Fact Checking Sen. Menendez ACA Diatribe

Dear Senator Menendez,

As a N.J. citizen, taxpayer, physician, husband and father, I must offer factual correction on your healthcare policy ACA diatribes.

You tweeted:

Nothing could be further from the truth in your partisan message:

1. Insurance coverage is not healthcare.
2. Forcing citizens into ACA Medicaid at taxpayer expense is foolhardy.
3. ACA through “guaranteed issue(preexisting conditions)” destroyed the risk pools that kept prices stable. Now ALL commercial plans premiums have doubled and tripled.
4. The individual insurance market was decimated by ACA, destroying any semblance of insurance competition.
5. ACA put most private practice independent physicians, that are more efficient and cheaper, out of business and working for hospitals. As you know, hospitals inflated pricing schemes also extorts taxpayer dollars
6. ACA also pushed insurers toward “narrow networks.” eliminated patients long-term relationships with physicians and further limited their choice of physician and facility.
7. ACA and forced government dependence will bankrupt the country and its citizens, as a whole and individually.
8. Remember the three big lies of Obamacare? Keep your doctor. Keep your insurance. Each family will save $2500. All proven false partisan narrative.
9. Attacking the president of the United States is a waste of time, money and energy when he would gladly work with you on these issues.

I would be glad to work with you and other legislators on competitive free-market plans and assure quality and give patients best choice and restore personal responsibility and freedom.

Sincerely
Craig M. Wax DO
Independent family physician, media host and healthcare policy expert

Senator Menendez: Stand Up Against Killer Kickbacks

Call Senator Menendez office today! (202) 224-4744 

Give him key questions to ask at tomorrow’s Senate meeting on PBM‘s. Please read below and call today. 

Dear Senator Menendez,

You are aware that the Senate Finance Committee meets on Tuesday, April 9, 2019,  to question Pharmacy Benefit Managers.I am truly sorry that none of the Senatorial staff from NJ could attend the meeting on April 1, at the Library of Congress. I am proud to have been intimately involved in the planning and execution of that meeting along with many others that have fresh working solutions for our health care crisis.  Patient advocates and physicians from across the aisle and across the country came together. We were especially moved by the presence of the Black Healthcare Coalition,  a group of 3000 pastors from across the country who are leaders for their African-American congregations.  It has been eye-opening for the Black Healthcare Coalition to learn their congregations are being targeted by the PBMs and GPOs, as is the rest of the nation.  The Safe Harbor for Legalized kickbacks for PBM and GPO cause artificial medication shortages and forces those with preexisting conditions to pay exorbitantly at the pharmacy counteror skip taking their medication(s) altogether. As Pastor Stephan Broden   framed the issue of legalized kickbacks, “It’s time for us to take this to the streets… because people are getting hurt.“

Congress is responsible for legalizing kickbacks for the GPO’s in 1987.  In 2003, the PBM’s  had legalized kickbacks extended to their industry.  The pay-to-play scheme for GPO is controlling which brand medications, solutions and devices are available in hospitals.   The PBM pay-to-play scheme is controlling what prescription meds are covered by insurance plans.   Patients and physicians are confronting life-threatening issues for patients, and neither the patients or physicians have any control.

Of the 150 drug shortages currently listed by the FDA,  roughly 90% of those medications have a single manufacturer because they bought the right to “sole-source contracting.” This unethical business practice by the PBMs was exposed in the second Senate Finance Committee hearings on February 26, 2019. I saw you both in attendance at that hearing, Senators.  I watched the hearing; many patients and physicians watched it, many of your constituents, and some are copied on this email.

Senator, you took an oath, just as physicians have taken an oath.  And we are fulfilling the Hippocratic Oath in the best way we know how, by speaking out for our patients who are hurt by continual drug shortages,  and high prices at the pharmacy counter and on hospital bills.Social media, The Black  congregations, the Hispanic population (Dr Wust Smith,  Pa pediatrician,  who is writing for the Hispanic outlook magazine and also attended the conference ) and the 1.8 million member Association of Mature American Citizens (also  in attendance Monday)  are all solidly behind repealing kickbacks for organizations who are robbing the American public of $200 billion a year while offering no research and development no manufacturing,  not even distribution of medications. As Pastor Broden says, “ We are gonna shine light and Make noise!”

