A Board Certified Plastic Surgeon in Scottsdale
Health Policy
Healthcare Repealed, Now What?
01 year ago
by Dr. Aldo
in Health Policy
Scottsdale – The new Republican-led congress has repealed Obamacare. Where do we go from here?
There are some good things in the bill the president signed last year, but also many bad ones. Therefore, the House of Representatives voted to begin replacing the legislation.
“Today is Day One of our efforts to replace Obamacare with something better, a lot better,” new Energy and Commerce Chairman Fred Upton, R-Mich., said.
I hope so! We need a better piece of legislation that is fair and does help those people in need, but also does something to reduce the rising costs of health care, the abuse of the system, and frivolous lawsuits.
According to CBS, several sub-committees in congress are already starting to work on the positive changes needed. Congressman Upton said one of the first efforts his committee will take is to allow individuals to purchase health insurance across state lines.
“Competition does work, we know that, and we should allow it to work for health insurance as well,” he said, before asking why consumers can buy auto insurance anywhere but health care is restricted to within a state.
Rep. Dave Camp, R-Mich., said that his Ways and Means Committee will hold a hearing next week “solely dedicated to examining the economic and regulatory burdens imposed by the Democrats’ health care law.”
The chairman of the House Judiciary Committee, Rep. Lamar Smith, R-Texas, wasted no time by convening a hearing Thursday morning on medical liability reform.
My hope, as a physician and plastic surgeon, is that we do get an improvement in the law and that congress does not rush through this like they did in the previous 2 years. We need a law that is fair and does not put any more Americans out of work because of the financial burdens it places on small businesses and employers. If anything, I sure hope that this bill is no 2000 pages!
Options for Healthcare. What Else is There?
01 year ago
by Dr. Aldo
in Health Policy
Scottsdale – Alternatives to government-run healthcare are being discussed now more than ever. It is true, there are some good things about the new bill, but most Americans are unhappy about the new law, which is seen by many as government over-reaching. I ran into an interesting article posted November 8, 2010 on the Association of American Physicians and Surgeons (AAPS) website.
The article is written by Alieta Eck, MD, who is a member of the AAPS and has testified before the Joint Economic Committee of the US Congress about ways to improve the delivery of health care in the United States. She practices medicine with her husband in Piscataway, NJ and has founded a free clinic for the poor and uninsured that currently cares for 300 to 400 patients per month, utilizing donated services from volunteer physicians and nurses.
She outlines 4 important principles based on her experience:
- First, involves the average patient paying his doctor directly for services rendered. She believes this would drastically reduce paperwork, preserve patient-physician confidentiality, and reduce costs and prices which would be kept down by competition.
- Second, would include all patients obtaining a health insurance policy, non-cancelable for unforeseen major medical maladies and accidents. A requirement would make these policies carry the coverage and deductible that fits a family budget. States would merely oversee that contract terms are met, but not mandate what conditions are to be covered.
- Thirdly, develop a safety net of non-governmental charity clinics scattered throughout every state with each clinic deciding ways to determine the eligibility of those seeking free care.
- Fourth (and I added it here), the Federal Tort Claims Act of 1996 provides free medical malpractice coverage for professionals who volunteer at any free clinic. Dr. Eck believes that doctors freed from the specter of frivolous lawsuits can offer common sense care leaving compliance up to the patients.
Dr. Eck discusses, in her article, the experience at the Zarephath Health Center in central New Jersey. The center uses volunteer physicians and nurses to provide free care to the poor. Patients include the homeless, the mentally ill, the jobless, undocumented immigrants and even patients with Medicaid cards.
She reports that physicians there diagnose and care for patients with acute and chronic illnesses. The patients are treated with kindness by those who are willing to donate their time. Impressively, she reports the cost of providing services comes to $15 per patient visit compared to $150 per patient visit at a federally qualified clinic in the neighboring town.
She mentions that the latter clinic has huge bureaucratic administrative overhead and collects funds from federal and state governments, as well as patients. The government run clinic is constantly asking government for more money.
