There isn’t a lot in the local (Philippine) papers about the details of the US Health Care bill, but one article in our local newspaper mentioned that the President was getting out his own “activist base” to counter the grass roots protests at the town hall meetings.

WASHINGTON, August 18, 2009 (AFP) – President Barack Obama will hold a live online and telephone strategy meeting on Thursday to rally devoted grass roots backers as a backlash over his health reform plan spreads to liberal media commentators.

Not my business, of course. I was a Federal physician, and I know that Federally run clinics are better than no health care, but for ordinary folks they are less than adequate. Indeed, anyone who wants to see how the government would run medicine to visit a clinic at one of the Indian reservations (hint: go to a tribe that hasn’t decided that they can run their own health care better than the feds.)

So  I was aware that my academy (AAFP) backed health care reform (after all, most Family docs end up seeing people without insurance, fighting the system, and even writing off bills for those who can’t afford care).

What I didn’t know is that the AAFP has allowed self appointed activist types to politicize the Academy, so it looks like all Family Physicians are backing the present flawed Health Care bill in Congress.

One only has to read the enthusiasm of Dr. Epperly HERE (pdf) to wonder about the partisan takeover of the AAFP.

Not only is his enthusiasm for the President almost as strong as Chris Matthews, but he instructs all of us docs to join “Connect for Reform” on the Academy website, and push for this “bipartisan bill”.

Fortunately, it’s easier than ever to do just that,
thanks to an new e-advocacy, grass-roots campaign the
AAFP has unveiled. The Connect for Reform campaign
uses new tools and technologies to bring AAFP mem-
bers into the health care reform process. Members
can “opt in” to get a front-row seat to the health care
debate in Washington.

How politicized is this Academy group?

Heal Health Care Now – The American Academy of Family Physicians has partnered with the Herndon Alliance to develop Heal Health Care Now, an initiative that supports meaningful health care reform.

And guess who wrote the talking points for Democratic activists?

Yup…that same Herndon Alliance.

Some talking points from the Herndon Alliance and published on the Third Way site…

2. Tap into key values the public places on reform:

» Stability and peace of mind
» The middle class
» Choice and control
» Quality
» Continuity—keeping your current plan and doctor
» Value—paying less and getting more
» Affordability
» Patriotism—“uniquely American solution”

• Don’t say “universal” health care. Talk about “quality, affordable health care for
all.” (But remember—quality, affordable health care for all is largely a message
about access.)

Now, the AAFP website’s partisan report:

Health system reform is on a roll this summer, but many naysayers are trying to narrow its scope or slow the process down. Although no one can foresee the outcome of the debate, the good news is that bills drafted thus far contain many provisions favorable to family physicians and their patients.

Yup….those evil “Naysayers” insist on discussing the bill, and questioning it’s details. Such discussions are of course part of the normal democratic process, but apparently this is now considered something bad.

So why is the Academy supporting the bill? Essentially, because Family docs are “promised” more money in the bill, so we are supposed to overlook questions like paying for abortion, a question that makes many prolife people, including the Catholic bishops hesitate in backing the bill.

And then there is that “death committee” that no one wants to talk about. The Academy denies it will cause problems:

Won’t the comparative effectiveness research give federal bureaucrats the power to make medical decisions for your patients and force rationing of health care?

We do not believe that more knowledge about how various treatments, procedures, and products compare with each other will lead to rationing. Instead, we believe that the more objective information physicians and patients have about health care issues the better their choices will be. It is valuable to have a respected agency like the Agency for Health Care Research and Quality as a disinterested moderator of this information.

Ah, but a quick “google” of the AHRQ site shows that they are busy trying to get a “consensus” on how to measure your quality of life (“QALY”) as part of the decision-making process.

The QALY concept is important to outcomes researchers who are attempting to evaluate the efficacy and cost of various health care interventions based on their impact on QALYs.

