Obamacare: Repeal Now, Replace Later. Good or bad?

President Obama published, in the New England Journal of Medicine, a discussion of the dangers inherent in the Republican plan to REPEAL NOW REPLACE LATER.  I agree with Obama’s warning that such an approach is “IRRESPONSIBLE”

Here is the letter:

Health care policy often shifts when the country’s leadership changes. That was true when I took office, and it will likely be true with President-elect Donald Trump. I am proud that my administration’s work, through the Affordable Care Act (ACA) and other policies, helped millions more Americans know the security of health care in a system that is more effective and efficient. At the same time, there is more work to do to ensure that all Americans have access to high-quality, affordable health care. What the past 8 years have taught us is that health care reform requires an evidence-based, careful approach, driven by what is best for the American people. That is why Republicans’ plan to repeal the ACA with no plan to replace and improve it is so reckless. Rather than jeopardize financial security and access to care for tens of millions of Americans, policymakers should develop a plan to build on what works before they unravel what is in place.

Thanks to the ACA, a larger share of Americans have health insurance than ever before.1 Increased coverage is translating into improved access to medical care — as well as greater financial security and better health. Meanwhile, the vast majority of Americans still get their health care through sources that predate the law, such as a job or Medicare, and are benefiting from improved consumer protections, such as free preventive services.

We have also made progress in how we pay for health care, including rewarding providers who deliver high-quality care rather than just a high quantity of care. These and other reforms in the ACA have helped slow health care cost growth to a fraction of historical rates while improving quality for patients. This includes better-quality and lower-cost care for tens of millions of seniors, individuals with disabilities, and low-income families covered by Medicare, Medicaid, and the Children’s Health Insurance Program. And these benefits will grow in the years to come.

That being said, I am the first to say we can make improvements. Informed by the lessons we’ve learned during my presidency, I have put forward ideas in my budgets and a July 2016 article2 to address ongoing challenges — such as a lack of choice in some health insurance markets, premiums that remain unaffordable for some families, and high prescription-drug costs. For example, allowing Medicare to negotiate drug prices could both reduce seniors’ spending and give private payers greater leverage. And I have always welcomed others’ ideas that meet the test of making the health system better. But persistent partisan resistance to the ACA has made small as well as significant improvements extremely difficult.

Now, Republican congressional leaders say they will repeal the ACA early this year, with a promise to replace it in subsequent legislation — which, if patterned after House Speaker Paul Ryan’s ideas, would be partly paid for by capping Medicare and Medicaid spending. They have yet to introduce that “replacement bill,” hold a hearing on it, or produce a cost analysis — let alone engage in the more than a year of public debate that preceded passage of the ACA. Instead, they say that such a debate will occur after the ACA is repealed. They claim that a 2- or 3-year delay will be sufficient to develop, pass, and implement a replacement bill.

This approach of “repeal first and replace later” is, simply put, irresponsible — and could slowly bleed the health care system that all of us depend on. (And, though not my focus here, executive actions could have similar consequential negative effects on our health system.) If a repeal with a delay is enacted, the health care system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately. Insurance companies may not want to participate in the Health Insurance Marketplace in 2018 or may significantly increase prices to prepare for changes in the next year or two, partly to try to avoid the blame for any change that is unpopular. Physician practices may stop investing in new approaches to care coordination if Medicare’s Innovation Center is eliminated. Hospitals may have to cut back services and jobs in the short run in anticipation of the surge in uncompensated care that will result from rolling back the Medicaid expansion. Employers may have to reduce raises or delay hiring to plan for faster growth in health care costs without the current law’s cost-saving incentives. And people with preexisting conditions may fear losing lifesaving health care that may no longer be affordable or accessible.

Furthermore, there is no guarantee of getting a second vote to avoid such a cliff, especially on something as difficult as comprehensive health care reform. Put aside the scope of health care reform — the federal health care budget is 50% bigger than that of the Department of Defense.3 Put aside how it personally touches every single American — practically every week, I get letters from people passionately sharing how the ACA is working for them and about how we can make it better. “Repeal and replace” is a deceptively catchy phrase — the truth is that health care reform is complex, with many interlocking pieces, so that undoing some of it may undo all of it.

Take, for example, preexisting conditions. For the first time, because of the ACA, people with preexisting conditions cannot be denied coverage, denied benefits, or charged exorbitant rates. I take my successor at his word: he wants to maintain protections for the 133 million Americans with preexisting conditions. Yet Republicans in Congress want to repeal the individual-responsibility portion of the law. I was initially against this Republican idea, but we learned from Massachusetts that individual responsibility, alongside financial assistance, is the only proven way to provide affordable, private, individual insurance to every American. Maintaining protections for people with preexisting conditions without requiring individual responsibility would cost millions of Americans their coverage and cause dramatic premium increases for millions more.4 This is just one of the many complex trade-offs in health care reform.