Will you stand up for patients and the citizens of New Jersey, Senator Menendez, and ask the PBMs the following questions this Tuesday?

  1. How much do they take in rebates (kickbacks) from drug manufacturers and others. He should follow up with where do the so-called rebates go? They are supposed to go to the plan sponsor, employer, or individual purchasing the policy to keep prices down. They actually drive up prices and costs for all.
  2. Senator Menendez should insist that the PBMs make their rebates(kickbacks) transparent and report them to HHS, CMS, Congress and the public at large.
  3. Senator Menendez should advocate for the transparency and public report for all processes and payments by PBMs.
  4. Recommend that he advocate Senate and House to repeal the PBM safe harbor of 2002 that empowered PBMs to extort drug manufacturers for kickbacks called rebates, at the expense of patients, third parties, states, fed, and all taxpayers.
  5. Full repeal of 2002 PBM safe harbor for not only Medicare and Medicaid but also all payers including commercial and individual payors.

Senator, we are here to help you  take steps that are righteous and good in order to get our patients what they need which is affordable prescription medications, transparency of price and accessible quality healthcare.

Lastly, we would like to know  your position on the kickbacks themselves? Are you going to support Senator Braun’s Bill which will codify the Azar rebate rule as well as extend kickback repeal to the general insurance marketplace?

Simply put we are asking you, “do you stand for patients or do you stand for profits?”

Action Alert: Stop Killer Kickbacks

On Tuesday April 2, the Oversight and investigations subcommittee of Energy and Commerce is holding a hearing investigating Insulin pricing https://energycommerce.house.gov/committee-activity/hearings/hearing-on-priced-out-of-a-lifesaving-drug-the-human-impact-of-rising

Team: we need to and HAMMER them with calls.

Congressional Switchboard: (202) 225-2927
Chair Rep. Diana Degette Phone: (202) 225-4431
Vice Chair Rep. Joseph P. Kennedy (202) 225-5931
Rep. Janice D. Schakowsky (IL) (202) 225-2111
Rep. Raul Ruiz (CA) (202) 225-5330
Rep. Ann M. Kuster (NH) (202) 225-5206
Rep. Kathy Castor (FL) (202) 225-3376
Rep. John P.Sarbanes (MD) (202) 225-4016
Rep. Paul Tonko (NY) (202) 225-5076
Rep. Yvette D. Clarke (NY) (202) 225-6231
Rep. Scott H. Peters (CA) (202) 225-0508
Rep. Frank Pallone (NJ) (202) 225-4671
Rep. Brett Guthrie (KY) (202) 225-3501
Rep. Michael C. Burgess (TX) (202) 225-7772
Rep. David B. McKinley (WV) (202) 225-4172
Rep. H. Morgan Griffith (VA) (202) 225-3861
Rep. Susan W. Brooks (IN) (202) 225-2276
Rep. Markwayne Mullin (OK) (202) 225-2701
Rep. Jeff Duncan (SC) (202) 225-5301
Rep.Greg Walden (OR) (202) 225-6730

Put their numbers in your phone find 3 friends to do the same. Tell them to call and to have people call tomorrow and Monday to say:

“Insulin costs so much, because of GPO and PBM rebates. stand for people over profits, and make PBM and GPO kickbacks illegal.”

It’s NOT enough to support the HHS PBM rebate Rule, not enough to support S. 657 The Drug Price Transparency Act (S. 657), intro by Senator Braun of Indiana.

April 1, in the Library of Congress, Physician and Patient Advocacy Leaders will be telling the world exactly this on LIVE STREAM! The meeting attendees represent over 30,000 physicians. Lawmakers are most welcome to attend or send your Health Care Aide Congress must introduce and support a bill that repeals GPO kickbacks as well as PBM !!

How can anyone possibly support legalized kickbacks for GPO/PBM Pharma Middlemen who do no Research, no manufacturing and distribute no product?” The only ENDURING solution for safe affordable medications like insulin is full repeal of the legalized kickbacks enjoyed by BOTH PBM AND GPO. Remember, congress, you work for US!!!!

