AAPS: PHOENIX VA.

New Obamacare Endgame: the VA for All May 26, 2014 By Richard Amerling, M.D. author Physicians' Declaration of Independence Scandal at the Phoenix Veterans Administration lifted the curtain of secrecy on the VA’s secret waiting lists. The VA lies while patients die. This is by no means a new phenomenon. The nation’s single-payer system for veterans has long been greatly overloaded. Congress tried to fix it in 1996 by passing a law requiring that any veteran needing care had to be seen within 30 days. The VA is supposed to have a wonderful electronic medical records system, and the EMR is supposed to be the magic formula for efficiency and quality. The VA gamed the electronic system to hide the waiting lists. Readers of the British press will be struck by the similarities between fudging waiting lists at VA hospitals and stacking patients in ambulances outside UK hospitals. Finding it impossible to comply with a National Health Service mandate that all patients admitted to an emergency room be seen within four hours, ho spitals kept patients waiting in ambulances outside the ER! Britain’s NHS and our VA system are both administratively top-heavy, command-and-control bureaucracies. All such systems tend to expand, along with their budgets, as administrators hire more and more people to do what they were supposed to be doing. There is no competition, and virtually no accountability. Every problem is always someone else’s responsibility. Mandates and quotas, rather than incentives, are used to motivate those in the trenches. Physicians working in the VA system, like the NHS, are mostly salaried employees. There are many fine doctors in both systems, but the incentives in place do not reward them for going the extra mile, seeing the additional patient, or doing another procedure if it means going past their shift. Inevitably, these systems create backlogs and lengthening queues for care. Americans need to take a close look at the VA—and not only because of their concern about poor treatment of our wounded warriors. It is the prototype for Obamacare. The intent behind Obamacare is to completely centralize control over health care, and thus turn American health care into one huge Veterans’ Administration. In 2011 I wrote that Obamacare was designed as Medicaid for all. Medicaid expansion is a key component of the law. If Congress wanted to expand coverage to the ten million or so individuals who fall through the cracks of the private/public health system, this could have been accomplished easily by offering them Medicaid or Medicare. These creaky systems could be made to work better simply by eliminating the price controls on physicians and allowing them to balance bill patients for the difference between payment and the cost of providing service. But expanding coverage was not the goal. The stated goal of government central planners, and of many medical elites, is to abolish traditional fee-for-service medicine. They wrongly blame FFS for out of control health care spending. This is absurd on its face. FFS medicine pre-dates the massive health spending inflation that was largely brought on by Medicare and Medicaid, and the domination by third-party payers. The lack of price transparency and the removal of most disincentives to utilization of health services are what led to the incredible over-spending on health care that we’ve seen since the ‘60s. FFS is the only way to insure the prompt delivery of needed care. But what central planners want is for all physicians to be salaried employees of either the government or of large hospital systems. Then planners could centrally control care through “payment-for-performance” algorithms built into electronic records. The promptness and quality of care will suffer. Obamacare is already becoming like the VA. A kidney transplant patient suddenly developed blurred vision. This alarming symptom could signal a brain tumor or other serious diagnosis. I would have arranged for an MRI to be done the same day. Her new Obamacare plan, however, offered a specialist appointment two weeks hence. The shameful backlog in our VA system could be remedied overnight by either giving veterans vouchers for care in the private, FFS system, or by building incentives into the VA payment structure. Ah, but this would require an acknowledgment that their top-down system has failed. Richard Amerling, MD is an Associate Professor of Clinical Medicine and a renowned academic nephrologist at the Beth Israel Medical Center in New York City. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is President-elect of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence.

HAMBURG-EPPENDORF University Hospital PRIVATE STEM CELL TRANSPLANT for Plasma Cell Ca.

GERMANY: HAMBURG-EPPENDORF Univ Hosp STEM CELL TRANSPLANT 1460 bed Univ.Hosp HAMBURG-EPPENDORF: Auto.Stem Cell Transplant approx. Euro 50,000.

WELCH ALLYN PANOPTIC ophthalmoscope Toronto WOMENS' COLLEGE HOSPITAL

Welch Allyn $600 PANOPTIC ophthalmoscope now provided in all exam units of Toronto WOMENS'COLLEGE HOSP. About 10y ago CPSO discipline committee, after Peer review by Kitchener Mall Ophthalmologist, did not know of its existence and had to be shown pictures. Shows danger to Ontario doctors' career if they use advanced techniques unknown to CPSO less than up-to-date committee members; filling gaps in their clinical practice with paid visits to Toronto from distant regions of the Province.

OMA retirement homes; part of End-of-Life planning

Last OMA Pres, a Hamilton-area GP wanted to focus on End-of-Life. The OMA Board has ignored for at least ten years the suggestion that the OMA has its own Retirement Homes. Similar to the 15,000 member ACTRA (Alliance of Canadian Cinema, Television and Radio artists)Lodge on the Esplanade; regular Friday evening performances are held at the LCBO licensed Green Room. A TV program showed Retirement Homes sponsored by various USA Universities. Various other Unions have retirement homes e.g. United Steelworkers. As a Charitable "Home for the Aged" 80% of the cost would be paid by the Provincial Govt. The first ACTRA PERFORMING ARTS LODGE, formed with the Screenwriters' Guild, opened in 1993 at 110 ESPLANADE, near the NOVOTEL CENTRAL TORONTO. The OMA has over 23,000 members whose income is not less than ACTRA members.

SUNLIFE extends CRITICAL ILLNESS INSURANCE to 75y.

SUNLIFE extends CRITICAL ILLNESS INSURANCE to 75y. $250,000 paid by cheque. Money can used at will by insured.

ORASURE TECHNOLOGIES Inc.Saliva test for HIV 1/2

Not sold in Canada. $40 a test WALGREEN pharmacies 1202 PINE AVE NIAGARA FALLS, NY 14301 716-2850286

HILTON HOTEL,Toronto May 11-12 Canadian Centre for Applied Research in Cancer Control (ARCC)

ARCC ffices BC Cancer Research Centre (BCCBC), Vancouver & Cancer Care Ontario (CCO),Toronto. Key speaker: NY Memorial Sloane-Kettering Cancer centre Director Health Policy Dr. Peter BACH MD, MAPP(MA in Public Policy). Increasing cost of medicine depends on HIGHER UTILIZATION (Q) and HIGHER PRICES(P) 260 attended. No rep from OMA Board or OMA Policy Staff Cancer drugs now authorized by committees at (CADTH) Ottawa-based "Canadian Agency for Drugs and Technologies in Health." In April 2014 took over pCODR "Pan-Canadian oncology drug review." (For those with private insurance or private means treatment at USA hospitals avoids CADTH delays.