Dr. Kevin Most: MS and the Trump effect on healthcare
Word that Brian Bickell has been diagnosed with MS has probably hit many Blackhawk fans hard. I thought we would take just a minute to discuss MS so we understand what the disease is. To make it as simple as possible think of our brain as a complex electrical system. Just like the electricity we use in our homes, the cords that take electricity from the wall to the object needing electricity are protected with a rubber covering. That covering allows the electricity to work is important for function. In our brain we have a similar system where the nerves carrying the “electricity” from our brain to our eyes or vice versa are wrapped in a protective sheath called Myelin. This protective covering allows the messages to move clearly back and forth and thus the action of the nerve is intact.
We all know the importance of our immune system, it protects us from illness, it helps us fight infections and without it we would be in real trouble. Unfortunately in some cases the immune system is not our friend, MS is one of those cases. In patients with MS the immune system misfires and actually goes and destroys that protective lining of our nerves. When it does its damage the nerves don’t work or work poorly. That is why some of the symptoms of MS are double vision, blindness, numbness, dizziness and weakness. Looking back it appears that Brian had some of those symptoms in the past.
How can that occur? Well in MS the immune system wreaks its havoc and then stops, when it stops the body repairs the nerves and they work again just fine. It is a disease of relapses in many cases although there are some patients were the disease is progressive. The spectrum of this illness is huge, it is thought that many patients may have MS and not even know it.
We don’t know the cause of MS but there are many ideas, it may be due to a viral infection, it may be genetic , it may be environmental, we just don’t know.
There is no cure for MS. We have medications that will often help. We have medications that speed the recovery of the relapses, and we have medications that slow progression but none that cure. Donations to MS research will help us find a cause and a cure perhaps.
Well by now it has sunk in that Donald Trump will be the next President of the United States. So, what does that mean about Healthcare? We all know politicians make promises that they don’t keep but just in case let’s go over the stand that Trump had taken on Healthcare.
- The biggest is that he feels The Affordable Care Act needs to be repealed completely. With the changes in premiums this year we are finding that this healthcare is not as affordable as we once hoped. Trumps stand is that no individual should be forced to buy insurance unless he or she wants to. This puts doctors and hospitals again in a position of providing healthcare to individuals without the safety net of insurance. Believe me the ACA was not a windfall for physicians or hospitals, but it did allow them to care for patients without the fear that the cost of the care delivered would place some families in financial distress.
- He does see that we need to reform our mental healthcare programs and institutions in the US. He sees a need for more information and tools needed to treat this vulnerable population. He also wants community services to help with this. In Illinois that is huge as many community services have been shut down due to our state budget crisis.
- A huge concern is that he seems to equate autism with vaccines and that is concerning. He thinks that changing the timing of vaccines will impact the rate of autism and that is concerning as this will extend the time a child may be exposed to a disease that may harm a child.
- He feels that insurance companies should be allowed to sell across state lines as long as the plans fill the requirements of the states. This would allow for more competition and lower cost potentially. Many states currently have one insurance company that dominates the landscape. Allowing plans to cross state lines may allow for more options for both individuals as well as employers.
- Require price transparency for patients. He feels doctors and hospitals should post their prices so individuals can make a choice and shop for the best prices for procedures and exams. The whole issue of pricing for healthcare is very complex and confusing. In the hospital cost of care is all negotiated with insurance companies in many cases and in the case of Medicare the hospitals are paid a fixed price based on the diagnosis. In the world of blood testing and imaging it does not get any less confusing. A MRI at site A may be different from a MRI from site B, how is that? Well for one the equipment, MRI scanners are based on how strong the magnet is so a 1.5 Tessla magnet scan is not the same as a 3.0 Tessla magnet scanner. The quality of the image can be drastically different. The other confusing part about imaging is that there is also a radiologist doing the interpretation. Hospital based imaging usually requires Board certified radiologist and in many cases require additional training called fellowships. Other free standing imaging sites do not have the same equipment or quality of radiologist reading the films
- He certainly wants to see a revamp of the Medicaid program and push it back down to the state level and remove federal overhead. He feels this will force the state to look for more efficient ways to deliver care to these individuals and will have a larger impact on fraud and abuse of the Medicaid system.
- He also feels that we need open the opportunity for free markets for drug providers that will offer safe , reliable and cheaper medications. These would mainly come from overseas. This would allow for more choices for patients, would certainly lower prices but opens the question of who careful must we be to allow this. Big Pharma companies although being private companies, they provide essentially a public service.
- He also notes that we provide $11 billion worth of medical care to undocumented individuals, by enforcing the immigration laws we would relieve those healthcare costs.
- He feels that a deep look into the VA system is needed. He is concerned with the long waits for veterans at VA facilities. He also wants Veterans to receive care at local hospitals while using their Veterans benefits.