Cancer research dollars diverted on “study” linking Trump support with opioid abuse?

National Institute of Health funded researchers are hard at work seeking cures for America’s patients… except when they’re not.

The venerable Journal of the American Medical Association is out with a new NIH-funded “original investigation.” What medical breakthroughs are being announced do you ask? Not. A. Single. One. Instead JAMA has published a “study” the authors tout as “adding to the emerging literature on the relationship between health status and support of Donald Trump in the 2016 election.”

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2685627

Here’s what James S. Goodwin, MD et al claim to have “discovered”:

An analysis of a national sample of Medicare claims data found that chronic use of prescription opioid drugs was correlated with support for the Republican candidate in the 2016 US presidential election.

You read that right. Trump supporters are more likely to abuse drugs, according to Dr. Goodwin and his colleagues. However reading through the article, it becomes clear that the boldness of their claim is inversely proportional to the strength of the evidence backing it up.

It’s bad enough that the researchers are digging through and torturing medical data (statistically) for a political purpose. It’s equally bad that the patient data was used without any informed consent (because the data is “de-identified” don’t ya know).

What’s worse? A source of funding for this junk science appears to be a taxpayer funded NIH grant ostensibly for cancer prevention and control.

Whether you support Trump or not, there’s no debate over this: the diversion of cancer research funds for political purposes is bad for patients.  In addition, it is improper to use health crises like the opioid epidemic in this manner. The NIH should demand that the taxpayer dollars spent on this “study” be returned.

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Talking to Patients About Guns. A physician says “yes” and “no”

Should doctors routinely talk to patients about gun use?

That was a question my colleague Paul Hsieh MD addressed in the Wall Street Journal over the weekend.

Here’s another slant:

“Yes, physicians should ask about patient gun issues for their health and safety but No, no one should use EHR electronic health records or any data sharing mechanisms for that ultimately private discussion!” – Craig M. Wax DO

What do you think?

Is the hysteria about health insurance covering #pre-existing medical conditions #FakeNews?

Yes. The media hysteria that Republicans want to deny healthcare to Americans with pre-existing health conditions is #FakeNews. And here’s why:

ACA changed the health insurance industry from individual rating to community rating. This is a chief reason premiums have doubled since 2010. With individual rating, a healthy non-smoker pays less than someone that is an unhealthy smoker with cancer; rightfully so. With community rating under ACA, everyone’s insurance costs go up because the unhealthy smokers are often not paying a rate proportionate to the costs they are likely to impose on the system; unfair from a self maintenance perspective. Although ACA purportedly allows the imposition of a “smoker’s penalty” it is not required and a number of states (including California and New York) prohibit higher rates for smokers.

Then came the liberal social justice argument of what shall we do with those that are unhealthy smokers with cancer? The answer that had worked previously to Obamacare were risk pools. People with risk, just like bad drivers with extensive crashes, were assigned to companies to except the risk. ACA Obamacare did away with the risk pools and now everyone is considered a high risk and expensive. From the quality and price perspective, it seems fair to charge everybody the same. From the perspective of self-respect and taking care of oneself, it is completely unfair to rate people in this way.

The latest hysteria on pre-existing insurance coverage is indeed a political strawman argument, not a real issue..

Confusion Clouds HHS Cybersecurity Plans

Today’s article about HHS cybersecurity planning, published in Becker’s Hospital Review, reports on a yet another policy failure courtesy of the bloated bureaucracy in DC. The federal government is so big that it doesn’t know what departments it has or how it’s spent our money.

In April 2017 HHS announced the planned formation of a Healthcare Cybersecurity and Communications Integration Center (HCCIC). 14 months later, you’d expect that the HCCIC would be off an running, especially given the massive patient data breeches and ransomware attacks that have become all too common. Wrong. Instead massive confusion surrounds the status on the HCCIC. Congress is looking for answers and HHS seems to have few answers.

One telling quote from Becker’s:

Stakeholders have informed our staffs that they no longer understand whether the HCCIC still exists, who is running it or what capabilities and responsibilities it has,” the lawmakers wrote, noting HHS has provided only vague responses to requests for clarification on these issues.

Mix in to this milieu the fact that there are already existing government agencies tasked with similar responsibilities. Government inefficiently at its worst.

