Dr Philip Lee Miller (for Info only, not official)

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Dr Philip Lee Miller

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    ...Why is this important? For the last 40 years Edward Kennedy was the voice of the under-represented. His lifetime goal was a more perfect and accessible health care system in the United States. He worked tirelessly to achieve these goals. We are told that he counseled Barack Obama in the early days, “I will support you openly under the condition that you make health care the centerpiece of your administration.” Wise counsel. But this may have been a strategically and untenable position. Like the myth of Sisyphus, since the days of Franklin Roosevelt every president has aspired to a more perfect health care system. The debate that rages from all sides about health care reform is not about health care reform. It is about economic reform. This is about moving various pieces of the economic pie that are rapidly dwindling. There is no doubt that private and public debt burden is rising at unsustainable rates. This will become painfully evident in the 18 months. Guaranteed. We do not have a health care system. We have a disease management system. And the “crisis” is not new. ...

    TOI on Oct. 3, 2017, 8:19 p.m.

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    ...We wish this unreal set of expectations on no one. Medicare for all? Let me renew this debate with trilogy of blogs over the next week. First with a set of charts and diagrams depicting the daunting and inescapable statistics that face us. First consider this simple chart plotting the inexorable rise in yearly total health care expenditures from 1960 to 2016 (estimated). There is barely a perceptible sag at about 1995. To imagine an external force (the government) having any measurable effect on this curve stretches the imagination. We will expand a discussion soon on the nature of open and closed systems. The basic flaw in this entire “top down” approach to the “health care crisis” is based on a faulty concept of “fixing” a closed system. This is where all variables are known and can be controlled. Paul Krugman, in a brilliant New York Times Magazine piece talked about the failings of the science of economics. What underlies his lamentations is “the dismal science” as applied to an open system. An open system is filled with chaos, human frailties and uncertainties. ...

    TOI on Oct. 3, 2017, 8:16 p.m.

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    ...Now they have enlisted Tom Daschle and Bob Dole. What a pair — Tweedle Dee and Tweddle Dum. I have never understood what qualified Tom Daschle as a health care expert? His ties to the industry? A deposed ex-Senate Majority Leader? Howard Dean, who has been unceremoniously and conspicuously excluded from this process despite his physician credentials and incisive comments, has rightly derided this for what it is: “The Baucus bill is the worst piece of healthcare legislation I’ve seen in 30 years,” Dean said last night at a healthcare town hall and book signing in Washington. “In fact, it’s a $60 billion giveaway to the health insurance industry every year,” he said. “It was written by healthcare lobbyists, so that’s not a surprise. ...

    TOI on Sept. 22, 2017, 2:13 p.m.

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    ...A plethora of explanations from all the usual suspects to follow. You will hear some rumblings of dissent — press on. The simple answer: everything was wrong. This never was about health care reform. This was always an attempt at health insurance reform. And in that regard it was a miserable failure. The Senate bill, was a cruel proposition. The ultimate lay away plan: pay me now and you might be able to enjoy your coerced purchase in four years. Do you know how much can change in four years? Everything. It involved all the wrong players — Tom Daschle and Max Baucus. You never involved any physicians, most notably Howard Dean. This was a policy wonks party gone awry. 2000 pages plus. It could have been so much shorter. You never framed the debate. You never defined the problem. If you cannot define the problem you have no hope of finding an acceptable solution. That is why all the DH administration spinmeisters could never convince us of the positive benefits. ...

    TOI on Sept. 22, 2017, 1:59 p.m.

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    ...A medical version of “show me the money.” I have always thought this was rather inane, since it presumed that all medicine for the last 2000 years has been unscientific and irrational. Although the reality is medicine is not nearly as scientific as asserted. Only 10-20% of medical practice is based on sound scientific principles. This rankles most physicians who believe that conventional medicine is scientifically-based. The highest form of medicine is the practiced art using scientific principles and technology. A continuing series of US Preventive Task Force recommendations have been released from the Department of Health and Human Services (HHS). These are well-intentioned and rational. Examining the literature and epidemiology of medical practices in an effort to determine what is safe, sane, practical and effective. The trap is “effective” as you will see. The current uproar regarding the task force recommendations on breast cancer screening highlights just how difficult these decisions can be. ...

    TOI on Sept. 22, 2017, 1:39 p.m.

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    ...Access does not equal care and certainly not quality care. Yes, one side “won.” But this is not a victory for you. It is not a left-wing agenda. It is not socialized medicine. This is the first time the Federal Government has mandated the purchase of a private party product. And from the very racketeering group that is the root cause of the problem in the first place. What a travesty. Another government subsidy. Effectively amounts to another “government bailout..” As Michael Moore wryly said: The larger picture here is that the private insurance companies are still the ones in charge. They’re still going to call the shots. And if anything, they’ve just been given another big handout by the government by guaranteeing customers. I mean, this is really kind of crazy when you think about it. This is not the same as a state mandate for auto insurance. The State of California is unrelenting on this point. Driving is a privilege! It is not a right. If you do not drive, you are not mandated to purchase auto insurance. Furthermore, the reality is auto insurance does not cost $5000-12,000 annually. ...

    TOI on Sept. 22, 2017, 1:33 p.m.

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    ...What do they care about? What is health? Very simple basic questions. But you cannot construct or reconstruct 10% of our economy on a fabricated, cynical, spiteful timeline without first asking these metaphysical questions? How do you know if you have arrived if you don’t know where you are going? Now, remember in January 2017, President Trump promised to cover everyone at a lower cost. “We’re going to have insurance for everybody,” Trump told The Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.””[They] can expect to have great health care. It will be in a much simplified form. Much less expensive and much better,” he said. (CNN | Jan 17, 2017) In 1949, the World Health Organization (WHO) offered this definition of health. I can remember being asked this very question in the first month of medical school. The answer was always wrong. It is not the absence of disease. Health is a state of complete mental, physical and social well-being, and not merely the absence of disease or infirmity. What is your mission? What is your future vision? ...

    TOI on Sept. 22, 2017, 1:30 p.m.

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    ...Imaging first — biopsy last. In 2004 Dr. Thomas Stamey, Chief of Urology at Stanford, published a seminal journal article in the Journal of Urology, heralding the end of the PSA era. He had been known as “the father of the PSA.” This was not greeted with great applause. He concluded that PSA testing was not an accurate measure of prostate cancer. In subsequent years, he has admitted the correlation coefficient between PSA testing and prostate cancer is approximately 20 percent. That is less than even odds that an elevated PSA equals prostate cancer. Men are in constant fear of an elevated PSA and its implications. It’s like watching the Dow. But the approach has been too slow to evolve. Let me give you the best example. Women typically have an annual mammogram — often followed by an ultrasound (it should be the opposite). If a suspicious mass is found, a wire-guided biopsy is performed. This is very targeted and limited only to the specific area of interest. A positive biopsy is now most commonly followed by a lumpectomy. ...

    TOI on Sept. 22, 2017, 1:21 p.m.