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Name: Tio
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Wednesday, February 22, 2012

Obamacare takeover

the earlier posts are actually a first draft of what I'm trying to say, so don't think I'm paranoid even if it sounds that way.

But there are subtle issues here

the removal of religious institutions from health care (religious ethics were pretty well removed from bioethics back in the 1980's).

The takeover of medicine by big business

The replacement of the Hippocratic/personal method of caring for patients by the business efficiency ethic (which is why most of my patients go to naturapaths and chiropracters, who still are allowed to use the art of treating patients instead of flow charts).

And the worry that the efficiency ethic, that makes doctors put the gov't and cost control before patients, will adversely affect the most vunerable.

Much of this is the reason I worked for the IHS, because, although they did ration some care (e.g. TM tubes, MRI for chronic back pain, knee joint cleanups) they did a lot of preventive care and encouraged us to have diabetic clinics and nurses to help us in the education. But they did NOT ration care for our elderly, because our tribe wouldn't allow such a policy. Yes, we did family planning, but were aware that sterilization should be approached with caution because in the 1970's a lot of abuse happened, and some women were sterilized without knowing it meant it was permenant.

With insurance, right now docs can ignore them and eat the costs while suing or sending in for a waiver, but it is a lot harder to go against a government guideline.

And the real question: Who will watch the watchers if the government essentially takes over and decides what you will be paying for? In effect, the insurance company is only doing the paperwork for the government decisions on your health care.

And without private hospitals, where will you go?

I blame the "modern nuns" who back in the early 1970's got rid of their prayer life, the idea of poverty, and community living in order to do their own thing, and as a result many women left, and they have few if anyone replacing them.

There were problems with the old ways, but the new ways were disasterous, and one result is that the work of the nuns in the past is now being derived of it's original meaning, and the result will be no alternative for either patients or staff workers.

and too many of the arguments in the press are mere spin and even lies trying to persuade you otherwise.

Sigh.




Catholic hospital take over:Part 2: Follow the money

for all the talk of bioethics, years ago Dr. Pelligrino wrote that the big bioethics issue that no one is discussing is the takeover of medicine by the business sector, a problem that includes a business ethic.

This ethic will replace that of the Hippocratic ethic, with it's "benevolence" and privacy and replacing the idea that being a doctor is a holy profession with responsibilities to the patient to that of a "health care provider" who will deliver cost effective and scientific based medicine to a "client".

The robotification of medicine, especially with a lot of "guidelines", many of which are based on dubious data if you bother to dig into them.

So what does this have to do with Obama's war against Catholics?

the business ethic behind modern health care results in financial pressure for Catholic hospitals to merge.

But this means the nuns have accepted the business ethic as a necessity. There goes all that stuff about caring for people. (One Hindu friend of mine saw this cost effective mania at her Catholic hospitals she decided that in her next life she won't ask to become a nun to care for the sick).

The problem is usually placed into the context of abortion/sterlization/birth control...and Obama will be using this to pressure them into becoming secular. Today it will be insurance coverage, but tomorrow it will be services mandated.

The good sisters then have a choice: become secular or shut down...I suspect in a few years they will no lonter have the option to insist that the merging hospital agree to follow Catholic rules.

the NYTimes article laments the first, but the Deaconsbench blog notes the problem of the second.

You have to realize that this allows the for profit hospitals to gain the "goodwill" and good reputation of the Catholic hospital, not to mention the staff and equipment, while doing their own thing.

Yet removing those inefficient catholic hospitals who routinely cared for the poor and those without insurance in the past will also allow more government efficiency in the system.


Accountable Care rules for hospitals and integrated health care organizations include Shared Savings methodology or a bonus if you will, for those medical groups which produce desirable clinical outcomes. This realignment in Medicare & Medicaid reimbursements will ultimately save U.S. taxpayers money for federally funded health care programs

one reason I worked for the IHS was that we could hospitalize sick people for social reasons: because they lived alone and couldn't care for themselves, or because they lived far away and couldn't come in for outpatient treatments every day. (we also had nurses to go to their homes which helped). The tribes insisted on this for their patients, but by removing the religious aspects from hospitals, it means one less obstacle to cost efficient care.

