, has a hope of success until Americans reset expectations when it comes to the very fundamentals of healthcare insurance.

                                  blog founded by Kelly Victory

                       written by Kelly Victory MD all rights reserved

The Unsung Story: George W. Bush’s Overwhelming Success in the Battle to Fight HIV and Aids

Despite continued focus and attention on America’s healthcare crisis – And the Obama administration’s crafting of a reform bill that will drive the final nail into the coffin – there is a true “feel good” story about healthcare that’s been largely ignored.  In their fury to blame George W. Bush for everything from the failing economy to global warming, the media have ignored the overwhelming and sustained success of his efforts to address HIV and AIDs in Africa.  


AIDs activists, NGOs and media elites are quick to heap praise on Obama for expanding AIDs-fighting programs, but the real credit belongs to his predecessor.

The “secret” to Bush’s formula for success was a departure from previous multi-billion dollar aid initiatives. Bush envisioned a new kind of aid program – One that focused on creating partnerships with businesses and private industry rather than delivering trucks full of cash to corrupt local governments and inefficient aid organizations.  He proved that large scale treatment and aggressive prevention programs can be implemented by leveraging relationships with the pharmaceutical companies that produce retroviral drugs, and the private sector, including churches, to deliver care.

Both the 2002 Global Fund to Fight AIDs, Malaria and Tuberculosis and his 2003 President’s Emergency Plan for AIDs Relief (PEPFAR)delivered remarkable and measurable impact on a hugely suffering population.  Indisputably, the programs helped to save 30 million lives from the scourge of AIDS, and proved to be one of the most successful foreign aid initiatives ever.   Recent economic development and free market reforms have been possible in Africa largely as a result of its people being yanked back from the brink of near certain death.

In addition to markedly decreasing the incidence of new HIV infection and deaths from AIDs, Bush’s efforts engendered significant good will and gratitude from the peoples of Kenya, Sudan, Tanzania, Zimbabwe, and Uganda – an important and rarely reported side-effect by those propagating the myth of the U.S’s dismal reputation around the globe.

Today, PEPFAR and the Global Fund continue to provide retroviral drug therapy to suppress HIV infection and programs to prevent maternal transmission of HIV to children.

But that’s not all: Bush’s healthcare legacy extends beyond these initial programs to the work that his twin daughters, Jenna and Barbara, are now pursuing.  The Bush daughters helped to formulate the concept for Global Health Corps, an NGO with a mission to improve access to healthcare in impoverished communities in the Unites States and around the world. Both are now actively involved in its operations.  


Similar to their father’s approach with PEPFAR, the Global Health Corps leverages people with operating experience and connections to supply chains rather than simply providing cash and supplies – the only truly sustainable way to manage global health crises.  Given our country’s current financial constraints, we can anticipate growing challenges to our commitment to many humanitarian efforts; this model for foreign aid provides our best hope for continued success.

Whether this story has been simply over-looked or actively suppressed by the main stream media is unclear.  Without question, the media and the current administration remain obsessed with unfairly blaming Bush for a host  of economic and other ills, and he rarely receives the recognition he deserves for his accomplishments.  Many have predicted that history will ultimately paint his presidency quite attractively.  


In the near term, however, the irrefutable, if oft ignored, legacy of George W. Bush may well be the story of his optimism, creativity, commitment and success in addressing suffering and a true healthcare crisis on another continent, and his vision for a sustainable approach to humanitarian aid.

                                                    blog founded by Kelly Victory

                           written by Kelly Victory MD copyright 2012 all rights reserved

Death Panels? The Reality of Healthcare Rationing By Kelly Victory, M.D.

In a conversation that has received much attention since it occurred in November, conservative talk-radio host Mark Levin spoke with a neurosurgeon who reported some disturbing information regarding ObamaCare, and the sorts of insidious and surreptitious control that it gives the federal government over healthcare.  


During the call in question, the physician reported that he had come from a recent meeting of neurosurgeons in which they reviewed new HHS guidelines for advanced neurosurgical care.  According to their reading of the documents, patients over the age of 70 who are on federally subsidized insurance (Medicare, Medicaid or other “public option” alternatives) should only receive “comfort care” in the case of a stroke, hemorrhage or brain aneurysm that would otherwise benefit from surgical intervention.  Mark Levin vetted the caller and confirmed his identity and profession, as well as his attendance at the referenced neurosurgical meeting.  