Tweeters can tweet and retweet right @ those lawmakers and @potus, @pence @senatorbraun, etc:

Make insulin affordable by repealing the PBM AND the GPO #kickbackskill https://www.theintell.com/opinion/20190306/guest-opinion-make-lawmakers-cut-kickbacks-hold-drug-companies-accountable .

Assisted Suicide Bill on Verge of Advancing in NJ

A warning from veteran NJ physician Louis Keeler, MD:

My message today is mainly directed to the practicing physicians of New Jersey and in a special way to all the citizens of New Jersey.. The subject of discussion is a bill that is to be voted on by both houses of the legislature on March 25. That’s four days away. The name of the bill is both deceptive and euphemistic. It is entitled Medical Aid in Dying For the Terminally Ill Act. It is also known as” assisted suicide” but I assume that by a collective guilt of those legislators who are voting for the bill they have specifically put in the bill a prohibition against using the words “assisted suicide”. Have no doubt what were talking about is voluntary euthanasia.

Euthanasia is defined in the dictionary as the painless killing of a patient suffering from incurable and painful disease or an irreversible coma. Synonyms are mercy killing, assisted suicide, physician assisted suicide. Continue reading

Stop the Rush to Legalize Cannabis/Marijuana

Dear Governor Murphy:

I am opposed to the rush to legalize cannabis or marijuana in New Jersey, without research, trials, adequate review of history, and consideration of risk of collateral damage. With the current heroin, fentanyl, opiate crisis, it is foolhardy to rush into legalization of a gateway drug like cannabis or marijuana. At this time the hurry seems to be all about tax revenue, with no concern for the heath and welfare of the citizens of New Jersey.

https://nypost.com/2019/03/19/stop-ignoring-the-brutal-downside-of-legal-pot/

Please feel free to contact me with any questions or for ongoing discussion.

Best wishes for good health,
Craig M. Wax, DO
Family Physician

P.S. Please see below note in agreement from my fellow NJ physician colleague, Dr. Rob Pedowitz.


The Legalization of Marijuana Is All about the Money!

Dear Fellow Physician,

As a concerned physician and NJ Resident, I am writing today to ask for your assistance on defeating a very significant legislative bill, “The Legalization of Recreational Marijuana,” S2703, due for a floor vote on Monday, March 25, 2019 in Trenton.

Regardless of your political affiliation or personal beliefs, the decision by the legislature to move forward quickly with trying to pass this bill without consulting the medical community, or without fully exploring the legal, social, psychological, financial, and medical aspects of this issue may have significant repercussions. We have fought hard the last few years to battle the opioid epidemic, and though marijuana has many benefits for medicinal purposes, there are very little proven benefits when used recreationally. To legalize marijuana and make it readily available to the public, would only provide an easier gateway for people to desire stronger drugs, including prescribed opiates, heroin, and other psychoactive drugs. There are recent reports of other countries and in several states in the U.S. where people who smoke marijuana are now seeking more potent forms of cannabis, which are causing serious psychoactive complications. Treating mental illness has been difficult in NJ and the rest of this country, and if not properly regulated, we can have a worsened mental health crisis. We also may have to deal with worsened air pollution, which is already a problem in NJ as we have very high rates of asthma and other respiratory conditions.

Additional concerns for the medical community include determining evaluating employees and potential new hires for whether they may be under the influence of marijuana. Since the metabolites of marijuana can stay in the body for at least 72 hours, drug tests may be positive, even if a person did not use marijuana on the day of question. However, we may not be able to fully determine whether or not an employee is under the influence or not. Better testing and better guidance is needed for both the medical community and for employers.

Since there is much still to discuss and much more that needs to be decided, we need to defeat this bill. It is imperative that you call your local State Senator AND Assembly Representative today or Friday. There is still a lot of legislators on the fence and the vote can sway one way or the other. From my discussions with numerous legislators, they were very honest and said that this issue is “ONLY ABOUT MONEY.” They were very clear that the decision to pass this bill only comes down to money – taxes and revenue. In addition to contacting your local legislators, I also urge you to contact a few “key” State Senators who are on the fence but leaning to vote against the bill.