In other words this changes the equation from paying for volume to actually paying for clinical performance,

Yup. there goes most of my patients. You know: the 30 percent of our patients who don't take their medicine properly, or even throw it out...who don't exercize and who continue to party and eat hamburgers.

 Not only do I have to work with them to get them better, but I'll be punished for spending too much time with them instead of doing record keeping, and will be punished when they don't get better as fast because they won't stop drinking, smoking, or eating fast foods.

You always have the poor with you, but now Catholic hospitals will be part of the medical industrial complex, making you healthy whether you want it or not.

That is why the Catholic hospital association is in the middle of all of this: thanks to modern nuns deciding to do their own thing instead of caring for the poor in schools and hospitals, these institutions have to pay people decent wages instead of being staffed by low wage nuns. And paying people takes money, so there is an emphasis on money and making the budget balance instead of charity...charity is now the government's business.

But of course the gov't will use make rules making it impossible for these hospitals to continue without allowing "health care services" that go against Catholic teaching, so expect to see many become secular and those who can't afford the fancy equipment will be forced into bankrupcy. Ergo, no choice  but to merge.

And with the health care bill it means merging and giving up the catholic identity, and it's only a matter of time until all catholic hospitals become no different than those of HMO's money making hospitals.

Catholic Healthcare West, one of the nation’s largest hospital systems, is ending its governing board’s affiliation with the Catholic Church and changing its name, two steps intended to help the system expand throughout the states in which it operates _ California, Arizona and Nevada — and beyond.

The changes, which executives plan to announce Monday, underscore the unique challenges facing Catholic hospitals in the marketplace, where there are tremendous financial pressures for hospitals to merge or form formal alliances with other health care providers in order to survive and thrive.

The change will have no effect on any patients or the medical care provided at the 25 Catholic and 15 secular hospitals in the system. But executives hope it will make it easier to merge or affiliate with other hospitals, doctors’ practices and other health care providers.


from the WSJ:

Hospital deals can touch a nerve, because of the institutions' central economic and emotional position in their communities. Often, the debate centers around whether a for-profit company based elsewhere will continue to provide charity care and meet other local needs...."I don't think a hospital that belongs to the people of Kentucky should be merged and be dictated to by people who put restrictions on certain procedures," says Rep. Tom Burch, a Democrat who chairs the health and welfare committee in the state's House of Representatives. "It has hit a sore spot with people."

so the result will be gradually to force catholic hospitals to secularize, meaning giving the HMO and government their assets, which no longer will be part of the Catholic church's charitable outreach.

No effect on people? No, unless you consider the spirit of the institution as "no effect": whether you are cared for by those who see caring for the sick as a vocation or a job, see patients as more important than finishing the mandated paper work, or see helping grandmom to eat as more inefficient than putting a tube in her or letting her starve.

Who benefits? why, the medical industrial complex, who now can belong to a huge faceless but efficient health care monolith that can tell your doctor what to do and punish him if he doesn't do it.

Yet the catholic hospitals still have the "good will" and the charitable contributions of the church. Going secular means losing this, and many nurses and docs of all religions who want to practice without being forced to do abortions etc. will no longer have a haven to work in.

The rest of the WSJ article is a rosy picture of intrusive nannies telling you what to eat and to stay healthy.

a similar take is found in this article.

let me state that by mandating a base level national health surveillance system, such as an annual physical, offered gratis, we can find the people that are hypertensive or pre-diabetic and prevent more serious health damage. By reaching out and treating people earlier we will save money in government funded health programs. In order to accomplish this goal as a nation the country needs to continue to look at aligning provider incentives and reimbursements to promote national health not just a medical service. The goal of the country should be to work towards optimizing the health of its citizens not just treating their illnesses and injuries

but what if we don't want you to take care of us?

