Handling Absolute Lies – What Does One Do ?

Gentle Reader:
About a month ago, I received a request for help from a friend, S.  Her mother-in-law – F. – had been sent a series of assertions related to the Affordable Care Act; things that “were going to happen”.  They were so outrageous, so absurd, that they demanded a response.  So the request was to provide some information that would allow this friend to address, point-by-point each issue.
I was able to assist this friend in some small way. Whether or not she actually succeeded in convincing her mother-in-law of anything is open to question; some folks have their minds made up and no amount of data will change what they think.
So here are the assertions – actually outright lies –  and my response to them, Enjoy !
AJ Layon

================================


Below is an email my mother-in-law sent me. I am delighted she has opened the door to a discussion about Obama Care and I would love to respond to this with some accuracy. Unfortunately I have not read all that is covered by the Affordable Health Care Act, specifically this part where Hospitals will have a panel of eight doctors to review surgeries on people over 70 years old and that the board will be active eight hours a day so that when someone needs a surgery during the off hours, they must wait until the board re-convenes the next day.
I can point out the more obvious and discussed aspects of the Affordable Health Care Act but can Joe offer an explanation, perhaps with a google-able site to read up on this topic? Do you know what is being talked about below or can you suggest someone or some place that might know the answer?

S.

—— Forwarded Message
Conversation: Obama Care-Per Emory Hospital-Atlanta Georgia
Subject: FW: Obama Care-Per Emory Hospital-Atlanta Georgia

This was from our friends; their friend in Atlanta sent this to them.

———- Forwarded Message ———-


—–Original Message—–
From: F.
Subject: Fwd: Obama Care-Per Emory Hospital-Atlanta Georgia
Assertion # 1:
When I had my colonoscopy a couple weeks ago I asked the doctor what ObamaCare would do to doctors – her reply was ” let me tell you what it will do to our patients ” – and, she did!!  Very similar info.  BUT, it will affect EVERY AGE because millions more will be on the insurance rolls.  WE will have a problem getting any care because the doctors will be overrun with those ‘newly insured’ who will be taking advantage of newly acquired benefits!!  This is first hand info from a medical professional to me.  F.

Response # 1:

This is perhaps the only part of this e-mail string that has a modicum of truth to it. There are inadequate physician numbers in essentially all specialties EXCEPT dermatology and plastic surgery.  We will have to make better use of physician assistants and nurse practitioners in order to accommodate the approximately 45 million more people who will – at some time – present for care.  I expect that medical schools will train more physicians and many will have loans forgiven if they go into primary care, but this is going to be a slow process.  On the other hand, the very way that the Affordable Care Act (ACA) is designed will relatively more slowly integrate these uninsured into the health system.

As a point of information, both Germany and the Netherlands have a health system similar to what is prescribed in the ACA and they do quite well.

Where we might expect further difficulty is in the payment mechanism for these newly enrolled citizens.  The ACA uses Medicaid as the payment mechanism for groups that can’t afford care or otherwise opt out of one of the private insurance programs.  This State / Federal partnership is highly variable in its fee schedule system and many physicians don’t like it because it – sometimes – doesn’t pay enough to cover overhead….and here I am talking not about the rabid right’s definition of overhead, but what most of us would consider appropriate.  So this will have to be fixed at some point.  None-the-less, your MIL is seriously mistaken about this part.

Assertion # 2:

Folks, this was sent to me by a friend who is a retired orthopedic surgeon and I was talking last night (Sunday) with my son-in-law’s brother who is a Neurosurgeon at Emory Hospital in Atlanta , which, if you are not familiar with it, ranks up there with the finest hospitals in the country.

A group of non-doctors, from ‘our’ (????) country’s Department of Health arrived last week at Emory for a two day session and is on their rounds around the country to make sure every hospital fully understands the new rules (which start in December (after the elections) concerning treating all patients over 70 years of age.

You heard of the death squads early on after Obamacare was passed and many people claimed it was not true and that people were misquoting what was in the bill.  Well if you believed this you are wrong.  DEAD WRONG!

Response # 2:

There was NEVER any talk of “death squads” or “death panels” in the law; this was an outright lie invented by the Tea Partiers and their right wing friends. To be clear, I actually read the law – well, at least the first approximately 600 pages that deals with acute care – there are no death panels.  What the death panel talk DID DO was to eliminate a provision that would have paid physicians when they have end of life discussions with families.  As an intensive care physician, I have these conversations several times each day that I am on service.  It is impossible NOT to have them, because some of our patients – despite our best efforts – will die.  The discussions are an attempt to allow death to occur with some dignity; but we always defer to the family and patient.

Assertion # 3:

This group informed the staff [at] Emory and all the doctors present that they will very soon not be allowed to operate on anyone over 70 (no matter how urgent or life threatening the situation is), without first having it approved by a board of eight doctors.