Please call:

Declan O’Scanlon (R) – Holmdel, (732)444-1838
Vin Gopal (D) – Freehold/Ocean/Tinton Falls, (732)695-3371
Paul Sarlo (D) – Passaic, Wood-Ridge, (201)804-8118
Joseph Lagana (D) – Paramus, (201)576-9199

You do not need to have a political background to contact a legislator. Just look up their contact information and call them up. Tell them who you are and that you are a physician, and if you are in their voting district (this matters A LOT!). Please do NOT state you represent any organization or hospital or group, as this will not be helpful or necessarily accurate.

Please contact me individually if you have any questions.

Thank you for your assistance on this vital issue!

Sincerely,

Rob Pedowitz, DO

NPs Running the ER: What Could Go Wrong? A Lot.

Guest post from Patrick Horn, M.D.:

I made a post on Physicians for Patient Protection (PPP) earlier this week about my personal experience with an NP that was negligent and could’ve easily cost my life, but I typed up a statement for use formally and have sent it to a lot of groups. If you feel it might help you in the fight against NP independent practice feel free to use it. You have my permission to us my story, my name, whatever you need. And I’m happy to discuss my story with anyone.

My name is Patrick Horn from Edmond, Oklahoma, and I wanted to share my story regarding a poorly trained nurse practioner that could’ve cost my life. I came into the Mercy Hospital ER, Oklahoma City, on Wednesday, 2/27/2019, as a trauma case after a severe MVA at approx 8am where the vehicle rolled into a very deep ditch on its side at high speed after losing control on the ice at the bottom of a steep hill in a rural area.

My truck hit the deep ditch/ravine so hard that both front wheels cracked off, air bags deployed, the truck flipped on its side and wedged into the large ditch. After seeing my vehicle, everyone at the scene has said I’m lucky to be alive, much less that I crawled out of the vehicle under my own power.

At Mercy ER, I never saw a doctor. Just an NP, Dawn Womack, APRN.  I came in complaining of severe spinal back pain and abdominal pain. She ordered a thoracic x-ray only and a zofran for the abdominal pain, and almost sent me out the door with Naproxen after misreading the x-ray as normal.

I asked that an MD radiologist read it before I was released and learned that I had fractured thoracic vertebrae per radiologist reading and CT confirmation.

She never bothered to do more imaging, including none of my c-spine nor my lumbar spine nor my abdomen nor my head, nothing. Seems like she really didn’t want to do a thoracic CT but did so based on what the radiologist recommended and based on my pushing for help. She just tried to get me out the door as quickly as possible. I get that they were very busy that day due to all of the ice slips and falls, but given the potential severity of my trauma after a severe MVA that probably should’ve killed me, this management is inexcusable.

No abdominal CT for the abdominal pain after the MVA, no complete spinal CT, no imaging of the cervical or lumbar spine, no head imaging, nothing. I could’ve been bleeding in my abdomen from a ruptured aorta, lacerated spleen or kidney, and she never would’ve never known.

I fractured my spine and she sends me out with a script for the weakest pain medication available simply because she’s an NP and refuses to ask her supervising MD to write for something stronger. I’m still in pain and suffering.

I’m a physician and I went through a trauma rotation at OU as a student, at our level 1 trauma center at OU Medical Center, and I know how it should be done. I’ve talked to other ER docs and all said that my c-spine should’ve been cleared, I should’ve gotten a complete spinal CT, an abdominal CT given the abdominal pain s/p MVA, and maybe even a head CT given the force of the accident. She never even did a physical exam except for pointing to my back and asking where it hurt. I don’t even remember seeing a stethoscope. She completely missed my injured shin where I fell trying to crawl out of the vehicle onto the icy ditch. I also had to wait for hours (in pain in the waiting room) before even being taken back to a room, and then was taken to a makeshift room, never hooked to a monitor, not given an IV, etc. No labs were ever done. I was not given pain medication until a long time later, and then it was PO since they never started an IV.

And then the nurse announced an NP was coming in and would be running my case. Oh brother. I was in so much pain and shock I didn’t even think to ask for an MD, and had I done so, that probably would’ve delayed my treatment more.