This is the sinister side of that "optimizing health". All of this sounds nice, but it assumes the clinic, not the patient, is the one who decides what you need (including what you eat). And even the visiting nurse part means that the family and children don't have to worry any more about grandmom.

But there is a flip side:

Another paragraph, on how lousy American dialysis is:

International data on dialysis treatment shows that Americans on dialysis do not survive as long as patients in other industrialized countries and also experience more clinical complications. This should come as no surprise when the corresponding American health care incentives are based only on providing the dialysis procedure, not optimizing patient health.

a closer look at the data would find other countries don't dialyze an 80 year old diabetic with no feet either, and most of our IHS/University Mn dialysis patients were diabetics over age 70.

and anyone who follows QALY and the NICE of England knows that since dialysis doesn't optimize his health, he won't get it. Only 10 percent of their dialysis patients are over age 70.

and that, my friends, is the problem with efficient medical care: The dirty little secret is that the chronically ill, the handicapped, and the elderly just won't ever be up to their standard, and that when rationing hits, the argument that since your treatment won't improve their quality of life, which is lousy, you don't really "benefit" from treatment. From this article (that debunks the argument).

The most eloquent voice among the latter is that of Daniel Callahan, who in his book "setting limits" proposes that age, than need, should be the criteria for the provision of limited health-care resources (16). He argues that we should shift our attitudes from aging and the goals of medicine towards the rationing of expensive treatment.

Callahan believes that medicine must refocus its efforts in the elderly away from the curing of disease and the extension of life to an ethic of caring and compassion.

· Specifically concerning dialysis, Callahan writes: "Dialysis represents precisely the kind of technology that should not be sought or developed in the future. It does not greatly increase the life expectancy (an average of only five years) and for most the gain is at the price of a doubtful or poor quality of life and an inability to achieve earlier levels of functioning."


the article then goes on to point out:

I am not surprised that the concept of futility sprang up in our vocabulary during the last 5-10 years, when cost containment became a main concern. Agreeing that providers are not obliged to provide treatments that are deemed futile is the first step in this process. It is difficult to argue against this. However, agreeing on what is futile treatment and who would decide on it is another issue. If the physician is mainly concerned with societal good, and not the patient's interests, it is easier and less painful for the physician to refuse a treatment "because it is futile" rather than "because there is no money."

so where is this all headed?

In managed care, where the lowest bidder will be granted the care of a group of patients with a fixed amount of money, I am sure that the elderly, who often require expensive care and referrals to specialists, will be shortchanged, otherwise the health-care provider may not make a profit or even may lose money. This is a convenient way of transferring the responsibility of restricting provision of care from the managed care organization to the provider, and at the same time allowing both parties to make a profit, albeit at the cost of the elderly and other vulnerable groups (18).


In the past, public hospitals treated everyone, and Catholic and other church hospitals treated "charity" patients. So there was no monopoly, even though often these hospitals were "substandard" in comparison to those in richer neighborhoods that treated more affluent folks.

By eliminating the Catholic hospitals, or by using financial and other pressure on them to be part of the monolithic health care system, the cost control folks will be in charge, and you as a patient will have no other options, and the possibility that you might chose expensive care for your handicapped Trisomy 21 child will just be unavailable for anyone.


Obama's plan: steal hospitals, force Catholics to cooperate

this NYTimes article is echoing a theme well known in activist circles: Those dang catholic hospitals are standing in the way of a woman's "rights" to kill her baby.

So a woman who will go 49 miles to shop at walmart (which we did all the time) now laments she might have to go to the next town for her abortion or tubal ligation.

