Healthy Lifestyle Archives - Marilyn Singleton, MD JD

Culture & Society, Health Policy, Healthcare Reform, Medicare, Medicine, Socialized Medicine

The Medical Care Wheel of Misfortune

September 24, 2019 No Comments

By Marilyn M. Singleton, MD, JD

You finally get your dream and are selected to be a contestant on Wheel of Fortune. You get to see Pat Sajak and Vanna White! You win a vacation to some country that you don’t really want to see. You cannot get the cash equivalent. You have to take 10 days off of work to take the free vacation you did not want. You discover that you have to pay the tax on the free vacation.

Or you win a free car. You have a perfectly functioning 3-year-old car. The free car was not really the car you would have selected. You accepted it because it was free. Then you see that you have to pay tax on the list price of the free car. You also discover that the collision insurance and Department of Motor Vehicles registration for the free car are significantly higher than for the car you currently own.

These are examples of why nothing is “free.” This applies to medical care as well. You may have to see the “health care provider” the government program or private insurer makes available to you. You don’t particularly want to see a nurse, but that’s the way the cookie crumbles with free health care. Oh well, you convince yourself that it’s okay because, just like that car on the game show, it was free.

Here’s a new spin on “free.” Yes, your medical care should be free – free from the restraints of government control. Free from the government rules that have raised the price of insurance premiums. The Affordable Care Act mandated ten essential benefits that all insurance plans must include free of out-of-pocket charges to patients. Of course, this does not include the initial out-of-pocket charge: the insurance premium. Insurance premiums shot up over the post-ACA year because the insurance plan has to cover conditions that the insured persons may not even encounter in their own lives. A glaring example is obstetrics coverage in a menopausal female. Preventive and wellness visits are also labelled as free.

Moreover, a recent AMA study revealed that over the last four years the competition in the commercial insurance market has decreased. In over 50 percent of metropolitan areas, representing about 73 million persons, one insurer has half of the market. The more concentrated the market, the higher the premiums.

Remember that free car? We all know and readily accept that car insurance does not pay for the gas and basic maintenance. So why should maintenance medical care be covered by insurance? Car insurance would be unaffordable for most car owners if it paid for gas, oil changes, new mufflers, radios, and batteries. Most states require drivers to have car insurance. If people can’t afford the insurance, they lose the benefit of owning a car.

Similarly, if you lose your health due to long waits or delayed diagnosis because the CT scan was not authorized or poor medication response because you had to take the formulary drug that was not the doctor’s first drug choice for you, the care is not free, but very costly.

The underlying message of free “health care” is disempowering. The message is that we are incapable of taking care of ourselves. Empowerment is having control over our own lives. First, we take charge of our own health by thinking about the choices we make. We choose to not smoke, overindulge in food or drink, or engage in foolhardy behaviors. Second, we decide what is important for our own health. If you do not want insurance coverage for obstetrics or fertility treatment because you are 50 years old and do not want children, there should be a less expensive insurance product available to you. Third, we need to be free to choose our own doctor as well as the treatment the doctor—not the invisible third-party payer—recommends.

The promised free health care would increase the payroll taxes on all workers, even if that worker does not want that particular brand of free medical care. The next time you hear that medical care is free, just think about that “free” car that is the wrong color, is too small, has uncomfortable seats, inadequate headroom, and overall is not what you really want.

Bio: Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

Culture & Society, Health Policy, Medicine

Create Your Own Healthcare “System”

June 19, 2018 No Comments

By Marilyn M. Singleton, MD, JD, @MSingletonMDJD

Kudos to the folks in D.C. who are advancing alternatives to the Affordable Care Act’s over-regulated and expensive health insurance policies. Small business association health plans and expanding health savings accounts (HSAs) are among several tools to increase health care choices. However, one element in the medical care cost analysis that is rarely addressed is personal responsibility for one’s health. Politicians are reluctant to “blame the victim” (patients) so they criticize the health care “system.” That misses the point: It is not the government’s job to keep us healthy.

Estimates of 2016 U.S. health care spending averages $10,345-per-person. Purchasing insurance makes up the bulk of the spending: $3,852 annual insurance premium, $4,358 to meet the deductible, for a total of $8,210. But most of the actual spending on medical care is for 5 percent of the population, mainly for chronic conditions.Eighty-six percent of the nation’s $2.7 trillion annual health care expenditures (2010) were for people with chronic and mental health conditions.

It takes more than good luck to maintain good health. Up to 40 percent of lost years of life from each of five leading U.S. causes (heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries) are preventable according to the Centers for Disease Control and Prevention (CDC). Sadly, opiate use disorder jumped from 52nd on the list in 1990 to 15th in 2016.

Research suggests that behaviors, such as smoking, poor diet and over-eating, and lack of exercise are the most important determinants of premature death. Over the last 25 years the percentage of Americans with healthy lifestyles (exercise, good diet, “normal” body fat, non-smoking) has dropped from 6.8 percent to 3 percent. More than two-thirds of all adults and nearly one-third of all children and youth in the United States are either overweight or obese. The CDC reports that 9.3 percent of Americans have diabetes. Will this problem be solved by expanding government “healthcare” programs? No. In 1965 when Medicare and Medicaid were established, 1.2 percent of Americans had diabetes. This number had doubled by 1975, even with more sources for medical care, and continued to rise at the same rate despite the implementation of the ACA.