Given that Republicans have yet to craft a replacement plan, and that unforeseen events might overtake their planned agenda, there might never be a second vote on a plan to replace the ACA if it is repealed. And if a second vote does not happen, tens of millions of Americans will be harmed. A recent Urban Institute analysis estimated that a likely repeal bill would not only reverse recent gains in insurance coverage, but leave us with more uninsured and uncompensated care than when we started.5

Put simply, all our gains are at stake if Congress takes up repealing the health law without an alternative that covers more Americans, improves quality, and makes health care more affordable. That move takes away the opportunity to build on what works and fix what does not. It adds uncertainty to lives of patients, the work of their doctors, and the hospitals and health systems that care for them. And it jeopardizes the improvements in health care that millions of Americans now enjoy.

Congress can take a responsible, bipartisan approach to improving the health care system. This was how we overhauled Medicare’s flawed physician payment system less than 2 years ago. I will applaud legislation that improves Americans’ care, but Republicans should identify improvements and explain their plan from the start — they owe the American people nothing less.

Health care reform isn’t about a nameless, faceless “system.” It’s about the millions of lives at stake — from the cancer survivor who can now take a new job without fear of losing his insurance, to the young person who can stay on her parents’ insurance after college, to the countless Americans who now live healthier lives thanks to the law’s protections. Policymakers should therefore abide by the physician’s oath: “first, do no harm.”

I have a few comments.

First,  historically, every major piece of legislation passed by Congress and the Senate has received revision and amendment to correct original deficiencies recognized after a few years of implementation, EXCEPT THE ACA. No piece of legislation is perfect from the beginning.  Even the US Constitution has been amended! There are always problems that should be identified and corrected. Such is the case with the ACA. But because the Republican party put electoral politics ahead of our nation’s best interest, no improvements were sought or implemented. Instead, an immediate “repeal” position was taken by the Republican party and maintained until the election.

Second, the irony of this situation is that the ACA was modeled on the Republican party’s alternative to Hilary Clinton’s original plan put forth during the Clinton administration in the 1990’s (neither of which were passed) That very same model was subsequently enacted by legislation and implemented in Massachusetts by Republican governor Mitt Romney. In fact the economist who helped design Romney’s plan was part of Obama’s team that drafted the ACA!

Clearly, partisan politics has TRUMPED the interests of our nation.

Sleep well, live clean.

Bob Hansen MD

Interview with Dr. Ede about preventing Alzheimer’s

My friend and colleague, Dr. Georgia Ede, was recently interviewed concerning dietary interventions to prevent Alzheimer’s Dementia. Great interview, lots of information, references provided at the bottom of the transcript.

Here is the link.

Are You On The Road To Alzheimer’s? Interview With Dr. Georgia Ede – Choc & Juice

Another reason to eat a clean Paleo diet.

Eliminating sugar, flour foods, and fruit juices will also improve your gut flora and help to prevent dysbiosis.

Regards

Bob Hansen MD

More toxic substances proposed for our food supply

I recently received this warning from one of my favorite food safety organizations.

“The U.S. Environmental Protection Agency (EPA) is taking comments on a dangerous proposal that will put our farms, our food, and our environment at risk.

The EPA is proposing a dramatic expansion of the use of the toxic pesticide Enlist Duo. Enlist Duo is a mixture of glyphosate (the active ingredient in Monsanto’s Roundup®) and the even more toxic 2,4-D (part of the chemical mixture Agent Orange). If approved the pesticide cocktail could be used on corn, soy, and cotton in 34 states — up from 15 states where the product was previously approved for just corn and soy.

Tell EPA to reject the expanded use of Dow’s toxic mix of glyphosate and 2,4-D >>

The rush to expand the use of Dow AgroSciences’ toxic chemical concoction of glyphosate and 2,4-D for use on the next generation of genetically engineered crops comes only one year after the EPA asked a court to revoke its previous approval due to the unknown risks it posed, and now EPA suddenly wants to more than double the number of states where the pesticide can be used.”

Unfortunately we will likely see an acceleration of such proposals under the Trump administration. Trump has discussed terminating the EPA altogether. It is going to be a difficult four years for food safety.

Be careful out there. Things are about to become very NASTY.

