Did
you know that in the U.S. more people die each year from the
complications of surgery than die in car accidents?  This is one of
many stunning facts that Atul Gawande reveals in his most recent
contribution to the New Yorker, “The Cost Conundrum.”

He
elaborates: “In recent years, we doctors have markedly increased the
number of operations we do. In 2006, doctors performed at least sixty
million surgical procedures, one for every five Americans. No other
country does anything like as many operations on its citizens. Are we
better off for it? No one knows for sure, but it seems highly unlikely.”

In Part I of
this post , I described what Gawande discovered when he visited McAllen
Texas, home to the most expensive health care in the world.  First, he
asked, why is care in McAllen so costly?  The answer: Volume.  The
citizens of this poor Rio Grande town receive “more of everything”—more
diagnostic testing, more hospitalizations, more surgery, more home
care.

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With a single bullet, the killing of Dr. George Tiller, an abortion provider in Wichita, Kansas, made the process of finding “common ground” in the abortion debate much more difficult.

As much as President Obama has been talking up conciliation, the rhetoric and ideology espoused by some abortion foes makes it almost impossible to work toward a national reconciliation on abortion and freedom of choice. So far, seven abortion clinic workers and doctors have been murdered by right-to-life extremists since 1994. More than a dozen clinics have been bombed over the last fifteen years and many others have suffered vandalism and near-constant threats of violence. These acts of violence are condemned by traditional right-to-life groups and conservatives, but the level of rancor coming from many of these groups serves to incite the acts nonetheless.

In my previous post I mention that there is a severe shortage of doctors who will provide abortions. This killing will make that shortage even direr—a goal that abortion foes have actively pursued.

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Did you know that the Federal Employees Health Benefits (FEHB) didn’t cover contraception until 1998—decades after most Americans had accepted “the Pill”?  FEHB did cover other prescription drugs and devices, but not birth control. Congress just didn’t approve. 

The government does not provide insurance to federal employees directly. It contracts with hundreds of private sector insurers to provide a menu of policies—some good, some not so good.. But Congress does lay done some rules.  As Naomi notes in her post below the plans cannot pay for abortions—even though many other private sector plans do provide coverage.

This is one reason why I like the idea of a hybrid health care system, private sector alternatives competing with Medicare E (for everyone).

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For the first time since 1995, it appears that Americans who describe themselves as “pro-life”  outnumber those who call themselves “pro-choice”  At least, that’s what a recent Gallup poll suggests. Gallup has been asking the question for fourteen years, and this time around 51% of those polled identified themselves as “pro-life” versus 42% who said they were “pro-choice.” These findings came out just days before President Obama delivered a controversial speech at the University of Notre Dame’s commencement where he reiterated his support for reproductive choice, while asking that both sides of the abortion issue establish common ground and “make sure that all of our health care policies are grounded in clear ethics and sound science, as well as respect for the equality of women."

How those stirring words will translate into policy remains to be seen.  As Sonia Sotomayor, Obama’s choice for the Supreme Court, faces confirmation hearings, the country is sure to be consumed once again by abortion politics as legislators scrutinize each and every one of her judicial decisions.

Meanwhile, the Gallup poll is not the only sign that Americans remain very conflicted about abortion and how it should be regulated.  A week after Gallup’s findings were announced, CNN and Opinion Research Corp. framed the issue a different way by focusing on Roe versus Wade:

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HealthBeat readers who responded to my invitation to join the “truth squad” have sent in a number of superb examples of how the opponents of reform distort the truth. I’m starting with a piece by Dick Morris because it includes some of the most common false claims that are clouding the debate on healthcare reform. (Hat Tip to reader Harry Wetzler for calling my attention to Morris’ column.) In future posts, I’ll be spotlighting other, attacks on reform. Please keep the submissions coming. The only way to defeat campaigns of disinformation is to be as tireless as they are. 

Very likely, the name “Dick Morris” sounds familiar. This is because Morris was Bill Clinton’s campaign manager when Clinton ran for re-election in 1996—until the papers broke the news that Morris had allowed a prostitute to listen in on his conversations with the president on more than one occasion.  (The morning after, even the hooker raised an eyebrow: “Someone as intelligent as he is should have kept his lip buttoned when he unzipped his pants,” she told the Washington Post. “I mean, how can you maneuver worlds, and he can’t even control what he’s doing in his own room with a paid lady?”)  The New York Times reported that Morris also gave the prostitute sneak previews of speeches that First Lady Hillary Rodham Clinton would be delivering.

