Policy news this week centered on reaction to the government handling of the proposals for healthcare perform. As before, observers from all sides have noted that proposed changes would result in over 20 million people becoming uninsured, adding to the financial and human burden that we would face. It would also result in premium increases of approximately 20% across the board according to the Congressional Budget Office, and this, well before the next election.
In a stunning turnaround Senate Majority Leader Mitch McConnell (R-Kentucky) warned that if the GOP senators could not get 50 votes required to repay and replace the ACA (Affordable care act), then, (emphasis mine) THEY MAY HAVE TO WORK WITH DEMOCRATS to repair the existing marketplace. The current proposal will, in fact fail since only three Republican votes against it could sink it, and there are many more Republicans than that opposed to the bill.
Delaying action on the GOP plan for healthcare until after July 4 recess week had one interesting unintended consequence. Congressmen returned home for about nine days, not just 4. In that timeframe they had plenty of time to hear from the local officials at home most pointedly, from the Governors of their respective States. Governors are worried about losing billions of dollars in Medicaid funding if the Affordable Care Act repeal bill is passed. Washington will not inherit all the problems that ensue if the ACA is repealed, they will.
Plans under consideration and go all the way from the Sanders bill introduced by Democrat Bernie Sanders which provides for "Healthcare for all", to a buffet style set of plans favored by senate Republicans from Texas and Utah, where one could buy plans in conformance with the Affordable Care Act or less costly, less comprehensive plans geared for healthier people. The problem of course with this is that it short-circuits the whole beauty of broad-based health insurance which pools risk and pools money. Money for low risk people subsidizes the poor and those who are misfortunate enough to sustain expensive and long-lasting illness. It is this exact feature to which many people object, not feeling an obligation to those less fortunate than themselves. I feel people of this opinion exhibit not only a lack of compassion but a lack of fiscal common sense. Money spent on the health of the poor, on early diagnosis, on pregnant women, and money spent keeping up on the care of the chronically ill is money saved and an insurance policy for a better future.
In the Texas and Utah plans there would be a multitiered system of healthcare where some people would not get all benefits. Physicians like me know that one's health cannot always be predicted and that the unexpected does happen. Thus, patients given the option of incomplete plans may find themselves wanting for adequate coverage. Physicians like me also cringe at the notion of a double standard in in health care since it is our training and our philosophy to believe that everyone should get the best of care all the time.
At the present time, under the Affordable Care act, IRS (The Internal Revenue Service) has a role in enforcing the individual mandate. The individual mandate is the portion of the Affordable Care Act which requires that individuals must maintain health insurance at all times or be fined. GOP lawmakers are currently working on a plan to prevent the IRS from enforcing the Affordable Care Act individual mandate. I think you would be hard pressed to find a physician who does not support the individual mandate.
In our country, one must have auto insurance in order to exercise the privilege of operating an automobile on public roads. Conventional wisdom and existing data teach us that if one does not maintain auto insurance that one poses a significant liability to others. In my opinion, not having individual health insurance is exactly the same thing. Without insurance, one is less likely to obtain contraception, less likely to obtain vaccinations, less likely to obtain mental health and substance abuse treatment, and more likely to blow into the emergency room with some health crisis or accident costing the healthcare system and taxpayers a huge amount of money.
In medical news, the number of total births has declined for two years running. Most notably the teem birthrate has decreased to nearly 10%. Unfortunately rates of preterm birth continue to rise.
In the absurd department, both the UK and United States noted increasing rates of labioplasties not only among women but particularly among teenagers. A labioplasty is the surgical modification of the labia, the flaps covering the vagina, often for cosmetic purposes. Obstetricians and Gynecologists in both British and American Societies of Obstetricians and Gynecologists as well as Pediatricians have sounded the alarm over this trend indicating that it may be a sign of a deeper disorder called body dysmorphic disorder. They have called for clinicians to screen these patients accordingly. I also have to observe that this trend highlights the power of media images in our lives, including those provided by what must be classified as porn.
A recent study of robust design has revealed that women consuming large amounts of sugary foods and drinks in the latter part of pregnancy produces children who are at higher risk for allergies and asthma. The study was published in the European Respiratory Journal. It been hailed as a strong study with a large number of participants. A call has been made for additional research to understand exactly how this works.
In the we-already-knew-this department, a recent study has confirmed that women’s cognitive performance is not affected by her menstrual period. This was documented recently from a study published on July 4 in the journal Frontiers in Behavioral Neuroscience.
In the concerning department, new research has shown that poor sleep may be associated with an increased risk for Alzheimer's disease. It is not at all clear whether the poor sleep leads to the Alzheimer's or whether the impending Alzheimer's leads to the poor sleep.The study involved sampling the spinal fluid of cognitively normal people with an average age of 63. Specific physical findings are present in the spinal fluid which can be followed to determine this relationship. This is clearly an area deserving of more research and this is a step in the right direction. The findings were published online July 5 in the journal Neurology.
In the good news department, a new study has shown that simple aspirin may reduce the risk of complications for those pregnant women who have antiphospholipid antibody syndrome. Yet another study has shown that a simple dose of aspirin at 150 mg per day significantly reduced the incidence of preterm preeclampsia (toxemia) in high-risk women.
Also in the good news department, clinical trials for Zika virus vaccine are underway. Zika virus can potentially affect all people who contract it,. Most distressingly, it produces serious birth defects in the fetal brain if the Zika virus infection is contracted by pregnant women during her pregnancy. A working group consisting of bioethicists, OB/GYN's, vaccinologists and others have recently released a set of ethical guidelines whereby pregnant women can be included in these clinical trials.
Stay tuned for more breaking news from the world of Obstetrics and Gynecology, right here, next week, on Medical Monday. And remember... it really matters when you contact your elected officials to tell them what you think.