The doctor went on to describe the so-called “ethics committees” that have been put in place by the administration to determine where monies will be appropriated and what medical and surgical procedures will and will not be reimbursed.  The conclusion of the ethics committee is that neurosurgical intervention is “generally not indicated” for patients over 70.  And so it begins.

Although Sarah Palin may have coined a somewhat inflammatory phrase in suggesting that the healthcare reform bill included “death panels”, in a sense, she was correct; we are clearly seeing the impact of the legislation as committees of primarily non-medical administrators make decisions that profoundly impact the way in which doctors and hospitals can render care to their patients.  And sometimes those decisions – as in the case of a 70 year old with a brain hemorrhage -- can be tantamount to a death sentence. 

The new mammogram guidelines are another case in point: In this example, the “United States Preventive Services Task Force”, whose members were appointed by the Obama administration, after reviewing years of data on breast cancer, came out with new guidelines for mammography that contradict those of the American Cancer Society. Instead of starting regular mammograms at age 40, the task force said that women who were not considered high risk could wait until age 50. And instead of once a year, the task force determined that getting screened every 2 years was adequate.  


Interestingly, the ACS reviewed the same data and held their ground, choosing to stay with their previous recommendations. The issue here is that the guidelines were changed by the Task Force, not on the basis of any new scientific or medical studies, but purely on the basis of an actuarial analysis that determined that it was not cost effective to diagnose and treat women with breast cancer before age 50 and after age 74 – a decision that you might disagree with should it be your wife, mother or daughter with the disease. The new guidelines for mammography were published in November of 2009, pre-dating the actual passage of the reform bill the following March, but were clearly a harbinger of things to come, including the significant rationing of healthcare. 

Once the government’s guidelines for a particular medical condition have been set, the next step is for reimbursement to be denied for those tests and procedures that are no longer recommended.  


The FDA’s recent rescinding of approval of Avastin for breast cancer, initially approved for the disease in 2008, was likewise an economic decision, and again reflects the obvious move toward rationing  which has been built into the ObamaCare plan.  


The FDA, formerly tasked with assessing drugs purely based on their clinical safety and efficacy, was asked in this case to opine on the economic value of the drug, and determined that it was simply too costly to justify the “minimal extension of life” that it generated.  Both private and public insurance companies have scaled back on their coverage of Avastin as a result of the FDA’s decision, rendering many patients unable to pursue the treatment.  These are just a few examples of the provisions within the bill that granted authority to bureaucrats to promulgate rules and programs governing our healthcare.  


Surgeons and other practitioners whose specialties require significant costly interventions will be the most impacted early on.  If certain screening exams and treatments are deemed to have unacceptable cost-benefit ratios, they will be cut. In all of these cases, the message from the government is clear: We are putting cost savings before human lives and outcomes.  Many, many more “new treatment guidelines”, rescinding of drug approvals, and changes in reimbursement for procedures will be coming down the pike, should the bill not be repealed. 

Lowering healthcare costs will require identifying and eliminating wasteful spending and fraud in the system, improving the overall health of Americans, and allowing the free-market to create competition and natural cost pressures.  But providing for the early diagnosis and treatment of breast cancer, and pursuing neurosurgical intervention for patients over 70 isn’t a waste.  While the healthcare reform bill might not include the classic and repugnant concept of a discreet panel that casts a “live” or “die” decision, individual by individual, what it does is perhaps more insidious: sweeping, depersonalized determinations that entire categories of people will be denied certain treatments based on economic and age criteria.  


Although people have eschewed the phrase “death panel” as inflammatory, it is, if fact, a fundamentally correct descriptor; forcing physicians to follow guidelines set by panels of administrators, considering economic criteria over human lives, and weighing actuarial analyses over years of medical education, training and experience will have exactly that effect. 


                                                  blog founded by Kelly Victory
                        written by Kelly Victory MD copyright 2012 all rights reserved

The Obama Administration's Covert Healthcare Rationing

I spent over 15 years practicing as a trauma and emergency medical specialist. During those years, I learned that many patients -- especially those facing death, imminent limb loss, or another devastating outcome -- are willing to try potentially risky, but cutting-edge interventions, as long as there's a reasonable chance of improving their outcomes.