My take on healthcare options
It did not take much to convince me we need other options with this new healthcare law. The fear many people have is that so much bureaucracy has been build into the system. This may provide some with government jobs, but the level of inefficiency will drive up costs, increase wait time, frustration and patient dissatisfaction. Doctors, even plastic surgeons, will feel it too, since we are the ones who have to hear and manage patient complaints, and not the administrators. Based on the points she has made, her recommendations are sensible and cost-efficient. For more insight on the subject, I suggest you read her entire article.
Lawnmower injuries still a serious concern.
01 year ago
Summer Lawnmower Injuries
Scottsdale – Each summer there is a trend in the number of injuries experienced by adults and children from lawnmowers. The American Society of Plastic Surgeons (ASPS) reports that 247,000 people were treated for lawn mower-related injuries last year. A little more than 18,000 were children under age 19, the U.S. Consumer Product Safety Commission reports.
For this reason, the ASPS, the American Society for Reconstructive Microsurgery, the American Society of Maxillofacial Surgeons, the American Academy of Pediatrics, and the American Academy of Orthopaedic Surgeons are working together to prevent injuries and educate adults and children about the importance of lawn mower safety.
“Lawn mower injuries are not only among the most devastating I’ve seen in over 20 years of practice, they are also the most preventable,” said Peter Neligan, MD.
Typical lawn mower injuries are usually very complicated and require a team of doctors from various specialties, including, plastic surgery, microsurgery, pediatrics, and orthopedic surgery to properly repair.
“Lawn mower injuries often include deep cuts, loss of fingers and toes, limb amputations, broken and dislocated bones, burns, and eye injuries,” said Michael McGuire, MD.
Careless use of lawnmowers is a critical factor that often times leads to injuries. Several professional medical societies suggest some simple tips to prevent injuries and keep lawnmowers safe:
- Children should be at least 12 years old before operating a push-style lawnmower.
- You should not operate a ride-on lawnmower unless you are 16 years old.
- Children should never be passengers on ride-on mowers.
- Always wear sturdy shoes while mowing. Avoid sandals.
- Young children should be at a safe distance from the area you are mowing.
- Pick up stones, toys and debris from the lawn to prevent injuries from flying objects.
- Always wear eye and hearing protection.
- Use a mower with a control that stops it from moving forward if the handle is released.
- Never mow in reverse unless absolutely necessary. Carefully look for those behind you when you do.
Antibiotic Use in Plastic Surgery.
11 year ago
Use of Antibiotics in Plastic Surgery
Scottsdale – Evidence-based medical practices for the appropriate use of intravenous antibiotic prophylaxis in plastic surgery are important to reduce the risk of infection. The information below is based on multiple resources including the standards developed via the Centers for Disease Control and Prevention, the Medicare National Surgical Infection Prevention Project, and various professional medical societies. These recommendations are used to reduce the risks of infection at the surgical site while reducing the risks of developing pathogens with drug resistance. In our practice, some patients may be transitioned to oral antibiotics.
Recommendation for the Use of Antibiotics at Phoenix Plastic Surgery:
Antibiotics used for prophylaxis should be carefully selected, consistent with current recommendations in the literature, and taking into account the issues of antibiotics resistance and cosmetic surgery patient allergies. Cefazolin is the most commonly recommended antimicrobial agent for plastic surgery operations. Clindamycin or vancomycin may be used for patients with a confirmed ß-lactam allergy. Vancomycin may be used in patients with known colonization with methicillin resistant Staphylococcus aureus (MRSA) or in facilities with recent MRSA outbreaks. Exposure to vancomycin is a risk factor in the development of vancomycin-resistant enterococcus (VRE) colonization and infection. Therefore, vancomycin should be reserved for the treatment of serious infection with ß-lactam-resistant organisms or for treatment of infection in patients with life-threatening allergy to ß-lactam (i.e. Penicillin) antimicrobials.
Recommendation on the Timing of Antibiotics during Arizona Plastic Surgery:
Timing and dosage of antibiotic administration should optimize the efficacy of the therapy. Prophylactic antibiotics should be administered within one hour prior to skin incision. Due to an extended infusion time, vancomycin should be started within two hours prior to incision. Dose amount should be proportional to plastic surgery patient’s weight. In patients with weight greater than 80 kg the doses of Cefazolin should be doubled.
Additional intraoperative doses (during cosmetic surgery) of antibiotic are advised when:
- The duration of the procedure exceeds one to two times the half-life of the antibiotic used.
- There is significant blood loss during the procedure.
General guidelines for frequency of intraoperative antibiotics are as follows:
| Antibiotic | Frequency of Administration |
| Cefazolin | Every 2-5 hours |
| Clindamycin | Every 3-6 hours |
| Vancomycin | Every 6-12 hours |
Recommendations on Stopping antibiotics after surgery:
Duration of prophylactic antibiotic administration should not exceed the 24-hour post-operative period. Prophylactic antibiotics should be discontinued within 24 hours of the end of surgery. The medical literature does not support the continuation of antibiotics until all drains or catheters are removed and provides no evidence of benefit when they are continued past 24 hours.
Thirty years of freedom….
01 year ago
by Dr. Aldo
in Health Policy
Scottsdale – I am glued to the TV this afternoon, as the House of Representatives works its way to the big vote on health care reform.
I believe I sit here in the majority and find the current health Bill to be quite Un-American, wasteful, and not true reform. Some say that it is better to pass something than nothing, but this massive piece of legislation goes too far to hurt physicians, patients and all Americans in general.
Once it becomes law, if indeed it does, the people will find out just what the President meant when he set out to “fundamentally change America”. I foresee that a great price will have to be paid as a result of our leaders irresponsibility….
God Bless America.
GOP proposes 10 ideas for fixing healthcare to the President.
01 year ago
by Dr. Aldo
in Health Policy
Health care on Capitol Hill
Scottsdale – The Republicans have proposed 10 ideas for the President and the Democrats to consider (Source: Wall Street Journal). I have listed these for your eyes only! I agree with all these ideas. I also believe you should read the original article for yourselves by clicking on the link above. Here are the 10 ideas:
- Make insurance affordable.
- Make health insurance portable.
- Meet the needs of the chronically ill.
- Allow doctors and patients to control costs.
- Don’t cut Medicare.
- Protect early retirees.
- Inform consumers.
- Eliminate junk lawsuits.
- Stop health-care fraud. Save up to $120 billion each year.
- Make medical breakthroughs accessible to patients.
I believe the current health care bill in congress is bad for the country. It creates more spending (that we cannot afford), more bureaucracy, and more regulations that limits access and reduce the quality of health care. We need to start over!
These are good ideas that cost little to implement, could save the country lots of money, and will improve the system. I hope Congress can help us here. My only other suggestion would be to STOP making cheesy deals with unions and out-of-touch Senators that infuriate the American people. Only by working together and putting away political influence, can we reform the health care system so that it benefits us all!
Breaking News: YOU can STOP the Cosmetic Tax!
02 years ago
by Dr. Aldo
in Health Policy
Big Tax Burden on the Middle Class.
Scottsdale – We can all do something to Stop the Cosmetic Tax. The U. S. Senate has added a provision that would add a five percent tax to “cosmetic surgery and medical procedures” to help cover the $849 billion price tag for health care reform.
The tax would cover any medical procedure deemed “not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.”
Because of this language, the tax could apply to a wide-range of treatments and surgeries designed to help enhance a patient’s self-confidence and create self-improvement. The tax will likely include charges to treatments with botulinum toxin, dermal filler injections, laser hair removal, breast implants, lipo, dental caps and implants, teeth whitening, etcetera..
Taxes on self-improvement should be opposed because:
- The tax is punitive and places an additional burden on the middle class (60% of patients make less than 90 thousand/year).
- The tax discriminates predominantly against women (86 to 91% of patients).
- The tax does not result in significant health reform.
- The tax mistakenly and unfairly categorizes cosmetic medical procedures in the same level as unhealthy habits (cigarettes and alcohol).
- The tax will be impossible to administer, converting physicians into tax collectors.
- The tax discourages scientific innovation and promotes dangerous and unregulated alternatives to safe, FDA-approved techniques.
This tax will impact Americans who are:
- Patients who are having or considering any procedure that might be taxed;
- Physicians who perform and administer those treatments and procedures;
- Employees of companies who manufacture cosmetic medical treatments;
- Americans opposed to additional taxes on individuals and small businesses to cover the costs of health reform.
YOU CAN HELP!
By calling your senators and telling them to stop this proposed tax on cosmetic medical procedures which will predominantly affect women. Your support matters, so please take a moment to partake in this effort. Look below to see what else you can do to STOP THE COSMETIC TAX!
- Contact your Senators to be linked at the top of this page and send a message to Congress that you oppose the self-improvement tax.
- Join the Cosmetic Tax Opposition Movement to protect your rights and stop Washington from adding these arbitrary and discriminatory new taxes.
- Sign the Petition to STOP the Cosmetic Tax.
- Tell a your Friends about this unfair and discriminatory taxation.
- You can also go directly to www.stopcosmetictax.org and get more information on this important issue.
Health reform without tort reform hurts all Americans!
02 years ago
by Dr. Aldo
in Health Policy
Save America! Give us tort reform!
Santa Barbara – Several months ago, the Congressional Budget Office completed an analysis of the effects of Tort Reform proposals on the costs to our health-care system which could save the country $54 billion over 10 years. Despite these findings, and the general belief that tort reform will save even more tax payer money by reducing costs of defensive medicine (up to $200 billion dollars according to the American Medical Association) – I am not aware of any significant tort related amendments in the current health reform bills.
Sadly, it is the American public that will continue to pay what I call the “tort premium”, which is spent on health-care and has nothing to do with actual “health care”, but instead goes to cover litigation expenses. However, Americans have realized that reform to the medico-legal system should be part of health-care reform. According to Phillip K. Howard, an attorney and chairman of Commongood.org, “83% of Americans believe that as part of any health care reform plan, Congress needs to change the medical malpractice system.”
It is interesting to contrast what appears to be a lack of interest in Congress for Tort Reform to the savings that could be achieved if only medical malpractice reform would be passed. The Congressional Budget Office has some important recommendations for Congress in their updated analysis of tort reform proposals (addressed to Senator Orrin Hatch), which I recommend every American read. The document can be downloaded as a PDF at the Congressional Budget Office (CBO) website.
The CBO recommendations include a cap on non-economic damages, a cap on punitive damages, a reasonable statute of limitations, replacement of joint-and-several liability with a fair-share rule, and modification of the collateral source rule to allow evidence of income from health/auto/life insurance and/or workers compensation to be introduced at trials or to require that such income be subtracted from awards decided by juries.
“I think that this is an important step in the right direction and these numbers show that this problem deserves more than lip service from policy-makers,” said Sen. Orrin Hatch, the senior Republican on the Senate Finance Committee, after receiving the report from the CBO. “I look forward to having a continued comprehensive dialogue on this critical issue with CBO”, said Mr. Hatch. The findings by the CBO provides momentum to press for tort reform to be included President Obama’s health care legislation.
Supporters of tort reform argue that the expense drives up the price of medical care, limits access to health-care, and leads to defensive medicine, in which doctors order unnecessary tests to make sure they won’t get sued. The support for tort reform reflects growing awareness that reform will allow better management of health care systems, a reduction of costs and increased access to medical care. Tasks which are likely impossible when physicians go through the day thinking about how to protect themselves from lawsuits.
Opponents of medical malpractice reform say it is unfair to limit awards to individuals injured by medical negligence. Trial lawyers argue that they are champions of malpractice victims. However, a study in the New England Journal of Medicine (2006) outlines that under the current system 54 cents of the malpractice dollar goes to lawyers and administrative costs. Harvard Law Professor, Michelle Mello said, “It would be hard to design a more inefficient compensation system.”
According to Mr. Howard’s Wall Street Journal article, “a few thousand trial lawyers who are blocking reform that would benefit 300 million Americans.”
More Problems with Taxes on Plastic Surgery.
22 years ago
Scottsdale – Can you imagine a government that says they want to reduce the costs of health care and then goes on to create a series of new taxes to pay for it all? Well, which is it? Raise or lower costs?
That is exactly what the U.S. Senate Democrats have done. They want to raise your taxes to fund a less expensive form of health care? Does that even make sense? It looks like the government is saying “pay us a bunch of money now (via taxes), and you’ll feel great later, because you won’t pay so much for your health care”. By the way, this is literal! Pay NOW, get benefits in 2013.