Morris was known as a “spin doctor,” and not well liked by some of Clinton’s advisers. Former White House Chief of staff Leon Panetta later blamed Morris for advising Bill Clinton to lie about Monica Lewinsky: “All Clinton needed to do was to tell the truth at once, instead of listening to the advice of his double-crossing ex-consultant Dick Morrris,” Panetta told a reporter. “It was Morris, immediately after the scandal exploded a year ago, who explained to Clinton that America would never forgive him for his escapades with Monica. I had warned Clinton from the beginning about the bad influence of that man, who cares only about opinion polls, bends with the wind of the moment, and doesn’t give a damn about moral and is still on the scene political principles.”

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McAllen, Texas likes to think of itself as the Square Dance Capital of the World. McAllen doesn’t like to think of itself as the home of the most over-priced health care in the U.S..

Yet it is, as surgeon/author Dr. Atul Gawande reports in the June 1, issue of The New Yorker. (Thanks to reader Jim Jaffe for calling my attention to the article when it first hit the blogosphere)

McAllen seems an unlikely spot for Gold-Coast Medicine.  “Lonesome Dove was set around here,” Gawande writes.  “McAllen is in Hidalgo County, which has the lowest household income in the country.”  Nevertheless, if you have the patience to pore over nationwide Medicare data, you’ll discover that “only Miami—which has much higher labor and living costs—spends more [than McAllen] per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average,” Gawande notes. “The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.”

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As the campaign against health care reform heats up, I would like to ask for your help.

As I have suggested in earlier posts here and here, those who would defeat reform show little respect for the truth.  In their effort to confuse and frighten their audience, they will continue to spread misinformation and disinformation.  They will rely on “big lies” –lies so colossal that people will believe that they must be true. (Who would dare make up such a whopper and repeat it on television, online or in print?)

The only way to combat a deliberate campaign of misinformation is to expose the lies —again and again. I plan to use this blog to do just that. But I need your help. If you read or hear someone assert something about health care reform that you know isn’t true –or suspect isn’t true—please send the quote, citing who said it, when and where, to maggiemahar@yahoo.com. If you have evidence that debunks the false claim, send that too. If you don’t, I can probably find the facts needed to set the record straight.

No surprise, these days more and more doctors are searching online for medical information. What is surprising, however, is that in a recent study, nearly 50% of physicians indicated that they use Wikipedia—the open-access encyclopedia that allows anyone to edit articles—as their source for medical information.

The study, conducted by Manhattan Research, and reported on here found that although physicians were visiting Wikipedia for medical conditions and other health information, only about 10% of the 1,900 physicians surveyed created new posts or edited existing posts on the encyclopedia.

“The number of physicians turning to Wikipedia for medical information has doubled in the past year alone,’ said Meredith Abreu Ressi, vice president of research at Manhattan Research. ‘Physicians, just like consumers, are heavily search engine reliant, and often Wikipedia results are what come up in the top of the organic results.’

Abreu Ressi noted the concern about accuracy regarding Wikipedia, which allows its users to create content for the site essentially without restriction. Articles are subject to perpetual editing by Wikipedia's readers. Inevitably, false information sometimes slips through the cracks.”

Wikipedia is not a reliable source of medical information for doctors.

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Did you know that when there is “no hope of recovery” there are still things for the patient to hope for?

Did you know that a “living will” is not a legal document in New York State or Massachusetts?  

Did you know that environmentalists have created nature preserves where you can be buried?  “What we are doing is basically land conservation,” says Dr. Billy Campbell, who has created a preserve along Ramsey Creek in South Carolina. “By setting aside woods for natural burials, we protect it from development. At the same time, I think we put death in its rightful place, as part of the cycle of life. Our burials honor the idea of ‘dust to dust.’”  Ramsey Creek is just one place where families can arrange “green burials.”

These are a few of the things I learned yesterday at a “Leadership Connection” lunch for women in business, politics and the non-profit sector.  There, New York Times health editor Jane Brody spoke about her new book : Jane Brody’s Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare, Medically, Legally, and Emotionally for the End of Life.

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When Brandeis professor Stuart Altman appeared before the Senate Finance Committee last week, he acknowledged, “I’m reluctant to mention it— but,  why waste money on in-depth treatment for people who won’t live long anyway? Better to warehouse them and save the resources for the young.”

At least, that’s what hotair.com says Altman said.  

Writing on “Hot Air,” Ed Morrissey takes his interpretation of Altman’s testimony and runs with it: “What happens when the state controls all the resources? New resources do not develop, and the government winds up rationing care based on its own priorities, and not the priorities of the patients or caregivers. . . . Anyone whose value does not show a positive “cost-benefit” ratio to the state will also likely wind up without the kind of care necessary to stay alive and healthy. . . . We’ve essentially returned to the eugenics arguments of the early 20th century, a dark period of human history we should be avoiding rather than embracing on the floor of the Senate.”

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