Indeed, if you're suffering from a life-threatening illness or injury and traditional treatments aren't working, there's nothing to be lost by trying a riskier treatment -- and everything to gain.

Yet, a recent ruling from the Food and Drug Administration eliminates that option for thousands of late-stage breast cancer patients. And, even worse, that decision appears to be part of a broader push to put the government and its regulators between patients and their doctors, and to weigh cost over outcomes.

In December, the FDA rescinded approval for Avastin in the treatment of advanced breast cancer. Initially approved for the disease in 2008, the drug has been shown, when coupled with chemotherapy, to delay tumor growth by a median of 11 months -- almost five months more than chemotherapy alone.

But upon re-evaluating Avastin, FDA officials decided that the drug's potential side effects outweighed its benefits for breast cancer patients and voted to withdraw its approval for that disease.

 That decision is now being appealed, but assuming FDA approval for Avastin is withdrawn, public and private insurers will likely scale back their coverage of the drug for breast cancer, leaving these patients to either pick up the drug's $90,000 per-year price tag on their own, or forgo it. Most simply cannot afford it.

People in truly life-or-death situations will take on extra risk for the chance of months or years of additional life. Many advanced breast cancer patients are in exactly such a situation. Conventional treatments haven't worked, and the disease continues to progress. Without action, they can, and will, die quickly.

Avastin won't save all of them; for some, however, it could provide a significant extension of life. Yes, the drug might have some adverse side effects, but shouldn’t the ultimate determinant of that risk be the individual who stands both to benefit or to suffer from that choice? Neither I, as a physician, nor the government, have the right to make that choice for someone else.  

The Avastin ruling seems to be driven largely by cost concerns, and public insurance programs no doubt, stand to reap huge savings if they stop paying for the drug for breast cancer.

Unfortunately, the Avastin decision isn't an isolated incident. The Obama administration is pushing rationing, insidious as it may be, on multiple fronts.

Last year, the Agency for Healthcare Research and Quality changed mammography guidelines to tell women they shouldn't get their first exam until age 50. This modified guideline wasn't based on a new study evaluating the effectiveness of mammograms; it was based on an actuarial evaluation indicating that exams for women under 50 didn't have sufficiently high cost-benefit ratios.

In May, the National Institute of Health (NIH) released the results of a comparison study between Avastin and the biological drug, Lucentis, for the treatment of age-related, "wet" macular generation (AMD).

This time, however, the government looks to be coming down in favor of Avastin -- but for the same purpose of blind cost-cutting.

Lucentis is officially approved by the FDA to treat wet AMD, which can cause blindness, while Avastin is not. However, when broken up into small bits and injected into the eye, Avastin has been shown to stop the progress of the disease, and doctors have taken to prescribing it off-label for this purpose.

These two drugs drew the government's attention because of their price difference: A Lucentis regimen for AMD costs about $2,000 per year. A similar course of Avastin clocks in at just $50.

The NIH found that Avastin is "as effective" as Lucentis -- even though 5 percent of patients on Avastin encountered more "serious adverse events" than those on Lucentis. Many fear that the government will use the NIH comparison to influence its public insurance policies. Specifically, officials could impose a "fail first" in Medicare for wet AMD treatment, forcing patients to try Avastin first.

There is a serious danger in such a policy. While these two drugs might be comparable for most wet AMD patients, there is a select group for whom Lucentis works better. Human bodies are amazingly complex and can react to drugs in vastly different ways, for reasons we don't yet understand. If that select group is forced to use less effective Avastin first, their eyesight could be permanently compromised.

In all these cases, the message from the government is clear: we're putting cost savings before human lives and outcomes.

Lowering healthcare costs will require identifying and eliminating wasteful spending and fraud in the system, improving the overall health of Americans, and allowing the free market to create natural cost pressures. But giving breast cancer patients a serious shot at additional years of life isn't a waste. Neither is screening women in their 40s for the disease. Or giving people facing permanent blindness the best options for saving their eyesight.

Our government needs to get out of the doctor's office.

                                                  blog founded by Kelly Victory
                                    Kelly Victory MD copyright 2012 all rights reserved