The kerfuffle about tieing tubes at the time of c section sounds fine, until you realize the rate of them opening again is quite high, and some ladies change their mind: I've seen women change their mind ten minutes later while on the operating table.

they use Kentucky as an example, but what no one is asking is: Why are there only catholic hospitals there. Could it be because this is a charity work by the church to the poor? So if you don't like it, why don't the atheists make their own hospitals?

The ultimate plan is a take over, as the many quotes from "sister" keenan show. She is a liberal who has been working on this, and her pull back from supporting the Obama slight of hand has pulled back a bit, probably because she got a lot of emails. But that won't stop her from promoting this.

If this was one thing, it would be bad enough, but it is combined with the trends forcing catholics to pay for services they consider immoral and murder, and the removal of conscience rules from the HHW that allows doctors and pharmacists to be fired if they won't give out these things.

This is not about birth control, it is about abortion of course, and eventually euthanasia. Why do I say this? because the real issue is the abortifactant "morning after pill", which if take within a few hours of intercourse might stop ovulation, but will cause abortion if taken later, which is how it's being pushed.

A lot of docs and pharmacists have moral problems with this, but the next step is to mandate the abortion pill for later pregnancies.

The Obama adminstration is also pushing the "reproductive health" bill here in the Philippines, which would make it hard for Catholic or Muslim midwives to work in rural areas, since they not only would be forced to promote the pill but would be fined or lose their job if they even make a remark against the pill (such as pointing out side effects).

The point is not that Catholic women use or don't use contraceptives: The point is that once the government sees the church as the enemy in the way of their agenda, this is a danger to any believer.

And the dirty little secret is that "eugenics" has long been a wish of the left, as this article in the left wing UK Guardian points out.

and isn't it cynical that an attack on the Catholic church has resulted in the meme that the Republicans want to take away their birth control pills?

Something sinistar about deathmaking and lying.
and I'm a democrat, ashamed at the radicals who have succeeded in taking over my party.




Friday, February 17, 2012

Big Brother is watching you

--Medical headlines: Docs don't prescribe enough gout medicine.

Well, duh. If you call a uric acid of 6.8 high, half the men in the US have a high uric acid level. That's why the cut off is 7 or even higher in older men.
  • Adult males: 2.0 - 7.5 mg/dl
  • Adult females: 2.0 - 6.5 mg/dl;
  • Elderly:
    • Males older than 40: 2 - 8.5 mg/dl
    • Females older than 40: 2 - 8.0 mg/dl;
And maybe the reason that "Epidemiologic studies have linked asymptomatic hyperuricemia, defined by a serum urate in excess of 6.8 mg/dL, to increased risks of hypertension, cardiovascular disease, diabetes, chronic kidney disease, and all-cause mortality." is that older men tend to have higher risks than older women or younger women.

so what's your risk:
While awaiting the outcome of the prevention trials, it’s worth bearing in mind that Framingham Heart Study data indicate that individuals with a serum uric acid level above 9 mg/dL have a 22% chance of developing gout within the next 5 years.

So we docs don't always prescribe it for a lab test, or even after a single episode. Why? Because most gout patients are men, and men hate taking medicine:

Moreover, poor treatment adherence is a huge problem in gout. A study of close to 4,200 gout patients started on urate-lowering drug therapy found that 56% of them were nonadherent (Arthritis Res. Ther. 2009;11(2):R46).

I usually avoided HCTZ for mild hypertension: you will read studies lamenting why docs don't use this cheap and effective medicine, but some of our male patients lose their ability to make love taking it.

Another small thing mentioned in the article: That many medicines (including those cheap water pills used in heart and high blood pressure patients) increase the uric acid.

So which came first: The HCTZ for mild hypertension, or the high uric acid?
The big unanswered question is whether using medications to lower serum urate in individuals with asymptomatic hyperuricemia reduces the risk of any of these conditions. That’s the subject of ongoing large clinical trials in high-risk patients. If those studies prove positive, clinical practice will change.