Bob Hansen MD

Sugar Industry paid Harvard researchers to trash fat and exonerate sugar!

By now most of you have already heard about the study published in JAMA that reveals an unsavory historical scenario wherein the sugar industry  funded an academic review paper that diverted the medical community’s attention from sugar as a vector for disease and erroneously placed it on saturated fat and cholesterol consumption. You can read about it by clicking on the following link.

How the Sugar Industry Shifted Blame to Fat – The New York Times

Here is a quote from the above cited article in the NY times:

The internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, and published Monday in JAMA Internal Medicine, suggest that five decades of research into the role of nutrition and heart disease, including many of today’s dietary recommendations, may have been largely shaped by the sugar industry.

Here is the abstract of the article published in JAMA (Journal of the American Medical Association).

Sugar Industry and Coronary Heart Disease Research:  A Historical Analysis of Internal Industry Documents | JAMA Internal Medicine | JAMA Network

Early warning signals of the coronary heart disease (CHD) risk of sugar (sucrose) emerged in the 1950s. We examined Sugar Research Foundation (SRF) internal documents, historical reports, and statements relevant to early debates about the dietary causes of CHD and assembled findings chronologically into a narrative case study. The SRF sponsored its first CHD research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor. The SRF set the review’s objective, contributed articles for inclusion, and received drafts. The SRF’s funding and role was not disclosed. Together with other recent analyses of sugar industry documents, our findings suggest the industry sponsored a research program in the 1960s and 1970s that successfully cast doubt about the hazards of sucrose while promoting fat as the dietary culprit in CHD. Policymaking committees should consider giving less weight to food industry–funded studies and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple CHD biomarkers and disease development.

This disturbing conspiracy reveals yet another industry sponsored distortion of science which had great impact on the health of our nation. The impact is accelerating today as the epidemics of obesity and diabetes rage out of control. But sugar consumption has not just been tied to obesity, diabetes, heart attacks and strokes. Sugar added foods and beverages have likely contributed to dementia,  many forms of cancer and other chronic debilitating diseases. Sugar and refined carbohydrates mediate these effects by increasing systemic inflammation and contributing to insulin resistance. Inflammation and insulin resistance are pathways to many disease processes. Metabolic syndrome (pre-diabetes) is the hallmark combination of multiple abnormalities with insulin resistance as the underlying root cause. Prolonged insulin resistance leads to type 2 diabetes and contributes to heart attacks, strokes,  cancer and dementia. In fact dementia is often referred to as type 3 diabetes, mediated in large part by insulin resistance in the brain.

Here are links to discussions and videos relevant to these topics.

Preventing Alzheimer’s Disease Is Easier Than You Think | Psychology Today

How to Diagnose, Prevent and Treat Insulin Resistance [Infographic] – Diagnosis:Diet

Reversing Type 2 diabetes starts with ignoring the guidelines | Sarah Hallberg | TEDxPurdueU – YouTube

I have previously provided links to the YouTube lectures given by the brilliant Dr. Jason Fung, These are worth mentioning again.

The Aetiology of Obesity Part 1 of 6: A New Hope

Insulin Toxicity and How to Cure Type 2 Diabetes

How to Reverse Type 2 Diabetes Naturally

Nina Teicholz is also worth a watch.

Nina Teicholz: The Big Fat Surprise – (08/07/2014)

And here is an important talk about sugar, refined carbohydrates and cancer.

Plenty to chew on.

We did not evolve to eat lots of sugar! It is dangerous stuff.

Bob Hansen MD

 

 

 

Roundup and GMOs, are dangerous to your health and threaten the future of family farms in America

There is a brief discussion of Roundup (Glyphosate) on Medscape.

Our Toxic World; Is Roundup Slowly Killing Us?

The discussion covers several important issues. To Pique your interest in reading further here are a few salient quotes.

Glyphosate is the most used herbicide in the world, the pride and joy (as well as a great cash cow) of mega-giant chemical manufacturer Monsanto. Although ubiquitous as Roundup® and generally presented for many decades as safe for humans and animals, in 2015 The International Agency for Research on Cancer (IARC) of the World Health Organization labeled glyphosate as “probably carcinogenic to humans.”[3]

The European Union (EU) is trying to determine whether Monsanto should have its license to sell Roundup renewed this year. With that renewal in mind, in the spring of 2016, 48 members of the EU Parliament, representing 13 nations, volunteered to have their urine tested for glyphosate. All were found positive by a German lab.[4] In May 2016, a University of California, San Francisco, lab working for The Detox Project, funded by concerned individuals, reported positive urine tests for glyphosate in 93% of 131 urine samples from across the United States.[5]

Is this widespread presence of glyphosate in humans incidental and harmless or are we all in danger of being poisoned by this Monsanto product? That is a very good question.