Read more at:

https://www.beckershospitalreview.com/cybersecurity/congressional-leaders-to-hhs-it-s-unclear-if-troubled-cybersecurity-center-still-exists.html

One Easy Hack @RealDonaldTrump Can Use to Ignite a Consumer-Directed Revolution in American Medicine

Options are about to multiply for 12-million Americans trapped in ObamaCare plans, the 12% uninsured, and others ACA victims, with coming new proposals from the Trump administration.  After signing “Right to Try” into law Wednesday, President Trump hinted that these changes are mere weeks away.

Once the new policies are in place, new lower cost and flexible insurance alternatives will be unleashed, freeing Americans from disruptive (in a bad way) ObamaCare rules that drive up costs and decrease patients’ and workers’ choices.

Here are the two expected policies plus one hack that will floor the accelerator on their impact:

First, the Department of Labor is set to expand the availability of Association Health Plans. These will give Americans with common connections the ability to join together in plans they control.  Less regulation is not the only advantage of AHPs, although savings will be significant: an estimated $9,700 a year less compared to the individual market by 2022, reports Avalere.  Escaping state-based mandates is another advantage; these plans can be sold across state lines. In addition, association plans will allow employees to more readily keep their plan if their work situation changes.

The second anticipated policy, this one from the Department of Health and Human Security, will increase access to short term health insurance plans that are almost completely free of failed ACA requirements. Under President Obama, these plans were limited to 90 days of coverage, but Secretary Azar is expected to extend the limit to 364 days.  Coverage in such a plan would costs on average $342 a month, vs. $619 per month for an exchange plan, reports Michael Cannon of CATO. Mr. Cannon also suggests the administration should allow short term plans to offer guaranteed renewability or even sell the guarantees separately (he estimates the average cost at $86/month).  Renewability options would not only help consumers retain these plans long term, but would also inhibit expensive enrollees from being pushed back into the ACA exchanges.

Both of these proposals are going to help Americans; however the Trump administration could turbo-charge these good ideas with one simple hack. One sleek additional change to federal policy would lower costs even further, while increasing patients’ access to high quality care.

What else should the Trump administration do immediately? It’s simple: let patients use Health Savings Accounts (HSAs) for Direct Primary Care (DPC).

Most people already know about HSAs but, perhaps aren’t yet familiar with DPC, a direct arrangement between doctors and patients, that cuts the red tape out of health care, kicks the bureaucrats out of the exam room, and is set to sweep across the U.S.   Dr. Marilyn Singleton explains DPC like this: “The Direct Primary Care (DPC) model is burgeoning as patients yearn for quality time with their doctor at an affordable price. Here, all primary care services and access to basic commonly used drugs at wholesale prices are included in a fixed transparent price,” often around $50 to 75 per month.

The bottom line is DPC saves money for patients and downstream payers (like Medicare), increases quality of care, and it relieves physicians of counterproductive red-tape hassles that are driving them out of practice. DPC is a win-win-win.

You’d think everyone would agree that encouraging the use of DPC is a no-brainer. Shockingly, the Internal Revenue Service is blocking the use of this innovation for the 30 million Americans with HSAs. Thanks to a letter issued by Obama’s IRS commissioner, John Koskinen (yes the same one who stonewalled efforts by Congress to investigate IRS retaliation against conservatives) patients are prohibited from contributing to their HSA if they are in a DPC practice. To add insult to injury, HSA funds cannot be used for DPC.

As the public becomes aware of this flawed IRS decree —deserving of a blue ribbon in the Health Policy Hall of Shame—momentum grows for change. Just last month, Senators Ted Cruz and Ron Johnson wrote Treasury asking for a reversal.  In addition 1,125 patients and doctors have asked Congress to pass the Primary Care Enhancement Act (HR 365/S 1358) and force the IRS to change its misguided interpretation of law.

Disrupting (in a good way) Koskinen’s obstruction of patient freedom must be a priority for the Trump Administration as it moves forward with other reforms to remedy past policy disasters.  Allowing patients to use HSAs for DPC will turbo-charge the ability of patients with short term and Association-based plans to make their health care dollar go even further and get the best care from the physicians of their choice.

Need one last reason, President Trump? DPC will boost your plans to lower prescription drug costs.  A 72-year old female patient with multiple chronic conditions purchases all nine of her medications through a Direct Primary Care office in Allentown, Pennsylvania for $14.63 per month. Through Medicare “coverage” her cost would be $294.25 per month.

There is simply no legitimate reason for blocking patients with HSAs from DPC physicians … unless you are a middleman profiting off the status quo.