Even reading the six papers on the link is frightening, because it essentially using the jargon of medical ethics to justify not treating the chronically ill, the senile, the elderly, and the handicapped.

They don’t say: kill the useless eaters. The denial of care is coached in terms of “distributive fairness”, and “quality of life/years”, which mean if your quality of life is low, your number is low when they calculate if you deserve to get care.

This article summarizes eight areas of consensus reached during the workshop, including that QALYs are one (but not the only) health-based input to health and health care decisions, that they can be used at various levels in the health care system, and that distributive fairness needs to be addressed in developing QALY measures.

And, indeed, one of the six papers (alas, only one) agrees with my analysis:

The author of this editorial is critical of the usefulness of the conventional QALY… He cites an alternate approach developed by the German Institute for Quality and Efficiency in Health Care, which concludes that QALYs are both unethical and unconstitutional within the context of that nation’s health care system.

That figures. The Germans are a bit more sensitive on how these things can get out of hand…

And how would the Family doc work within the proposed health bill? The AAFP FAQ  explains how, using small words and pat reassurances so that we dumb docs can understand and obey our wise leaders.

For example, we are told we won’t be “gatekeepers” under the new health bill.

The medical home model is on which patient care is an integrated team with the primary care physician at the center.

Patients are active participants in their own health and well-being. They are cared for by a physician who leads the medical team that coordinates all aspects of preventive, acute and chronic needs of patients using the best available evidence, appropriate technology, and referrals to sub-specialists when needed.

Again, italics are mine.

But the big question is: whose evidence, and who decides what is appropriate technology and who decides who can be seen by specialists?

Actually, as a federal Doc, I did this for years.

But at least I only had to fight the bureaucracy who was guarding a tight budget.

The real danger in the Health care bill is that the “suggestions” of government agencies such as the AHRQ will now become mandatory: go along with them or don’t get paid at all.

And if they add that “QALY” to their decisions, you can see where this is going.

But what angers me even more is that Medicaid is being cut to fund the Health care bill, but the Academy insists “… the legislation does not eliminate the program, nor does it eliminate benefits….”

That is a half truth. Even MSNBC notes that the cuts to Medicare are there:

When the Republicans were in power, their attempts to cut Medicare to reduce government spending ran into a wall of opposition from Democrats. Now that Democrats are in control, they’re calling for hundreds of billions in Medicare cuts to help the uninsured get coverage.The House bill — the congressional proposal that has advanced the most — would reduce projected increases in Medicare payments to providers by more than $500 billion over 10 years, a gross cut of about 7 percent over the period

Supposedly, the cuts will not affect care, since the decrease in funding will be offset by savings from cutting waste from programs.

However, every doc knows about meetings on how to increase our billing to get around all those government regulations in the past, so I figure new regulations will have similar loopholes so the companies can make a profit, and if not, the companies will simply cut care for patients who don’t know better.

Cynical, ain’t I? Yes, but that’s why I went to work for the Feds instead of an easier and higher paying job at an HMO…

So, anyway, the entire bill is a mess, and mainly because it is being pushed through by those who think “we’re on a roll” and who ridicule anyone who worries about details as “nay sayers”.

But in the meanwhile, I wonder how many overworked Family docs are going to let their Academy push a partisan bill with their dues.

Because I am assured by the AAFP in an email:

I can assure you that the AAFP telephone town hall meetings are being developed by the AAFP for our members, independent of any outside influence.  The intent is to provide an opportunity for our members to engage with their elected AAFP leadership on this important issue. I do hope you will be able to join our officers next Monday night for one of their telephone town hall calls.

So there you have it.

Knowing my fellow docs, most of whom are to the right of Rush, it should be an interesting “telephone town hall”.

I wonder if the AAFP is aware of the opinions of their ordinary members? You know, the ones who don’t get involved in the politics of the Academy because they are too busy taking care of patients?


Nancy Reyes is a retired physician living in the rural Philippines.

She writes medical essays at Hey Doc Xanga Blog.

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