I am not an economist; I do not claim to understand the complexities of the health care market, nor can I accurately predict how the proposed health care legislation will impact our nation's health care industry. However, many aspects of the proposed reforms make me uneasy.

1) Creating a centralized oversight committee in Washington puts too much power in one place. This group of doctors and other professionals will be making decisions about what treatment or procedure is appropriate for what person at what age or stage of their illness. Those decisions should remain between you and your doctor, not a committee in Washington. Further, many of the decisions will inevitably be made for political rather than medical reasons, as swarms of lobbyists and special interest groups will exert their influence over this committee to obtain results that benefit their own self-interest instead of the patient's. Imagine, for example, the frenzied efforts of drug companies to sway the government-approved formulary to choose their medication over their competitor's. Billions of dollars and tens of thousands of jobs could be at stake. Such far-reaching power over the industry will lead to corruption, no matter how well-intentioned the President or his oversight committee may be.
2) Like it or not, health care is a business. That cannot be changed, and attempting to change it will lead to laziness and stifled creativity. The most successful businesses succeed because they provide their services better than anyone else. In a market system, a business cannot survive unless it stays one step ahead of its competitors. Incredible innovations in health care technology and health care delivery have come from the opportunity to compete and succeed in a competitive market. Introducing more government-supported players into the market will dilute creativity and distort the field of innovation. Private health care companies must provide quality health care within a limited cost, or they go out of business. A universal government health plan has no survival accountability; if it fails to control costs or deliver quality services, it can simply be bailed out with more tax dollars. There will be no real consequences for poor performance, and therefore, I fear that the federal government's health care bureaucracy will become more and more bloated and eventually crowd out private health care companies that have to play by the tougher rules of a free market. Furthermore, competition among health care providers is the factor most responsible for the high level of patient satisfaction that exists in this nation (I believe our system needs reform, but I also believe that claims of imminent collapse and widespread dissatisfaction with our system are vastly overstated for political gain). One of the leading indicators being looked at by doctors, hospitals, and insurance companies is patient satisfaction. This is because patients can, for the most part, choose who will provide their health care. I believe the proposed reforms, despite President Obama's promises to preserve choice, will actually limit patient's choices, and the health care industry will begin to care less and less about patient satisfaction when their clientele no longer have the option of going to the doctor across the street if they are dissatisfied.
3) While I do not think tort reform would answer all of our health care problems, leading experts from diverse political backgrounds agree that the medical malpractice industry is draining resources from our health care system. Yet, no attempt was made in the proposed reform to address this issue. If we are really trying to control costs by any means, shouldn't tort reform be part of a broad health care reform package?
Though I have not read the 1000 page House bill, I will say that I am encouraged in hearing about increased funding for Federally Qualified Health Care centers that provide much of the health care in areas stricken by poverty. I am also encouraged by the proposal's promise to redirect resources toward prevention and primary care. Even so, I think the overall philosophy of increasing government's involvement in health care will have disastrous results.
As an alternative, I have read much of Senator Tom Coburn's proposed plan, and I agree with much of it. He is a physician and he understands the importance of preserving the doctor-patient relationship, something I think the President's plan will damage even further. Sen. Coburn also understands the value of having doctors and insurance companies compete for patients, and attempts to preserve that dynamic in his plan. Links to the entire bill or a summary can be found here.
It will be interesting to see how this unfolds and I would love to hear what you think.
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I am not an economist; I do not claim to understand the complexities of the health care market, nor can I accurately predict how the proposed health care legislation will impact our nation's health care industry. However, many aspects of the proposed reforms make me uneasy.

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This morning on WMBI I talked about a recent study on the popular Proton Pump Inhibitor (PPI) medications and their potential to cause "rebound" acid reflux. This could lead to a dependence on these medicines. Many callers and e-mailers have questions about this. If you are on these medicines, should you stop them? If so, what is the best way to stop? Is there any risk to staying on the medicine?

The PPI medications are commonly known as Prilosec, Prevacid, Nexium, Aciphex, and Protonix. The generic names have the common ending "-prazole". These medicines block the stomach's production of acid. They are useful for people with acid reflux disease, or gastroesophageal reflux disease (GERD). This class of medicines is one of the most commonly prescribed group of drugs in the world. Many doctors prescribe them the first time their patient reports symptoms of heartburn. Some of these drugs are now available over-the-counter without a prescription.

The problem that is now coming to light is this: it turns out that while these medicines are in the system, the stomach responds by attempting to crank up acid production. When the medications are stopped, the floodgates open and heartburn symptoms return, possibly in a more severe form than previous. This study actually placed people with no heartburn symptoms on a PPI medication for two months, and when the medicines were stopped, the patients with no history of GERD developed symptoms of heartburn within a few weeks.

So what are the implications? First, if you are on a PPI, there is no documented long-term risk of staying on the medicine. That being said, it is best to use these medications for the shortest time possible in order to avoid the "rebound" effect. The recommended time frame is 2-3 weeks, in order to treat a severe flare-up of GERD. During that trial, there are lifestyle modifications that should be tried. These include limiting the intake of alcohol, tobacco, caffeine, and spicy foods. Stress can also contribute significantly to GERD.

If you are already on these medicines, and you have been taking them for some time, talk to your doctor about stopping. One way to do this is to wean yourself off by cutting your dose in half, then going to every other day, then every third day, etc. Do this over the course of 4-6 weeks. What may happen, as suggested by this study, is that your symptoms may return when the dose is reduced. I would encourage you to try to ride this out over 1-2 weeks, because the stomach may re-calibrate its acid production on the new lower dose. This may need to occur over several weeks and multiple, step-down dose reductions.

For those who cannot manage their GERD through lifestyle modifications (mentioned above), another medication option is ranitidine (brand name Zantac). This medicine is available over the counter in a 75mg tablet. The maximum dose is 150mg (two tablets) twice a day. Start by taking one tablet at night, go to two if needed, and then add a morning dose if necessary. It is safe to start on the ranitidine while you are weaning yourself off the PPI's, and this may help with any "rebound" heartburn you may experience.

There is a group of patients that should be on PPI medications for life. These are people with something called "Barrett's esophagus". This occurs when the acid reflux is so severe that it causes tissue damage to the esophagus. This damage can progress to esophageal cancer and can be deadly. Barrett's esophagus is diagnosed by esophagealgastroduodenoscopy (EGD), a test in which a GI specialist passes a small camera down the esophagus and can look at or biopsy the tissue. Anyone with a positive test should stay on PPI's. For the rest of us, it seems best to limit the use of these medications.

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The recent death of famed pitchman Billy Mays was tragic (he convinced me to spend $19.95 for not one, not two, but six tubes of "Mighty Putty"). He apparently died from heart disease, but initial speculation blamed his death on a head injury he suffered during a rough airplane landing the night before. While the head trauma seemingly did not cause Billy May's death, it raises the question: what worrisome signs should I be looking for if I bump my head?

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There are many foods that are healthier than cereal bars (like fresh fruits and vegetables), and I am not endorsing Nutri-Grain products, but I am a big fan of their new ad campaign. Watch their commercial here and be inspired to make a small change today.

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