This NP was grossly inept and her treatment of a complex trauma case was negligent. Mercy shouldn’t be having NPs run trauma cases in their ER. If this ever happens again I will not be going back to Mercy if I can keep from it (sometimes in traumas we have no choice where we go) because I easily could’ve become paralyzed or even worse died.

I asked for as much as I could given that I’m a doc and know some things, and pressed for the CT, but given that I was in so much pain, it was tough, and by the end of it, I was tired of fighting the negligent care and just wanted to go home.

What’s scary is that I’m a physician and knew some of what to ask for…what does the general public do who doesn’t know any better? Suffer as a result of the negligence until something catastrophic happens?  Even at that, I’m a psychiatrist, so trauma/surgery isn’t my specialty, and I really didn’t know fully how negligent the care was until I got home and talked to a few ER physician colleagues of mine.

I had an idea though that I wasn’t getting the best of care, but it’s been awhile since I did trauma/surgery in med school…still even I could tell that so much was being missed.

Simply put, NPs shouldn’t be managing such complex cases, especially without adequate supervision. The fact that I never even saw a physician is scary, given the severity of my case. It’s as if she blew it off and didn’t realize how serious it was. I really don’t think she intentionally tried to do me bad (she seemed nice), but she was just incompetent and way in over her head with my case. NPs are not physicians and don’t have the training to be in that role. God forbid we allow them to practice independently. My story is a great example of what will happen if we do that.

Patrick Horn, M.D.
Medical Director, Psychiatrist
Oklahoma City, OK 73139

What is Healthcare? And How to Fund It.

Dear Chairman Alexander,

Thank you very much for asking America’s MD and DO Physicians to weigh in on solutions to improve Americans’ health and launch an efficient and sustainable path for the healthcare ecosystem.

The first critical step is educating your colleagues that there is a difference between medical care and health insurance. My recent article published in Medical Economics may help policymakers understand that the difference matters: https://www.medicaleconomics.com/med-ec-blog/what-healthcare

Solving the current healthcare policy disaster ultimately means less federal intervention and regulation, combined with more freedom and liberty.

Please consider:

1. Expanded universal HSA heath savings accounts for all, independent of insurance, and usable for every healthcare service, medication and device.

2. Remove ACA restrictions on insurance policies and stop multi-billion dollar bailouts of the insurance industry. Insurers have driven up costs. Instead allow a diversity of insurance plans to compete side by side: from catastrophic with high deductible to first dollar HMO-coverage. Unique individuals should be shopping for unique plans to suit their own needs.

3. Repeal the Group Purchasing Organization safe harbor to the Anti Kickback Statute that is also being abused by Pharmacy Benefits Managers. The federal government has permitted kickbacks disguised as “rebates“ for decades and it must stop. Make kickbacks illegal again. GPO and PBM middleman must compete legally and not extort manufacturers.

4. Innovative solutions like Direct Primary Care (DPC), and similar direct payment arrangements between specialists and their patients are must not be subject to over-regulation under insurance rules . These arrangements are not insurance but cut out the third party bureaucracy driving up the cost of care. DPC serves to strengthen patient-physician relationships not interfere in them. This healing relationship is critical for regaining health and health maintenance. It makes both patients and physicians responsible to each other directly, as it should be.

5. Allow physicians and patients to opt out of Medicare, MACRA, and other top-down government programs. They should be voluntary, not compulsory. Direct contracting between patient and physicians will save lives and tax dollars.

6. Consider legislation to protect patient access to physicians of their choice, even if they are not in their plan’s network. Narrow networks serve to trap patients into obtaining care in the most expensive settings instead of from higher quality and less expensive options like independent physicians.

Please feel free to contact me via letter, email, social media, phone, or any other mechanism for short and long-term planning. Together we can harness free market and personal individual responsibility to organically solve America’s healthcare crisis.

My article catalog: https://www.medicaleconomics.com/authors/craig-m-wax-do

Best wishes for good health,

Craig M. Wax, DO
Family Physician
VP Healthcare Policy, Practicing Physicians of America
National Physicians Council on Healthcare Policy member
Independent Physicians for Patient Independence
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax
HealthIsNumberOne.com