By Dr. Mark Hinkes, DPM
I recently read a synopsis about how Obamacare will affect the type of health care services that will be available in the marketplace and the age groups that will be helped and hurt the most by this new law.1 Not really knowing much about Obamacare, I read the article and ended up feeling deeply disturbed and shocked at what Mr. Obama and the Congress have unleashed upon us. The news is not good for patients with wounds and for those who practice wound care.
The Price of Health Care Reform on Wound Care
For many years I have watched the trends in medicine: increasing numbers of people depending on finite medical services, stressing the system to its financial limits, providers working harder to manage these patients while receiving decreasing reimbursements through managed care agreements. It was clear to me that the resolution of the situation was either going to be withholding or rationing of care. And because neither of these choices are good ones, I have been promoting PREVENTION in the arena of foot health as the logical alternative, because diabetic foot prevention is a valid alternative strategy to withholding or rationing care.
It seems that Obamacare will hit seniors hardest; the demographic group that has wounds that we know can be difficult, time consuming and expensive to treat.2
The unstated goal of Obamacare is to reduce expenditures for medical services to seniors and shift those funds into Medicaid expansion providing medical care for younger people. Ezekiel Emanuel, Rahm Emanuel's brother and Obama's initial White House Health Policy Advisor, describes a transformation by Obamacare of the American medical care system in detail. He states:
"1. Medical care is to be attenuated (i.e. rationed) for those older than 45 and younger than age 15, so that medical resources can be concentrated on those whom bureaucrats deem most "valuable" to society.
2. Doctors should be taught to do away with the Oath of Hippocrates and its focus on the individual patient. Doctors should instead be taught to make medical decisions aimed at what is good for the "collective," or society as a whole."
This philosophy makes the hair on the back of my neck stand on end. Can he really be serious? Not since George Orwell's 1984 have I heard of changes mandated by a central government for "the benefit of the masses," as have been placed into law by Obamacare. And even worse, Mr. Emanuel wants to change what has been the guiding light, the standard of care for healers since the 5th century BC. What we have here is a management failure by the Federal Government that will set back the delivery of medicine and the quality of care nearly 100 years.
Emanuel's views are the reason why over $716 billion have been cut from the Medicare budget over the next decade. These Medicare cuts will reduce hospital, skilled nursing care, home health, hospice and other services for seniors that have been covered by Medicare in the past. The priorities are clear, seniors have already lived their lives; so health care dollars are being shifted to Medical care for younger people. And the cuts don't just include surgical procedures—they also will affect medications, treatments and procedures for cancer, cardiovascular, neurological conditions, all of which that affect wound care.
A Strategy for Preventing Wounds in the At-Risk Population
So what should the response of a senior citizen, and especially a senior citizen who has increased health risks for developing wounds such as diabetes or PAD, be to Obamacare? The answer is PRACTICE PREVENTION. A strategy of prevention works in the area of the diabetic foot in prevention of ulcers, infections and amputations.
People with diabetes and PAD should adopt a strategy I call "The Big Five":
- Control blood sugars
- Do not use tobacco
- Understand food and nutrition and eat properly
- Practice preventive foot health behaviors
And as for the wound care industry, it is time for a realistic review of practices, costs, and strategies for wound healing so as to be able to survive the financial changes coming in Obamacare.
1. Miller's Money Weekly. Defend Your Life. January 2, 2014. Available at: https://www.millersmoney.com/money-weekly/defend-your-life. Accessed on May 18, 2014.
2. McCaughey B. Beating Obamacare, Your Handbook for the New Healthcare Law. Regnery Pub; 2013.
About the Author
Dr. Mark Hinkes is the former Chief of the Podiatry Service and Director of Podiatric Medical Education for the Veterans Affairs Medical Centers in Nashville and Murfreesboro, Tennessee, part of the Tennessee Valley Healthcare System. He was Chairman of the Preservation Amputation Care and Treatment (PACT) Program for more than a decade. He is Board Certiﬁed by the American Board of Foot and Ankle Surgery, and the American Professional Wound Care Association, and is a Fellow of the American College of Foot and Ankle Surgeons.
Dr. Hinkes spends time consulting, lecturing, and writing about foot health issues on his website, www.dr-mark.net. His most recent book, Healthy Feet for People with Diabetes, is a practical self-care guide designed for patient education.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.