Yes, in another five years the Obama health care bill will be making us check everyone who comes in with a cold for their uric acid and pay for the medicine whether you want it or not.
------------

If you are worried that your confidential medical information will be stolen by a hacker, well one might shrug that an ordinary hacker won't be interested in your medical information unless you are running for public office.

But this one I didn't think about:

A lot of doctors keep your credit card information on file.

How do you safeguard the credit information you keep on file?

The same way we do medical information; it's all covered by the same HIPAA rules. If you have an EHR, it can go in the chart with everything else; if not, I suggest a separate portable file that can be locked up each night.


So just refuse to give them your credit card, right? Yet this (non government expert) says:

How do you handle patients who refuse to hand over a number, particularly those who claim they have no credit cards?

We used to let refusers slide, but now we’ve made the policy mandatory. Patients who refuse without a good reason are asked, like any patient who refuses to cooperate with any standard office policy, to go elsewhere. Life’s too short. And "I don’t have any credit cards" does not count as a good reason.

Everybody has credit cards in this day and age. My office manager does have authority to make exceptions on a case-by-case basis, however.


This is from an AAFP (american academy of Family Physicians) official magazine.

Two months ago, they sent me an email telling me my personal information (but not the credit card information) was hacked.

If the AAFP couldn't keep the hackers out, what makes you think the average medical office will do so?

----------------------------------
robo doc will see you now:

Rite aid will have clinics for you to "see" your doctor on screen.

A patient walks into a private room, usually near the pharmacy counter, and registers himself or herself on the computer terminal.... The patient can access several free educational tools or talk with a nurse via video chat. The NowClinic website says a pharmacist can help get a patient connected.

The services offered at Rite Aid are the same as for the online NowClinic: treatment of allergies, bladder infection, bronchitis, cough and cold, diarrhea, fever, insomnia, nausea, pink eye, rash, seasonal flu, sinus infection, sore throat and viral illness.

James V. Springrose, MD, senior director of provider strategies for OptumHealth, said there's no charge for virtual consultations with a nurse, who also can advise patients whether a doctor visit is warranted.

If the patient would rather talk to a physician -- or the nurse advises that the patient should -- he or she can pay $45 for a 10-minute visit and enter credit card information. The system does not accept insurance coverage, though patients can submit claims to their plan to get reimbursed.



Yet I wonder: How many patients come in for one complaint, but their real worry isn't mentioned until they are ready to leave? And how many patients do we diagnose just by watching them walk in, or by noticing they have clubbed fingers (lung cancer) or an increased abdominal girth (pregnancy, cancer, ascites) but we would miss via computer screen? And how many times does our clinical instinct let us figure out that the "cold" patient had to breathe a bit faster than normal or looks a bit pale (and has Congestive heart failure or severe anemia), or the diarrhea patient is dehydrated, or the real cause of their insomnia is financial or a druggie kid or alcoholic spouse, and a ten minute talk will be better treatment than a sleeping pill?-----

-------------------------

the AMA notes that not all patients are computer geeks:

Patients directed to online tools don't necessarily use themA study finds that health information on the Web is read less often than the same material on paper.


considering most folks just throw away those papers, that is saying a lot.

The study showed that 42% of patients given paper-based resources reviewed them, while only 24.6% of patients given access to Web-based information reviewed it.

I'd make a comment that if a doc actually spent time giving the information to the patient, but actually studies show the patient is often so upset or nervous they forget what you told them.

Often having a family member in the room with them helps, as does telling them to call your nurse if they have questions after they get home, and if she can't answer the question I'll get back to them.

Why the nurse? Because often we are busy, and when we don't get back to them right away, they give up.

---------------------------------------
One reaction against this machine oriented medical care is the increased use of chiropracters and alternative medicine, where the "doctor" actually has time to listen to you.

The tip of the iceburg on this problem can be found on this article:


Home births rise despite higher neonatal mortality rate
 Although the vast majority of deliveries occur in hospitals, more women who want a less institutional experience are opting to give birth at home.