The American Diabetes Association estimates that in 2017, diabetes and its related complications accounted for $237 billion in direct medical costs — a 26 percent increase from 2012. The price of poor lifestyle choices is staggering. For the years 2009–2012, the costs for direct medical care due to smoking was at least $170 billion. Medical costs linked to obesity were estimated to be from $147 billion to nearly $210 billion per year.

Let’s face it. Many Americans have been duped into ignoring responsibility for their own health. With the drug companies’ relentless ads, prescription drugs have become the equivalent of “As Seen on TV” products. These ads send the unstated message that the latest diabetes or lung disease medication will take care of you so you do not have to take care of yourself and possibly avoid these diseases in the first place. It’s no surprise that 70 percent of Americans take at least one prescription medication.

And the same government geniuses that permit food stamps to be used at fast food outlets mandates over-priced insurance products that include “free” preventive care. But, of course the high-priced cholesterol medication will cancel that out, right?

No sane person would wish a chronic condition on anyone, or deny treatment for such patients. But preventive health begins at home. Changing behaviors requires someone who connects with patients, will take time to listen and help identify personal motivators for change. This requires a physician who will spend time with you—not a storefront doc-in-the-box. Direct pay practices (DPC) offer quality time, service, and chronic disease management. These physicians are not constrained by insurance companies’ and the government’s paint-by-the-numbers treatments.

Health insurance is necessary for big ticket items like hospitalizations. But there is no need to pay thousands for services that will never be used. Pre-ObamaCare high-deductible plans and their out-of-pocket costs were generally offset by lower premiums and employer contributions to health savings accounts.

Shifting all our personal responsibilities to the government has not improved our nation’s health. Imagine if the $1,000 spent on designer coffee or manicures were spent on foods and a non-sedentary activities that improved health.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Health Policy, Healthcare Reform, Medicine, Op-eds, Politics, Socialized Medicine

ObamaCare Is About Your Money, Not Your Health

September 9, 2013 No Comments

By Marilyn M. Singleton, M.D., J.D.,

“Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly, and applying all the wrong remedies.” Groucho Marx

The politics of selling the Affordable Care Act (ACA) focuses on promising health and wellness. Somehow, having “coverage” is supposed to get you to a primary care doctor, who will keep you healthy. And if he doesn’t, he will be held accountable by not being paid.

The fact is that “healthcare reform” is not going to cure America’s health problems.

Physicians, think tanks, and politicians are pointing out a myriad of problems with ACA. But most of them miss the main point, which starts with calling it “healthcare reform.” The term, and the conversation about it, conflates health care and medical care. But they are not the same thing. Individuals are in charge of their own health care. Physicians provide medical care to those who become sick.

Health reform begins with making it clear that individuals’ health is in their own hands. The relationship between personal behavior and health is clear. Almost all of the illnesses that we can prevent are related to smoking, over-eating, lack of exercise, alcohol or drug abuse, high-risk behavior, or too much sun exposure.

According to the CDC, 19 percent of all U.S. adults (43.8 million people) smoke tobacco. Almost one third of adults living below the poverty line smoke. Adverse effects include heart and vascular disease, stroke, emphysema, bronchitis, and cancer (lung, oral, esophageal, and likely bladder, kidney, and pancreas). Smoking tobacco is responsible for almost $200 billion in lost productivity and medical care expenditures per year.

Under ACA, doctors will check a box saying they asked about smoking and counseled people to quit. But the decision is up to the patient.

One third of American adults and 17 percent of children are obese. Consequences include fatty liver disease, type 2 diabetes, heart disease, high blood pressure, stroke, gallbladder disease, osteoarthritis, breathing problems, sleep apnea, pregnancy complications, and increased surgical risk. In 2011, the estimated annual medical care costs of obesity-related illness were nearly $200 billion, or 21 percent of annual medical spending in the United States.

Such costs are expected to rise if we allow today’s obese children to grow into obese adults. Obesity must not become the new normal. Indeed, a recent study concluded that since black women are more likely than white women to be satisfied with their weight and have less social pressure to lose weight, merely maintaining their current level of obesity was a success!

Prevention of obesity occurs at home: in the kitchen, at the dinner table, and while shopping. Not in the doctor’s office.

One-fourth of American adults don’t participate in any physical activities. Exercise can lower the risk of heart disease, stroke, dementia, colon cancer, breast cancer in post-menopausal women, and endometrial cancer.

More than half of all cancers related to lifestyle factors: 25-30 percent to tobacco, and 30-35 percent to obesity, physical inactivity, and poor nutrition. Certain cancers are related to sexually transmitted diseases such as hepatitis B, human papillomavirus infections (genital warts), or human immunodeficiency virus (HIV). Many skin cancers are caused by sun exposure.

We will have healthier people only if patients value their own health as much as good doctors do. And doctors must practice what they preach—who is going to listen to an obese doctor or nurse?

Some patients place a higher priority on enjoying risky behavior than on their health. ACA will not make them healthy. It only shields them somewhat from the consequences of their actions by forcing people who do take care of their health to share their costs.

Government cannot make us healthy, not even by trying to prohibit overindulgence or bad habits. Certainly, ACA’s massive new regulations, erosion of privacy, and higher taxes don’t bring health. But ACA’s subsidies compound our unhealthy reliance on government.

ACA redistributes the money flowing through the system. But your health care is still your responsibility. We can make others share the health plan premiums, but the pain and suffering are still the patients’ to endure.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton