Are we Really Assisting the Middle Class Working “Stiffs”?

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I am angry after listening to the President give his State of the Union address as well as a number of incidents that my office has experienced over the last few weeks.

Our dear President described the Affordable Care Act as part of the fabric of middle-class economic recovery as he delivered a State of the Union address to a Republican-controlled Congress intent on dismantling the law.

Obama defended the Patient Protection and Affordable Care Act, pointing out that roughly 10 million Americans have gained coverage under its provisions and that the level of uninsured has dropped significantly since full implementation of the law. However, the numbers are not accurate, as we have seen in the past. How many paid their premiums, how many are actually new or just reinsured?

“We can’t put the security of families at risk by taking away their health insurance, or unraveling the new rules on Wall Street, or refighting past battles on immigration when we’ve got a system to fix,” Obama said, speaking before a packed audience in the House chamber at the Capitol. “And if a bill comes to my desk that tries to do any of these things, it will earn my veto.”

Obama laid out his priorities for the final two years of his administration, focusing primarily on spreading the economic recovery to the lower and middle classes.

However, additional comments that he made make me doubt that he really has an understanding of the truths. He wants to take away the tax benefits of the college tax-free 529 savings programs because they benefit the rich. So, he wants to take away a benefit of families that actually plan for their children to go to college because he believes that the program benefits the rich. How stupid! Almost as crazy as the free junior college program! The free junior college program would reduce it to an extension of high school. And what grades does one have to get to allow the students to receive a free education? Once again he and his supporters are actually hindering the middle class portion of our society.

What else, you ask? The double digit increase in the health care insurance premiums as well as the huge increase in the deductibles, or what the patient has to pay before the insurance companies start to pay make it difficult for the middle class patient and discourages patients to go to their physicians, nurse practitioners, etc. because they are paying out of pocket.

A survey showed that when deductibles are high relative to income, many people skip needed care. Forty percent of privately insured people whose deductibles represented 5 percent or more of their income cited at least one example of skipping needed health care because of their deductible: 29 percent skipped a medical test or follow-up treatment; 27 percent had a medical problem but did not go to the doctor; 23 percent skipped a preventive care test; and 22 percent did not see a specialist despite being advised to do so by their physician.

I mentioned that my practice has been experiencing the frustration of my patients. Consider the patients who called my office to complain that the cream that I prescribed for their facial precancers was going to cost almost a thousand dollars. When I checked the true cost I was amazed at the difference in price here in the U.S. as compared to the cost in Canada where the prescription costs only a few hundred dollars. The Medicare patients don’t even know if the Medicare insurance will pay and how much due to the “donut-hole”, the dark hole of inconsistency and confusion.

The only parts of our society benefiting from the Affordable Care Act happen to be the pharmaceutical firms and the insurance companies. These two factions need to be controlled before we have a truly sustainable health care delivery system.

President Obama used some of his State of the Union oration to lay out a grand vision for “precision medicine” and announce an initiative to realize it.

“I want the country that eliminated polio and mapped the human genome to lead a new era of medicine—one that delivers the right treatment at the right time,” he said. The initiative would help to “give all of us access to the personalized information we need to keep ourselves and our families healthier.”

According to a White House document accompanying the speech, the initiative would involve increased investment; though it’s unclear what agencies the money would be channeled through.

“Precision medicine” typically refers to the use of genomics to tailor treatments to the individual based on an analysis of one’s DNA. Indeed, Obama referred in the speech to Kalydeco, a cystic fibrosis drug from Vertex Pharmaceuticals, which helps treat the root causes of the disease in a subset of patients with a specific genetic mutation.

The term, however, can be broader than that. Dr. Jeff Shuren, director of the Food and Drug Administration’s Center for Devices and Radiological Health, pointed out in a July 2014 roundtable discussion on precision medicine that many device manufacturers hope to unveil devices that are tailored to a patient’s physiology, such as 3-D printed implants that conform to a patient’s body.

The White House has revealed few details on the initiative. HHS Secretary Sylvia Mathews Burwell said in a Jan. 15 speech to the New America Foundation that she hoped to “work with the Congress to scale up the initial successes we have seen in this promising avenue of scientific endeavor.” Obama’s speech, however, did not suggest that the administration planned to pursue the initiative through legislation. The White House’s media team had not responded to queries at deadline.

Precision medicine has been part of the focus of the House Energy & Commerce Committee’s ongoing 21st Century Cures initiative, which is expected to yield a broad legislative package that will propose regulation changes and promote investments in healthcare delivery and technologies. Energy & Commerce Chairman Rep. Fred Upton (R-Mich.) said in a statement before the State of the Union that he hoped the president would be able to work with him on delivering 21st Century Cures.

Lynn Etheredge, director of the Rapid Learning Project, an effort to use big data and electronic health records to assess the effectiveness of medical treatments, said that he’s very hopeful about precision medicine’s impact. “Mostly our science has been built around testing response to average patients. In fact we know that for most of our chronic diseases, there’s a wide range of response to the same treatment,” he said. More research will allow clinicians to make more-precise diagnoses, which will in turn drive better treatments.

Delivering on precision medicine’s promise is the culmination of many previous technological and policy efforts, noted Colin Hill, co-founder and CEO of GNS Healthcare, a company specializing in precision analytics.

Delivering the right treatment at the right time, he said, requires cheap sequencing technology and actual patient outcomes data, delivered through an EHR. That allows researchers and clinicians to more closely observe the real-world effect of their precision-guided treatments.

Hill said it’s “about time” for the government to push precision medicine. But there is a risk, he said. “Money does a lot of things” in spurring research and development, he said. But genomics data needs to be married to real-world impact data. “There’s more data-sharing that needs to happen,” he said, though he added that he’s encouraged by recent progress in that area.

Drilling down to the DNA of each patient means that no two treatments or drug regimens or combinations of strategies to combat an acute disease, or chronic conditions would exist. There are no economies of scale, and each patient would be a one-off. But that would violate the equal protection clause of the 14th amendment, as more white females would be given treatments for osteoporosis, more blacks for diabetes and hypertension, etc. Hey, wait a minute! Isn’t that what we are doing now already? Wonderful idea, but if you are unhappy with the high cost of medical care now, just wait for the price tag on this ‘moon shot’.

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