Ironically, when I was a doc, we had home births by the "green" type patients....one midwife was good, had done hundreds of home births, and I would take her problems in labor and give the kids their PKU test and checkup, but another one was stupid and thought she knew everything and after a few problems I refused to cooperate with her, and warned her she lacked the training to do home births: indeed, later, she had an asphyxiated baby who she did CPR wrong and ruptured the liver and killed the kid.

Ironically, we physicians were warned by our insurance companies that they wouldn't cover us if we did home births (I had a friend who was sued and faced bankrupcy for a birth gone wrong).

Most births could be done at home, but even in "low risk" ones, you sometimes run into an unexpected problem and face losing both mom and baby...in the UK they had "flying squad" ambulances for home births, but in the US, even in cities it takes awhile for the ambulance to arrive and get you to hospital.

---------------------
And yes, says the Massachusetts Attorney general, the government can order you to buy health insurance.

During her remarks, AG Coakley argued that the Individual Mandate provision of Massachusetts health care reform – that all who can afford it purchase health insurance – is a vital component of the ACA and constitutional under the Commerce Clause and the Necessary and Proper Clause of the U.S. Constitution.

AG Coakley noted that by requiring individuals to be insured, and thereby preventing healthy people from foregoing health insurance until they are sick or injured (“free-riding”), a comprehensive reform program can spread risk, control costs, and reduce the financial burdens otherwise borne by health plans and free-care pools.

\AG Coakley explained that Congress had a rational basis for concluding that free-riding by individuals has a substantial effect on interstate commerce.

So, because the constitution allows regulation of "interstate commerce", it means that everyone in the US will have to pay for contraception and abortion pills.

And if you've been following the argument, despite propaganda that Obama gave out a "compromise", some nasty republican checked the Federal document and found they didn't change the original wording.

Saying "insurance companies will pay not churches" is a lie: there is no such thing as a free lunch.

And it's not just church related organizations: it's the actual churches themselves, the organizations that "self insured" to get around mandates from state laws, and those of us who buy our own insurance coverage.

Dick Morris says this was a political move, so that they can say Republicans want to take away your birth control pills, and indeed, the left bloggers are already claiming that. But until the government shuts down the rest of us, from blue dog democrats like myself to Libertarians like Instapundit to Fox news, they will have problems.

Sorry, I don't have trouble with prescribing birth control pills or having my insurance company pay for them.

I do have a problem with the government ordering me to pay for it, however.

and I do have a problem with prescribing abortion causing morning after pills and paying for them And you know damn well if Obama wins the next election abortion will be on his "preventive medicine" list...

Oh well: Look at the postive side of things:

Unlike the US backed and paid for "Reproductive health bill" here in the Philippines, which if they pass it, will not only mandates everyone

(a) "Any healthcare service provider, whether public or private"

To push family planning, and even if passed will fine you 200 dollars if you criticize it,


Any person who maliciously engages in disinformation about the intent or provisions of this Act...

So be happy:there is still free speech in the USA.

So far, at least.


Monday, February 13, 2012

Medical stories of the week

Japan is having an Influenza epidemic of the same strain of flu that caused the HongKong Flu of 1968/69.

Yeah. that was a pretty nasty flu. And since a lot of us had it then, it may be hitting kids and young folks worse than the elderly.

more from ScientificAmerican
there is a note here about "factory farming" might be causing more mutations to spread, but since the "pig in the parlor with the chickens" has been blamed in the past for causing new mutations, I figure that everything is a risk.

Heck, here in the Philippines, our pigs even got infected with Ebola Reston...

------------------------------------
what is causing the epidemic of renal failure in middle aged laborers in Central America?
No, it's the hot weather...couldn't be a pesticide or chemical could it?

