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December, 1994
HEALTH CARE REFORMNow that an expensive, unwieldy, health care package has failed to pass through Congress, we should reflect upon the future of health care reform. Most citizens do not realize there is an excellent alternative to managed care (HMO, PPO, etc.) or big government approaches to medical care financing. Insurance was designed to shield us from catastrophic losses that we could ill afford such as fire, auto accident, premature death, or serious long-term medical illness. Insurance was never intended to pay every dollar of medical costs. When individuals stopped caring about the price of medical care because of "my insurance will cover it" attitudes, the costs spiraled out of control. The only viable solution to high costs is to put control of medical care choices and expenditures into our hands. I favor the "Medical Savings Account" approach to health care reform because the consumer takes control of choices and spending. Under this approach we all have our own personal Medical Savings Account that our employer funds annually, just as he pays insurance premiums now. The account is funded with pre-tax dollars and interest accumulates tax free like an IRA account. The account can only be used to pay medical bills but we decide where and how to spend our money. Unspent dollars carry over to the following year, unlike insurance premiums that are lost whether or not we utilize the insurance. Each year we buy a catastrophic insurance policy with a portion of the annual contribution to insure against a serious illness draining our account. With consumers in charge of spending, hospitals and doctors will compete to keep their fees reasonable. The consumer will be enabled to shop around to use money wisely and to get the best quality services at the lowest possible prices. Doctors must spend time discussing with patients why they recommend a particular test or procedure, and what are the alternative possibilities. I have always believed that patients should be well-informed consumers and that doctors should be advisors and educators, as well as skilled diagnosticians and technicians. This Medical Savings Account approach is favored by Sen. Phil Gramm (R-Texas) and others and encourages free enterprise in the health care setting. Medical care should be subject to the wisdom of the educated consumer. For example, when purchasing a car or appliance, we strive for the best of quality and convenience at a competitive price. We should expect to do the same for our medical care. Opponents argue that the public is neither interested nor qualified to make appropriate decisions. I disagree. Doctors must take the time and responsibility to educate patients so that patients can make excellent choices. This approach would slow the epidemic of unnecessary medical procedures and tests. It would eliminate impersonal plan administrators and bureaucrats who condescendingly determine for us the quality of care we can have and where and to whom we must go. Insurance companies will have to return to the business for which they were conceived -- providing catastrophic coverage for situations we are unable to afford. Patients with Medical Savings Accounts would be rewarded for staying healthy. If we did not spend our annual allowance, the balance would remain in our account accumulating interest. A person who exercises and avoids high fat foods and smoking will not only feel better, but will also save money! In countries that already use this approach, the money in these savings accounts becomes available in future years to help finance a child's education or to provide nursing care for advancing age. Consumers are frequently dissatisfied by the HMO (Health Maintenance Organization) structure. The HMO's impose the choices of doctors and hospitals upon their patients. Also, HMO's turn patient against doctor. The patient strives to get maximal care while the doctor tries to minimize the care provided. Instead of a cooperative venture, an adversarial relationship develops between doctor and patient. In case of a dispute, the administrative bureaucracy of the HMO intervenes to make the final decisions regardless of the medical and individual circumstances involved. My approach is to encourage families to stay healthy by taking responsibility for their health. I have attended over 2,000 home births in the past nineteen years of practice. Each home birth saves the patient and/or their insurance company over $3,000 in hospital costs. This represents a total savings of over $6 million generated from a single doctor! This does not include the substantial savings derived from encouraging successful breast feeding. These healthy babies rarely need to visit the doctor for sickness and parents avoid the costly infant formulas. The proven successful means of driving costs down include keeping patients healthy and avoiding unnecessary medical interventions. Recently my office researched the possibility of joining the new Abbott Company health plan. We have many patients who are Abbott employees who have been coerced by financial incentives to join this plan. A plan official told us that his policy was to discourage home birth services. What an outrage that an uninformed bureaucrat could interfere with medical decisions between patients and myself in such an arbitrary manner. Shame on the Abbott company, who prides itself as a model of free enterprise, for limiting the health care choices of its employees--choices that have saved the company thousands of dollars in the past! It is our responsibility as consumers and providers of health care to make our displeasure known to elected representatives and employers if we feel that our hard-earned dollars are being squandered on an inferior system. If you would like to learn more about Medical Savings Accounts and other common-sense approaches to health care reform, please contact my office for additional information.
