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By Jane M. Orient, M.D.
People are dying all over the country from opioid overdoses. There’s a movement to have the antidote naloxone available in all ambulances and even over the counter. This temporarily reverses the fatal effect of opioids, which stop the patient’s breathing. First responders themselves may need a dose because of contact with a tiny amount of fentanyl, an extremely potent narcotic, while attending a patient.
No, the fentanyl does not come from the patient’s bottle of legal prescription drugs.
Rep. Bill Foster (D-Ill.) introduced a proposal that he claims would “go a long way to fight the practice of doctor shopping for more prescription pain pills amid a deadly opioid crisis.” Doctor shopping “involves visiting multiple doctors.” Hardly new, this proposal, now passed by the House of Representatives as an amendment to a $99.4 billion Health and Human Services appropriations bill, lifts the ban on funding a Unique Patient Identifier (UPI).
The UPI is part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. You don’t have one yet because former congressman Ron Paul, M.D., (R-Tex,) sponsored a prohibition on funding it as part of a 1999 appropriations bill. Rep. Foster’s amendment repeals Dr. Paul’s prohibition.
So how is this 1996 idea supposed to work? And why would it be better than the Prescription Drug Monitoring Programs (PDMPs) now in effect in nearly every state? Every prescription for a controlled substance must be reported to the PDMP, and the doctor must check it before writing a prescription, to be sure the patient is not lying about having prescriptions from other doctors. This costly program that creates time-consuming hassles for doctors has not prevented opioid deaths.
PDMPs are ineffective because doctor shopping is not the cause of the problem. Only 2.5 percent of misused prescription pain medicine was obtained by doctor shopping. And this small percentage apparently increased after PDMPs. More than 97% of misused medications are obtained from a single physician—or from an illicit source. The spike in opioid deaths after 2013 was caused by illicit fentanyl, as Dr. John Lilly concludes from painstaking analysis of official data.
If Rep. Foster’s amendment is not removed, you might have to have a UPI to get legitimate medical care—“no card, no care”—but the drug cartel won’t mind. You can shop drug dealers as much as you like. There is a flood of fentanyl, mostly from Mexico or China, coming across our borders. Rep. Foster is apparently unaware of the armed lookouts protecting the smuggling routes in the Tucson sector. And once here, the drugs go to distributors—such as illegal aliens protected in sanctuary cities.
So, what about the other touted benefits of the UPI? “Specifically, assigning a unique number to a patient would give doctors a way to immediately identify a patient’s medical history,” said Rep. Mike Kelly (R-Pa.). He says it “would lower the cost of medical mix-ups due to misidentification.” His elderly father was nearly given the wrong medication.
To prevent medical errors, you need alert nurses and doctors—and the UPI is not going to fix the hazards of the electronic health record. The EHR, touted as the solution that will bring efficient, quality care, has created its own type of errors.
There is no guarantee that a UPI will improve access to the record, and critical information will still be buried in voluminous, repetitious data of dubious reliability, some of which may have been cut-and-pasted from another patient’s record. There may be critical gaps as patients withhold information they don’t want in a federal database. The new problem that brings the patient to the hospital won’t be in the old record—but may be the result of an old misdiagnosis that should be corrected instead of copied.
Patients need to be able to shop for doctors, especially if the one they have has not solved their problems. Some of them desperately need opioids, which are increasingly difficult to obtain. They do not need a UPI, and neither does their doctor.
The UPI is ideally suited for government tracking and control of all citizens. People like J. Edgar Hoover or Lois Lerner might find it very useful. But it would be the end of privacy, and the foundation for a national health data system.
Dr. Orient is the executive director of the Association of American Physicians and Sur- geons and is a policy expert with the Heartland Institute. For more reactions to the mid- term election, go to heartland. org under news and opinion. The Heartland Institute is one of the world’s leading free-market think tanks.
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By Dr. Glenn Mollette
We have watched corporations and famous Americans have ups and downs throughout the years.
We've all watched as Tiger Woods, Robert Kraft, and most recently, billionaire Jeffrey Epstein have had low moments.
Sadly we heard last weekend about coal billionaire Chris Cline's tragic and fatal helicopter crash.
Time and again we learn none of us are too famous, too successful or too rich to encounter a human downward life turn and tragedy.