The trade group for Nicaragua's sugar companies said the Boston University study had confirmed that "the agricultural sugar industry in Nicaragua has no responsibility whatsoever for chronic renal insufficiency in Nicaragua" because the research found that "in the current body of scientific knowledge there is no way to establish a direct link between sugar cane cultivation and renal insufficiency."

Brooks, the epidemiologist at Boston University, told the AP that the study simply said there was no definitive scientific proof of the cause, but that all possible connections remained open to future research.

But why only recently, and why only in Central America?

---------------------------------------------------
The US is running out of methotrexate.

Heck, this is a common drug, not only used for leukemia but also for various connective tissue diseases, and also to destroy life threatening ectopic pregnancies without surgery.

and it's not just methotrexate:

So far this year, at least 180 drugs that are crucial for treating childhood leukemia, breast and colon cancer, infections and other diseases have been declared in short supply — a record number. Prices for some have risen as much as eightyfold. President Obama issued an executive order in October to help ease the problems.

Could government price controls be contributing to the shortage?

Reasons behind the drug shortages are complex and vary from drug to drug, but one of the biggest problems is that Medicare drug reimbursement under Part B keeps prices low. At the same time, drug manufacturers face increasing production costs but cannot easily adjust prices, leading many to halt production.

And, of course, going "overseas" might not help:

Fake anti cancer drugs in Asia have been a major problem.

The Hangzhou Food and Drug Administration was alerted in September 2008 through an inquiry about a bottle of cancer drugs that had packaging only in English. Drugs sold in the mainland are required to have Chinese translations.

By the time the scandal was exposed in 2009, the organization had earned more than 7.5 million yuan (US$ 1.1 million), with sales as far as even in Peru and India.

as for that "executive order"

It instructs the F.D.A. to do three things: broaden reporting of potential shortages of certain prescription drugs; speed reviews of applications to begin or alter production of these drugs; and provide more information to the Justice Department about possible instances of collusion or price gouging.

Which is the medical equivalent of sending them a nasty letter.
-----------------------
Smoking dope doubles your risk of having a car accident.

Well, duh.
-----------------------
Teenagers who sleep 7 hours a night test better.

well, duh.
--------------------
why does the LATimes use a very horrid photo of a bishop in their report when discussing "Obama's policy change"? Maybe because the press is spinning the story to get Obama reelected by pretending it is just a political story.

Catholic institutions will still be required to buy insurance by law. That hasn't changed.

Obama's new executive order demands all insurance companies pay for birth control and abortion causing medicine. That has changed: but not for the better. It makes things worse, since up to now, it affected only religiously connected insitutions. But now everyone, including individuals such as myself who pay for our own insurance, can no longer opt out of paying for certain coverage, because the insurance companies are ordered to cover it.

as one comment elsewhere said: Why such a fuss about paying ten bucks a month for the generic pill at Walmart?

Because it's not about the pill.
One argument being spun is that paying for abortion medicine/birth control will lower the health care costs of everyone, so your premiums won't go up. Since you aren't paying more for insurance, you aren't really paying for birth control/abortion causing pills.
Wait: that doesn't make sense...
exactly.

This is a lot scarier, because it justifies destroying conscience/religion by assuming the utility and cost savings is more important to the Federal government than the first amendment.
And it orders insurance companies on what they pay for (and in the near future, on what they won't pay for).

Because of course it's not about birth control: it's about the government control of medicine...and it won't stop there.

Ratiioning based on your QALY anyone?

--------------------
Zebra stripes are good camouflage against predators, but they also confuse the tsetse fly and other insects that spread disease.
hmm...mosquitoes and fleas and flies always fine me to bite. Maybe I should  be wearing stripes...

--------------------------------------------

Cancer medicine destroys Alzheimer's placque and (more importantly) improves mouse functioning.

and making dopamine producing cells from adult skin cells might reverse Parkinson's disease...


faster please. And they won't get a lot of press because they aren't using embryonic stem cells, which for years the press has told us is the only way to cure these terrible diseases.





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