Remember the gut microbiome? We are learning a great deal about how it influences so much of human health. There is a project called Qmulus, at the Computer Science and Artificial Intelligence Laboratory at the Massachusetts Institute of Technology and funded in part by Quanta Computers of Taiwan. Under its auspices, authors Anthony Samsel and Stephanie Seneff, in a 40-plus-page review[6] with 286 references, paint a very troubling picture of glyphosate’s inhibition of cytochrome P450 enzymes. For example, one role of this enzyme is to detoxify xenobiotics. The authors propose that the consequences of this inhibition, when coupled with other synergistic disruptions, may insidiously induce many diseases associated with a Western diet, including diabetes, obesity, cancer, autism, Alzheimer’s, and others.

A 2015 paper[7] by the same authors takes these and new findings and deductions even further to manganese deficiency in cows fed genetically modified Roundup Ready feed. This update is 55 pages long with 328 supporting references. Both are in open access; peruse them if you choose. [Editor’s note: Links to the full text of these papers are included with the references.]

If you want to learn more about Roundup, GMOs, and the worsening global threat to our food safety (no exaggeration) you can learn more by visiting www.CenterForFoodSafety.org.

I learned about this organization while watching the film The Future of Food. Although this hit the screens in 2004 it is still worth watching. If you think ROUNDUP is safe or that GMO foods are OK, think again. At least give this movie and website a look before you settle back into contentment with Monsanto and all the other bad actors in the food-seed-pesticide industry making decisions that WILL destroy the ability of farmers in the US and possibly world-wide to use their own seeds.

Monsanto has genetically engineered and patented a suicide gene and placed it into all of it’s seeds (cotton, soy, corn) so that farmers must buy seeds EVERY YEAR. This seed produces crops whose seeds are sterile. If this seed is carried by wind, animals, or other common mechanisms, from Monsanto’s’ crops to non-GMO fields, the gene will hybridize with natural seed crops and after several generations render a majority of crops infertile.

Monsanto produces not just pesticides but pesticide resistant seeds that produce sterile crops. Monsanto is playing monopoly and quickly eliminating independent seed producers and destroying family farms that have every year used their own seeds which have been bred to thrive in the local environment of the family farm.

Other issues abound. Roundup resistant crops, eaten by American consumers, have high levels of ROUNDUP and other pesticides that have been demonstrated to cause tumors in > 50% of animals within 1 year. Monsanto only tested ROUNDUP for 3 months in animal studies and declared it safe. The USDA did not test it. The FDA did not test it. Government scientists and university scientists who expressed concerns were silenced by the economic power of this massive multi-national corporation.

When independent scientists published their alarming results (carcinogenesis), Monsanto used it’s financial resources to shut those scientists down. You can learn about this by watching The Future of Food or visiting www.CenterForFoodSafety.org.

Like big Pharma executives cycling between the pharmaceutical industry and the FDA, Monsanto executives and lawyers cycle in and out of the FDA and USDA. We have allowed the fox to guard the chicken pen and the stakes are high. Family farms have been put out of business by Monsanto’s unethical and predatory behavior, eliminating generations of private seed banks and wreaking havoc for family farms across America. Don’t believe it? Watch the movie. Many farmers have gone bankrupt fighting legal battles with Monsanto because the wind has blown Monsanto’s patented seeds onto their private lands and Monsanto successfully sued them for patent infringement. This predatory behavior has been going on below the radar for many years and it started when the Supreme Court ruled that Monsanto can patent seeds.

In fact, Monsanto has gone into the US national seed banks, collected samples of thousands of different seeds, and patented them! This outrageous and ridiculous scenario has allowed a private company to patent thousands of heritage crop seeds.

If this sounds incredible, you are right, but it is true.

In the meantime, support mandatory GMO labeling and support food retailers who have promised to carry only NON-GMO foods.

To your health.

BOB Hansen MD.

Berries, Dark Chocolate and Fruits-Vegetables improve blood vessels within 8 weeks

A recently published study reveals that within 8 weeks of consuming a combination of 70% dark chocolate (50 grams per day), one serving of berries, and four servings of polyphenol rich  fruits-vegetables per day, measurable improvements occur in the functioning of arteries in humans with high blood pressure. Just eight weeks and improvement was observed.

So what did the researchers do?