The Nike athletic shoe and apparel corporation is the world leader in athletic and apparel sales. They made about $34 billion in 2017. They have a global presence of athletic sales in over 160 countries. Their products are sold through 22,000 retail accounts worldwide. They are the largest supplier of athletic footwear in the world.
Almost all of Nike shoes are made outside the US in Asia and Latin America. Nike does not make the shoes themselves but they contract production out to other companies. There are various reports about who Nike employs and how much their workers make. One report claims Nike has 100,000 people making their shoes in Indonesia and that these workers make about $3.50 per day or about $3,500 a year. Thus Nike is very profitable and has massive dollars for marketing.
For example, Nike entered into a $50 million endorsement deal with tennis star Serena Williams in 2003. When golfing star Tiger Woods turned pro in 1996 Nike lavished him with a $40 million five-year golfing endorsement. They would later go on to pay Woods $30 million a year in endorsements. From 2002 to 2012 Nike paid Michael Jordan $44 million a year to represent their brand. They still pay him. Forbes estimated Nike paid Jordan $100 million in 2015 as Jordan's brand still made $3 billion for Nike in US sneaker sales. Lebron James is reported to receive as much as $1 billion from Nike in endorsement money by the time he is 64 years old.
Colon Kaepernick was already on Nike's payroll before he became controversially famous for not standing for the National anthem. Nike wasn't using him and reportedly didn't know what to do with him until he became famous over his social issue stance. Kaepernick is currently not playing professional football. No one has signed him after he became a free agent but he is making millions a year by being the face of Nike's revived "Just Do It" campaign.
Recently Kaepernick ignited controversy by reportedly telling Nike to pull its Air Max 1 Quick Strike Fourth of July sneakers. Nike said he told the company he believes the colonial flag used on the shoes is offensive, because it was flown when slavery was legal. While there has been much consternation toward Nike's decision, Nike's stock has risen $3 billion within the last week. If you can find a pair of the Betsy Ross shoes they are going for about $2,500.
The question is this, Can Nike do no wrong? Are they too big to fail? Nike is utilizing controversy well to breathe new air into its products. With major national sports figures wearing and promoting the Nike brand and cheap Asian labor Nike has locked into a formula that appears unstoppable.
Nike will continue on their path of global success if the American people buy their products. It's a free country. If Americans decide to stop buying Nike products it would be financially troubling. Either way, Nike's continued success or failure will be decided by how Americans utilize Nike's slogan, "Just Do It," and how Americans decide to "Just Do It."
Glenn Mollette is a syndicated columnist and author and is read in all 50 states.
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By Glenn Mollette
What do Americans want?
This question is always relevant and politicians now in the heat of rhetoric war each believe they have the answer. Americans have wants and we have desperate needs. We don’t always get what we want. A friend of mine used to say that people in hell want ice water. What we want, what we need and what we end up with in America are not always going to be the same.
Americans do not want war with Iran. We don’t want the Iranians bombing oil tankers and shooting down our 130 million dollar drones either. Iran is in the Middle East. Here we go again with the subject of oil. How much killing is going to go on over the world’s relentless thirst for oil? America doesn’t have another trillion dollars and two or three thousand lives to throw away on another war. However, here we are again in the Middle East boiling pot. Iraq? Afghanistan? Iran? Is there no end?
Most Americans would like a peaceful existence. We would like to work our 40 years, have a retirement and collect our social security. We would like to have medical insurance so we can go to the doctor. A meaningful existence of fulfilling daily activity, family and friends are important to most Americans. It would be very nice if we could have good roads and bridges which are crumbling in many parts of the nation. We want good and affordable education for our families and a military and police force that are strong and have what they need.
We must have secure borders. People must come legally and orderly to our country. A good wall, strong security forces and deportation of those who come unlawfully are imperative for our nation’s security.
America must still be the land where people can genuinely dream and pursue a better life. People who have sneaked into our country are desperate for a better life. However, they need to understand there is a right and wrong way to enter America.
We can’t live in the past in this nation. You can come to a standstill in your life if you are always looking back. You can’t really drive forward if you are always looking over your shoulder. We can’t change the past. Make amends, give or seek forgiveness if necessary and then make today and tomorrow better than yesterday. None of us living today can change anything that our nation did a 100 years ago. We can though treat all people equal today with equal opportunities for all people.