Response # 3:

This is quite amusing.  Really ? A panel of eight doctors ? I wonder where this came from ? 

As far as needing permission to do procedures on people over 70, even if they are emergent procedures….another lie made of whole cloth.  This is simply no-where to be found in the law.  The ONLY element of truth in this is that today, some of the private insurance companies will try to demand that we get permission before we do any procedure.  And some will claim the right to determine whether what we call an emergency is really – in their eyes – an emergency. If not, they try not to pay.

Assertion # 4:

Failure to comply will result in a huge financial burden to the hospital and more than likely the doctor will lose his/her ability to practice medicine anywhere in the country.

Response # 4 :

Again, this statement has no basis in the ACA law.  It IS TRUE that some private insurance companies – as I’ve noted above – will try not to pay even for an emergent procedure.  But this is not “ObamaCare”,  it is the much-vaunted private health sector that does not do justice to our country or the health system.

There is no basis in fact for the claim that physicians will lose their ability to practice.  Another outright lie.  These guys depend upon the fact that most of us havent read the ACA and that Obama and his people havent done a good job in educating the American people about the law.

Assertion # 5:

This board is to be established at every hospital in the country and the board members will only work eight hours a day.  We will discuss this a little later on as the DOH group almost got lynched at this point by the doctors who were present.

Response # 5:

Well, I would surely like to be on this Board.  I havent seen an 8 hour day for decades.  There is no basis in the ACA law for this statement.  There will be no Board, they will not work only 8 hours per day, because there will be no Board.

The ONLY thing that could remotely be interpreted like this was a board that was to be modelled after the British National Health Service’s National Institute for Clinical Effectiveness (NICE).  This board (perhaps 8 people, perhaps more, or perhaps less !) does look at clinical practices and where there are no data on clinical effectiveness they may recommend that the treatment either be studied or eliminated; this is simply a way to ensure that the dollars spent on health care are spent on stuff that works.  Personally, I would like us to have THIS kind of a board.

Assertion # 6:

This board of doctors will not be made up of active doctors. All the doctors must be retired – and may even be retired up to 30 or 40 years.  Further, Obamacare sees no need or requirement for them to be skilled in surgery. Another very vocal argument broke out here as these doctors likely may not even be aware of what advancements have taken place in surgery over the last 5-10 years nor what is going today as well. Also, anyone who has ever been a doctor can serve on these boards.  For example, Individuals with skills only in pediatrics, podiatry, dermatology, etc., may be making decisions as to whether a brain operation is required or not.


Response # 6:

Again, there is no board, so it wont have doctors on it who are podiatrists or who don’t know anything about brain surgery….because THERE IS NO BOARD !!!  This is crazy talk by people who either haven’t read the ACA OR have read it and don’t understand it.

However, today, some private insurance medical directors – not ObamaCare, but the private insurance that is loved by so many – MAY deny a procedure that is needed but that they don’t understand.  In this case we just do the right thing and work to get paid later.  The ACA makes this insurance company practice harder to do.

Assertion # 7:

The point that got the Emery doctors so upset originally was that the “Death Board” will be available on 8 hours during the day. And once their 8 hour shift is up, they may have to wait 16 hours to get in touch with them and another hour or two or three to get a decision and permission to operate.  But they daily have cases in which it is crucial to operate within 30 minutes.  The staff at Emory Hospital will be coordinating with other hospitals and together they will make a concerted effort to bring about significant changes to this portion of Obamacare.

Response # 7:

Well, there IS NO death board, so they can’t be available 8 hours per day and we WILL NOT have to wait 16 hours to get in touch with them because THEY DO NOT EXIST AND WILL NOT EXIST. Again, a lie made from whole cloth.

Assertion # 8:

When the question was raised from the floor by a young doctor as to whether doctors had to get permission to operate on congressmen and / or future members of the executive branch who would later be over 70, the answer was, “Of course not!”  When the same young doctor asked, “Why not.”  They refused to answer.

Response # 8:

This is interesting.  Congress-people have a federally funded health plan, a “public option” as it were.  This is what many of us think SHOULD have been included in the ACA.  So, it is entirely likely that our federal leaders will have better health care than the rest of us.  To my mind, if they were real leaders, they would take the system that they have offered us.  If it is good enough for the Senate and House, it is good enough for me !

So all in all, this email from your MIL is simply one lie after another.  There is no other way to interpret it.  You can look at my blog (Notes from the Southern Heartland) at ajlayon.wordpress.com.  I have several pieces on the ACA and what it means.

I suspect you will make no headway with your MIL on this.  Anyone who would believe this drivel will not be amenable to a discussion based upon fact.

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About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the past approximately 10 years, until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director of Critical Care Medicine in PA. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". You are welcome to respond to him at ajlayon@gmail.com.
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