Tuesday, May 25, 2010


As a supporter of House Resolution 615 (Congressman John Fleming), a resolution calling on Members of Congress to enroll in the public Health Care plan, I have another important update.

The non-partisan Congressional Budget Office (CBO) recently released a report confirming that spending under the recently passed health care legislation would be double what it had originally estimated.

Saturday, May 15, 2010


Bariatrics is a speciality in medicine that treats obesity.  Bariatric surgery is the term used for operations to help promote weight loss.  There is an epidemic of obesity in the United States and around the world.  Physical Education is rarely taught in school, and the abundance of fast food has contributed to an unhealthy lifestyle & poor eating habits.
Obesity has resulted in multiple medical problems such as heart disease, diabetes and hypertension.  Any surgical procedure has higher complication rates in patients that are obese.  When a person's weight increases to an extreme level, it is termed morbid obesity.

Bariatric surgery is beneficial in patients with morbid obesity (over 100 pounds overweight or a body mass index of greater than 40). It is always better to try to loose the weight with diet, exercise and lifestyle changes, but when these things are unsuccessful, surgery is an option.  The body mass index (BMI) is a standard way to classify obesity.  The BMI is calcuated based on a person's weight in kilograms (2.2 pounds equals one kilogram) divided by the square of the height in meters (39.37 inches equals one meter).
For instance, if you weigh 180 pounds and are 6 feet tall, your BMI would be calculated as follows:
Weight (180 pounds equals 81.8 kg)
divided by Height (72 inches equals 1.83 meters) squared

81.8 kg
divided by 3.35 meters        
equals a BMI of 24.4.

Overweight:      BMI of 25 or more
Obesity:            BMI of 30 or more
Morbid Obesity: BMI of 40 or more

Bariatric surgery is major surgery and has risks and long-term consequences.  With newer laparoscopic techniques (surgery performed through lighted scopes with smaller incisions), the surgery has become less invasive, although not every patient may be a candidate for laproscopic bariatric surgery. There are various types of Bariatric Surgery.  In Gastric Bypass (Roux-en-Y Gastric Bypass), the stomach size is permanently reduced to an "egg-sized" pouch. The pouch is reattached to a segment of intestine that bypasses the stomach.  In the Gastric Sleeve Resection, a portion of the stomach is removed, turning the stomach into a narrow tube. In the Adjustable Gastric Banding Procedure, the size of the opening from the esophagus leading into the stomach is reduced by an adjustable band that can be controlled via a port placed under the skin.  By inflating or deflating the band through this port, the band can be adjusted to make the opening larger or smaller.  The band can be removed at any time making this a reversal procedure.

Before considering this surgery, do your research and select a board certified surgeon with special training in this procedure.  Make sure he has had significant experience with all techniques. The hospital should be one that is committed to this type of surgery on a regular basis.

After the weight has stabilized (usually about a year), attention can then be turned to the excess skin in various areas of the body.  I will hold that discussion for another day!

Monday, May 3, 2010


Now that much of the rhetoric has calmed down, let's take a look at the new health care reform bill that is now law. It will probably take many years to analyze the scope of this bill, and even longer to determine the effects, both positive and negative.  The 2,700 page law contains a variety of mandates, directives, price controls and tax increases and subsidies. As with many things in life, there are some good things included in this bill, some things that should have been included that are not, and certainly things that will be determential to the health care of our patients.

Over the next decade, 32 million uninsured Americans will be able to obtain health coverage, mainly through an expanded Medicaid program and state health insurance exchanges. 11 Billion Dollars will go to community health care centers to care for this expanded Medicaid population. It is estimated that 23 million will remain uninsured, mainly through their own choice.  Starting in 2014, penalities will be assessed for individuals that do not obtain adequate coverage, $95.00 per year or 1% of taxable income. This will go up to $695.00 per year or 2.5% or taxable income in 2016.  Business owners with more than 50 employees must buy government-acceptable health coverage or pay a yearly penalty of $2000 per employee.  According to estimates from the Congressional Budget Office, 8-9 million people will loose their employer-provided coverage. It is predicted that these employees will be forced to accept a lower quality of care through government controlled insurance, instead of employer sponsored private insurance.

There will be an elimination of pre-existing conditions and a lifting of the life-time cap on coverage.

Dependent children will be able to stay on their parents policies to the age of 26.

There will be added funding for research into problems such as hospital infections, re-admissions, and intensive care.

The bill prohibits federal funding of abortion except in cases of rape, incest or when the woman's life is in danger.  It will provide about $25 Million over 5 years in state grants to extend the abstinence-only sex education program.

The bill has no liability reforms which would help reduce the high cost of medical care related to defensive medicine.

It imposes arbitary treatment standards to reduce the cost of care without improving the quality of care.  Some of the cost reduction will be on the backs of hospitals and physicians with penalities assessed for certain "preventible" medical conditions that we have no control over.

There will be an increase in government intrusion into the patient-doctor relationship.  There will be an independent payment advisory board which could result in mis-guided decisions on care and payment cuts which will undermine access to care.

One aspect calls for 16,500 IRS employees for enforcement purposes. These IRS agents can confiscate tax refunds, place liens on property and seek jail time if health related penalties and taxes are not paid. The law includes about 19 new taxes.  A few examples of the new taxes. This bill imposes a 3.8 % annual tax on investment income on individuals making $200,000 or more and on families making $250,000 or more.  This new tax is not indexed to inflation, which means more people each year will fall under this tax burden. Starting in 2018, a 40% annual tax will be placed on health care plans valued at $10,200 for individuals and $27,500 for families.  These health savings accounts were ennacted several years ago to encouraged saving, but with this new tax burden, many individuals will have to buy new policies or face this outrageous 40% tax.  Even some medicare receiptants will be hit by a new tax.  Medicare patients in the higher income bracket ($200,000 per year for an individual; $250,000 per year for a couple) will pay an additional 0.9% Medicare Tax.
There will be a new 3.8 % tax on home sales and other real estate transactions.  If you sell your $200,000 house, you will pay $7600.00 in new taxes.  There will be a new 2.9% tax on medical aid devices and a 10% tax on services at tanning salons.

The bill will reduce federal funding for care of the indigent and uninsured  patients at public hospitals by 14.1 Billion dollars or 40% by 2019.  This will negatively impact the training of medical doctors.

There will be a continued limit to access  care because nothing was addressed in the bill to fix the flawed Medicare Payment Formula.

Despite the "good, the bad and the ugly" of this new bill, as always, my goal is to provide the best medical and surgical care to my patients while abiding by state and federal laws.