It all sounds simple. Work hard. Treat others the way you would like to be treated. Help each other in this nation. Work to live at peace in the world. Don’t squander our nation’s money and resources. Keep America free. Live in peace and pursue our dreams. Mostly, this is what Americans want.
Glenn Mollette is a syndicated columnist and author and is read in all 50 states.
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By Marilyn M. Singleton, MD, JD
Listening to the campaign promises spewed out by the bevy of folks running for president brings the old but enduring story of Faust to mind. Despite being successful, Faust wanted more knowledge and possessions. To that end, he made a deal with Mephistopheles (aka the Devil) who promised to give him everything he wanted in exchange for his soul.
Who isn’t tempted by a bargain or better yet, something for nothing? Free income, free college, and free medical care. What do we have to lose? Self-respect, the opportunity to succeed at a career suited to one’s talents, your privacy and control over your own body.
Intended to ameliorate poverty, universal basic income can be counterproductive. Some promise income for merely having a pulse and others envision the government equivalent of a mama bird regurgitating food into the open mouths of her chicks. Neither option gives a sense of pride and accomplishment or the foundation for character development.
The high cost of college is the justification for free tuition. One key reason for the continually escalating tuition is readily available student loans: no matter the cost, the student can continue to borrow. Endless direct-from-the-government money would likely cause further increases. Further, one-third of college students drop out. The majority of these students were poorly prepared for, and not fully committed or suited to college. It is a bad idea to remove an incentive for perseverance, allow uncommitted students to waste their time on the government dime, or worse be stigmatized as a failure. Finally, as Senator Amy Klobuchar bravely pointed out, the taxpayers cannot afford it.
With regard to medical care, all “medically necessary” health services, including dental, vision, hearing, mental health, long-term care, home and community-based services, physical therapy, prescription drugs with no premiums, deductibles or co-pays from cradle to grave sound pretty good. Sold! Frankly, given the direction so-called reproductive health is going, you may never make it to the cradle. And with the current laser-focus on hospice for all, you may get to your grave a little faster.
Will free medical care halt one of the biggest drivers of poor health and medical costs? According to the Centers for Disease Control and Prevention (CDC), 40 percent of people in the United States are obese. And 47 percent of our $3.5 trillion per year of healthcare spending goes to treat the effects of obesity, with another 8.7 percent attributable to cigarette smoking. People have known for years that eating too much makes you fat and smoking contributes to heart and lung disease. Free care would worsen the problem because patients will expect more pills and procedures to cure their lifestyle-created illnesses rather than taking care of themselves.
Not only is the promise of free stuff an attempt to buy votes, but the politicians themselves have sold their souls to special interests. And we never know whether they are working for the metaphorical Devil or for you, the voters.
According to the Center for Responsive Politics, in 2018, both sides of the Congressional aisle received a total of $134,590,142 in contributions from the health sector (health professionals, device and pharmaceutical manufacturers, hospitals and nursing homes). The health sector was the top spender of lobbying money – some $562,968,799 spread among 2,810 hired guns. Pharmaceuticals/Health Products topped the list with $281,872,969.
On the bright side, when given the full picture, people are not that easily bought. A recent Kaiser Family Foundation study found that 70 percent of those polled approved of Medicare for All when told the plan would eliminate insurance premiums (which are sky-high thanks to ObamaCare). But up to 70 percent opposed Medicare for All when told it would lead to treatment delays, tax increases, or loss of their option for private insurance.
Perhaps those polled read that private insurance is allowed in all but two countries with universal coverage, and patients in all countries have some out-of- pocket expenses. Perhaps they realized that when the citizen money tree has been picked clean, promised services must be reduced. Perhaps they realized that free stuff can be used as a cudgel to keep the recipients in line and trap them in a system with no escape. Perhaps they were of a certain age where they were warned that the tasty-looking Halloween candy might be laced with razor blades. Or more likely, those infamous words, “If you like your doctor, you can keep your doctor” were flashing before their eyes or echoing in their ears.
Free stuff is an age-old snare, a temptation that can steal one’s critical thinking abilities. Despite the old saw that there is a sucker born every minute, there are always those who will not be fooled. Which will you be? .
Dr. Singleton is a board-certified anesthesiologist. She is president of the Association of American Physicians and Surgeons (AAPS). She attended UC Berkeley Law School, focusing on constitutional law and administrative law.