Rhubarb Ruminations: Episode 10

But wait, there’s more March Madness to be had in Texas. The Texas Legislature now in full swing. Now that is madness.

The Texas March Madness started earlier in the year by giving emergency status to a bill regarding pre-abortion ultrasounds, at a time when there are bigger fish to fry. As it stands, there is still a $27 billion budget deficit to be dealt with. I guess that as a politician, it is important to know where to put the priorities of your constituents. Slash a program here or there, make huge budget cuts that affect millions, and, well, spend hours in session debating the “emergency” status of this bill. Please feel free to inject a large dose of sarcasm here.

So with Madness in mind, I present Episode 10 – a little health care, a little Texas, a little cycling, and a lot of Rhubarb.

1. It’s good to see that some Senate Republicans like David Dewhurst and Jane Nelson are promoting varying degrees of health care overhaul for Texans. Imagine this – they are suggesting that “doctors and hospitals should not be reimbursed for volume of treatment but for quality and good results for patients”.

Senator Nelson, chairwoman of the Senate Health and Human Services Committee, noted that “we shouldn’t be rewarding the greater number of tests and treatments you get with more financial rewards.”

If “good results for patients” is truly the goal, then we have to make some simple observations. One condition that costs consumers millions of dollars is back pain. The scientific evidence indicates that conservative care – not the use of expensive diagnostic imaging – is the best point of entry for the management of back pain. This certainly involves physical therapy – and direct access to such – as a means of decreasing the costs of care. There are plenty of studies to indicate that the cost savings to the patient could be upwards of 50% – some pretty significant cash.

All of this sounds great on the surface. So where’s the catch?

As but an example, Senator Nelson’s number one campaign contributor in 2006, and number two in 2010, was none other than – the Texas Medical Association. The TMA has continued to stand firm against direct access to physical therapy in the face of sound data to confirm that it is an effective means of both access and cost savings.

On one hand, lawmakers pronounce that they want to do what is right for the patient in terms of cost and effectiveness. On the other hand, they continue to accept campaign contributions from organizations that have their own economic agendas that don’t necessarily jive with those of the constituents.

Once again, following the money trail tells us about the true incentives for lawmakers.

2. While we’re on the topic of the cost of health care – and doing what is right for the patient - let’s talk about over-utilization of care. Rosemary Gibson, co-author of “The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health and What You Can Do to Prevent It”, notes that one-third of all health care spending is waste. Using the back pain analogy above, tens of thousands of patients with chronic back pain undergo surgeries that have little to no evidence that the surgery will actually help. But there is money to be made from surgery …

Once again, we are reminded that over-utilization of care is one of the great scourges of the health care debate.

3. Finally, in yet another moment of Madness - or perhaps in the “I just don’t care anymore” department – doping in sport, especially cycling. It has become a farce. Clenbuterol in beef? Interesting. But what has become even worse is all of the money being spent by federal investigators to chase a smoking gun attached to Lance Armstrong. Authorities are trying to loosely associate drug use to misuse of funding from the USPS.

At last glance, Armstrong has yet to fail a single drug test. If Armstrong somehow doped, he would be guilty in the court of the UCI, the cycling federation. Doping is not a federal offense. Doping isn’t even a state offense. So why are we linking the words “doping” and “federal investigation”?

Remember, Barry Bonds is on trial for perjury – not for taking drugs. Let’s not confuse the issues at stake. I do still believe that “innocent until proven guilty” is the foundation upon which we should be standing. An investigation of Armstrong should not be held with taxpayer dollars in the court of public opinion, and it should certainly not be a witch hunt.

Photo credits: Erik Charlton