WINTER WELLNESSDuring the Winter months we spend more time indoors and are exposed to colds and the flu. When the heat goes on in our houses the air becomes too dry and causes our mucous membranes lining the respiratory tracts to dry out. The barrier function of these protective linings declines due to dryness and we become more susceptible to viral and bacterial respiratory infections. Moisturizing the air we breathe by using a humidifier helps to bolster our immunity. Remember to change the water in the humidifier daily to prevent mold growth. Drinking ample water will help to prevent dehydration. Avoid keeping the indoor temperature too high -- our bodies are supposed to adapt to colder temperatures in the wintertime. Changing the furnace filter is important to avoid recirculating molds and dust that have developed inside the heating ducts during the Summer season. Persons with allergies may find their symptoms decreasing after the installation of an electrostatic dust remover. Good nutrition and exercise are as always responsible for keeping the immune system healthy. A multiple vitamin and an additional vitamin C supplement may be helpful to offset the scarcity of fresh fruits and vegetables during the Winter. An exercise program can compensate for the lack of outdoor activities. With maintaining good health habits it is possible for the family to remain healthy throughout the Winter season.
FEVER TREATMENTParents become concerned when their child develops a fever. I often hear the question, "How high a fever is considered dangerous?" This is not easy to answer without knowing the cause of the fever. Any fever in a child six months old or younger is unusual and the child should be examined by a doctor. In older children a fever may represent their body's attempt to fight off an infection, and a certain degree of elevated temperature could be a healing response. In the case of a purely viral infection, antibiotics are of no benefit, and the body's immune defenses need to fight off the virus over time. For example in Chickenpox it has been proven that routine use of acetaminophen (Tylenol(TM) to lower fever, prolongs the course of the illness by a full day by inhibiting the immune response. A child's temperature should be taken carefully in order to get an accurate reading. Rectal temperatures are the most accurate and are recommended in small children. Lubricate the thermometer liberally with petroleum jelly and insert the tip gently and slowly into the rectum until the bulb disappears from view. A mercury thermometer takes two or three minutes to get a reading. Some children can be very ill despite a mild fever if they are also lethargic, vomiting, or irritable. Conversely a child with a high fever who is active, playful, and drinking well may not be very ill at all. In conclusion, fever is not a disease but is a symptom to consider as part of a complete picture of the child. Therefore fever should neither be ignored nor should it be treated with fever lowering medicines, unless the underlying cause is understood. If you are unsure what to do, it is always better to call and ask.
HEPATITIS B VACCINEHepatitis B vaccine is now available for the immunization of the general public. Hepatitis B virus infects the liver. The virus causes a spectrum of illness: a mild self-limited flu-like syndrome that resolves spontaneously, or a serious life-threatening liver infection that ends in chronic hepatitis or liver failure. A person once infected by the virus becomes a carrier for life. The virus is transmitted by blood transfusions, contaminated needles, and sexual contact. Casual contact, eating, or drinking do not normally spread this virus. The vaccine has been recommended for medical care workers who are at risk of accidentally sticking themselves with contaminated needles or instruments. The primary series is an injection followed a month later by a second injection, then six months later by a third injection. Immediate side effects of the vaccine are uncommon. Immunity from the primary series lasts for six years or longer. We test each pregnant patient for this virus with a prenatal blood test. If she tests positive for the virus we must immunize her baby at birth. The American Academy of Pediatrics recently made the controversial recommendation that all babies should be immunized with this vaccine regardless of their risk status. Their reasoning is that when kids become sexually active as teenagers and adults they will be immune to the virus. During the past year newborns in the nursery started receiving the vaccine before discharge from the hospital. Before you decide to immunize your child you should consider the benefits versus the risks of any vaccine. A perfect vaccine would protect against a dangerous disease and have no harmful side effects. Most children will not encounter Hepatitis B virus until later in life, and we do not know yet how long the immunity from a primary series of injections will last in children. If you delay immunizing until high school or later, they will have the immunity when they most need it. Also, by that time we should know if there are any long term adverse side effects due to vaccinating young children. In my opinion, vaccinating newborns is still an experimental procedure, because we have no long term data regarding delayed effects of the vaccine on children. Newborns have a blank immune system because they have never encountered bacteria or viruses. We do not know the effects of exposing an immature immune system to a vaccine--particularly a vaccine of undetermined value to the child's well-being. A newborn should first encounter his mother's germs and mother's colostrum (early breast milk rich in antibody protection factors) before he receives an injection of a foreign antigen. Therefore I do not recommend immunizing newborns with this vaccine unless the mother carries the virus. We do have the vaccine available if you decide to receive the vaccine for your children or yourself.
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