First, they took 102 adults with high blood pressure and instructed them to consume no chocolate, no berries and only 2 portions of fruits-vegetables per day for four weeks. After four weeks on a “low polyphenol diet” they measured forearm blood-flow response to two different vasodilators (a vasodilator increases blood flow by relaxing the muscle in the wall of arteries). Blood and urine samples were also taken.

After the four week period on a low polyphenol diet, 51 patients continued on the same diet (control group).  51 subjects had fruits and vegetables of their own choice (from a list rich in polyphenols), one serving of berries/day and 50 grams/day of 70% dark chocolate delivered free of charge to their homes weekly (intervention group).

All participants kept food diaries, answered food questionnaires, had regular consultations with nutritionists.

After 8 weeks, blood and urine testing demonstrated higher levels of polyphenols in the “high-polyphenol” group, as expected.

Most importantly the subjects consuming dark chocolate, berries and more vegetables-fruits on a daily basis demonstrated measurable and significant improvements in “endothelial function” compared to the other group. Endothelial function reveals the ability of arteries to respond to changes in demand for increased blood flow. “Endothelial” refers to the cells that line the walls of arteries, directly in contact with flowing blood.  These cells are endothelial cells.

The maximum forearm blood flow response to the infusion of acetyl-choline (a vasodilator) was the test used to measure endothelial function. The maximum forearm blood flow in the high polyphenol group was TWICE that of the low polyphenol group. This large difference occurred with just eight weeks of a simple dietary intervention.

Before the dietary intervention there was no measurable difference between the two groups of subjects. After the dietary intervention there was a very large and meaningful difference.

Endothelial dysfunction is a major predictor of cardiovascular risk (heart attack and stroke). Endothelial dysfunction is BAD.

You can read about polyphenols here .

Epidemiologic studies demonstrate the health benefits of diets rich in colorful vegetables and fruits. Among the fruits berries appear to have the greatest density of important micro-nutrients on a per calorie basis.

Dark chocolate has a high content of polyphenols and multiple studies suggest significant cardiovascular benefit with just an ounce or two per day. You must be careful though about your source since the dutch method of preparation depletes the polyphenols and some brands have high amounts of cadmium or lead. The richest source of dark chocolate identified by ConsumerLab with the lowest amounts of heavy metal contaminants is 100% (bitter) Bakers Dark Chocolate. Dip it in honey or have it with sweet berries to offset the bitter taste. Avoid in the evenings or late afternoon (the caffeine content can interfere with sleep)

So eat those colorful vegetables, berries and indulge in some dark chocolate.

Here is a suggested list of vegetables, Try to get 8-9 servings per day. I give this recommendation to my patients. I adopted this from the recommendations of Doctor Terry Wahls. (From a Wheelchair to Commuting on a Bicycle: How One Woman Naturally Reversed MS | Terry Wahls MD | Defeating Progressive Multiple Sclerosis without Drugs | MS Recovery | Food As Medicine)

9 SERVINGS  OF NON-STARCHY VEGETABLES PER DAY, 3 SERVINGS FROM EACH OF THREE CATEGORIES.

 

  1. DARK GREEN LEAFY VEGETABLES, 3 SERVINGS PER DAY EQUALS 3 CUPS MEASURED COOKED OR 6 CUPS MEASURED RAW
  • Arugula, Beet Greens, Bok Choy, Chard all colors, Chicory, Cilantro
  •  Dandelion Greens, Endive, Escarole, Kale-all kinds, Parsley, Radicchio
  • Radish leaves, Spinach, Turnip Greens, Watercress

 

  1. Colored vegetables, 3 cups daily:
  • GREEN: Artichoke, Asparagus, Avocado (FRUIT), Cabbage (red and green) Celery, Cucumber with skin, Okra, Olives, Peppers, Zucchini with skin
  • RED: Beets, red cabbage, red peppers, cooked tomatoes (fruit)
  • YELLOW: Carrots, Pumpkin, Squash-summer and winter, Sweet potato,

 

  1. SULFUR RICH VEGETABLES, 3 CUPS DAILY: Some leafy greens are also sulfur rich so there is overlap in these categories
  • Arugula, Asparagus, Bok Choy, Broccoli, Brussel sprouts, Cabbage, Cauliflower, Collard Greens, Garlic, Kale, Kholrabi, Leeks, Mushrooms, Onions red-yellow-white, Radishes, Scallions, Shallots, Turnip Greens, Watercress.

Eat the rainbow and enjoy good health.

You can read this study on Medscape but you must first establish a user name and password (free and open access)

Beneficial Effect of a Polyphenol-Rich Diet on CVD Risk

Bob Hansen MD.