Eyeworld

EW NEWS & OPINION 14 August 2016 health at lower cost, will prove false. Health care is a social good and, arguably, an individual right. Its services and technologies are best accessed when one has health insurance. But insurance and access are not guarantors of health. No legislation can compel a populace healthier. Without per- sonal responsibility, the provision of medical care is a costly, ex post facto stratagem. Intensity of services, variability in their provision and the adverse incentives of fee-for-service medicine are debated ad nauseam; their contributions to hospital, testing, procedural and pharma- ceutical costs are indisputable. Yet how much of the nation's treasure might be saved if Americans were to eat moderately and wisely, stop smoking and doing drugs, lose weight and exercise more, practice safe sex, maintain the family unit, wear seat belts and quit drinking to excess, driving under the influence and taking offense at incivility by firing a handgun? Assignment of responsibility for these social ills to the medical profession is fallacious, manipulative, and dangerous. With- out controlling costs engendered by lifestyle choices, accountable care organizations, MACRA and big data's electronic health record are morale-sapping experiments. Truman would not comprehend the progress modern medicine has made over the past 70 years. His as- tonishment at the improvements in life's quality and duration would be equaled by his appall at the dollars spent. He once said, "I never did give them hell. I just told the truth, and they thought it was hell." Who will tell America the truth today? EW Reference 1. Obama B. United States Health Care Reform: Progress to Date and Next Steps. JAMA. 2016 Jul 11. [Epub ahead of print] Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio since 1983. He has been a member of ASCRS for 35 years. Contact information Noreika: JCNMD@aol.com by J.C. Noreika, MD, MBA exceeded the Congressional Budget Office's estimates by 17 million. He concluded "the ACA might be more appropriately labeled the Medicaid Expansion Act." Skinner noted that the president reports substantially slower growth in health care spend- ing between 2010 and 2014. He asks whether this is due to the ACA, aftershocks of the Great Recession, or increases in patients' co-pays and deductibles. Bauchner, the sole physician editorialist, inquires, "has there been true improvement in the health of the nation and in indi- vidual health outcomes following enactment of the ACA?" He intuits that the answer may wait decades. Referencing 68 sources, Presi- dent Obama writes that "to assess trends in healthcare cost and qual- ity, this analysis relies on publicly available government estimates and projections of healthcare spending; publicly available government and private survey data; data on hospital readmission rates provided by the centers for Medicare and Medicaid service, and previously published analyses of survey, administrative, and clinical data." The degree of confidence in these sources predicts one's bias of the plan's future impact on America. Butler pointed out that, "if it were a separate economy, the US health system would be equiva- lent to the fifth or sixth largest econ- omy in the world." A single piece of legislation is unlikely to fix it. I anticipate that the fundamen- tal premise of the Affordable Care Act, i.e., insurance confers better ance posed a threat "to the integrity of scientific publishing." To maintain a semblance of political balance and peer-review, JAMA offered 4 editorials. The authors were: Jonathan Skinner, PhD, of Dartmouth College, and Amitabh Chadra, PhD, of Harvard's Kennedy School of Government; Peter Orszag, PhD, director of the Office of Management and Budget and director of the Congressional Budget Office; Stuart Butler, PhD, MA, of the Brookings Institute and former director at the Heritage Foundation; and Howard Bauchner, MD, editor-in-chief of JAMA. Each contributed impressions of President Obama's article that highlighted socioeconomic successes of the ACA, necessary changes to improve the program and lessons learned at and after its passage. Reflecting their authors' ide- ologies, the editorials provide a useful but incomplete mosaic of the consequences of the 6-year-old law. Orszag posits that the ACA provides coverage to many formerly uninsured Americans. Yet President Obama's promised goal of universal insurance remains elusive. More than 25 million Americans, main- ly poor, black or Hispanic, remain uninsured. Butler, a conservative, states that the reduction in the uninsured derives from the expan- sion of Medicaid and the Children's Health Insurance Program (CHIP). While enrollment in ACA exchanges fell 10 million short of projections, Medicaid and CHIP enrollment Journal of the American Medical Association publishes President Obama's article on the state of health care reform M ore than 67 years ago, the June 1949 issue of the Scientific American featured Michael M. Davis' article "National Health Insurance." Universal health care was on the minds of post-war Americans when Harry S. Truman addressed Congress 7 months after Franklin Roosevelt's death in April 1945. "Millions of our citizens do not have a full measure of oppor- tunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection." There were 185 million few- er Americans then; the president had Democratic majorities in both houses. A bill guaranteeing universal health care was defeated. Truman called it "one of the most bitter and troubling disappointments of his presidency." Another 20 years passed before Lyndon Johnson signed Medicare and Medicaid into law on July 30, 1965. Johnson handed the pens used to sign the bills to Harry and Bess Truman. On July 11, 2016, the Journal of the American Medical Association's OnLine First posted "United States Health Care Reform: Progress to Date and Next Steps." 1 Its author is Barack Obama, JD. The Scientific American admitted, "it may be the first time a sitting president has authored a complete academic arti- cle—with an abstract, findings and conclusions—that's been published in a scientific journal, at least in re- cent history." Controversy followed quickly. On July 18, the Los Angeles Times opined the article's appear- Health care reform's misdiagnosis Insights J.C. Noreika, MD, MBA

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