The current plan raises taxes on small businesses 8%, adds a new value-added-tax of 5% on the sale of all new products, taxes over-the-counter medications, taxes medical devices, and taxes drugs companies. The plan also calls for an increase in Medicaid benefits and will require individual states to raise taxes to pay for these medical benefits. California alone will have to generate 10 billion dollars to pay for this Medicaid expansion.
To top it all off, the Senate bill slapped the faces of all American middle class women by adding a 5% tax on elective cosmetic surgery procedures. I already mentioned (on the blog) that this is an unfair and sexist tax against women that make up 86% of the plastic surgery population. These types of taxes have already failed in some states, like New Jersey.
NJ is the only state to adopt a tax on elective medical procedures. A 6% tax on elective medical procedures was enacted in 2004. The NJ Department of Taxation experienced a 59% shortfall on projected revenue estimates. New Jersey Assemblyman Joseph Cryan, the sponsor of the 2004 bill, is now leading efforts to repeal the tax. This experience shows that these types of taxes are not going to work!
The big problem with this type of tax is that it is arbitrary and difficult to administer. Evidence in NJ, demonstrates that the line between “cosmetic” and “reconstructive” surgery is not always clear and leaves the determination of medical necessity up to state tax auditors. Can you imagine it now – a bunch of government cronies – telling you that your surgery is cosmetic and taxable as opposed to reconstructive? This is a completely inappropriate proposition for any government to hold over those they represent.
The part I hate the most about this bill is that it makes physicians tax collectors. Not only does that bill place physicians in the role of tax collector, it also holds physicians liable should an individual fail or refuse to pay the tax. Arguing about taxes and money with patients? What effects will that have on the doctor-patient relationship, I wonder?
The bill, if passed, will start taxing Americans on January 1, 2010. Remember their motto: “pay NOW, Benefits 2013″. This type of tax will place an incredible burden on physician offices, at a time when the economic recovery is very weak.
I believe that taxes on physicians and patients, in any form, will have deleterious effects on health care costs and limit access to quality patient care. I believe all Americans should oppose any legislation that increases costs and taxes and makes access to quality health care worse. Stay tuned to the blog to find out what you can do to Stop the Cosmetic Tax.
Unfair Tax Against Women and Plastic Surgery
02 years ago
Scottsdale – As congress mulls health care reform they continue to look for ways to pay for their massive overhaul of the health care system. They now propose a new 5 % tax on all elective cosmetic surgery procedures. I believe this tax is extremely unfair and especially towards women, who make up 86 % of the plastic surgery population. In fact, I cannot think of any other more discriminatory and sexist tax penalty in existence.
Adding a 5 % tax to plastic surgery might make sense to some people, mostly poorly informed individuals, who believe that it is only the rich that actually have plastic surgery. In reality, it is the average middle class hard working American woman that has the vast majority of plastic surgery procedures in this country. Contrary to popular belief, cosmetic surgery is no longer an exclusive luxury reserved for the very wealthy. The fact of the matter is that the vast majority of patients are women who work and already pay taxes!
Patients in my plastic surgery center are nurses, single moms, moms with children, hard working women with all sorts of jobs and professions. These women are hard working individuals who may choose to have plastic surgery for various reasons. That decision should be reserved between them and their doctor.
The American Society of Plastic Surgeons has demonstrated research targeting those who plan to have cosmetic surgery within the next two years and the results reveal that 60 percent of the respondents made an annual household income of $30,000-$90,000. Most importantly, 40 percent of those reported an income of $30,000-$60,000. Only 10 percent of the respondents report household incomes of more than $90,000.
“These data clearly refute the suggestion that elective surgery taxes are ‘luxury’ or ‘sin’ taxes affecting only a privileged few,” says ASPS Government Affairs Council Chair Anne Taylor, MD.
As an American citizen, I have to question the motivation of the U.S. Congress in creating such a discriminatory and sexist taxation on middle class women. I am very concerned that Congress is very badly misinformed and is acting on the belief that plastic surgery is only for the very rich. This likely represents only the tip of the iceberg on the amount of misinformation that has led to the creation of the current health care reform bill. It saddens me to see Congress meaning to unfairly tax the very people they were elected to represent!
