SEEING THE LIGHT

Also published on Newsmax.  #PBMTherapyHeals

Imagine being successfully treated, painlessly and safely, for a wide range of diseases and conditions. Imagine having a cure for chronic pain.

This revolution in health and wellness is already available and will be celebrated on May 16 as the United Nations’ Annual International Day of Light.

On May 16, 1960, American physicist and engineer, Theodore Maiman, operated the first successful laser, achieving coherent and controllable light waves. This revolutionized manufacturing, communications, and health.

In 1967, Endre Mester in Semmelweis University Budapest, Hungary conducted studies to determine if lasers caused cancer. He shaved the hair from the bodies of mice, divided them into two groups and gave a laser treatment with a low powered ruby laser to one group. They did not get cancer. Instead the hair on the treated group grew back more quickly than the untreated group. The concept of "laser biostimulation" was discovered.

Today, “biostimulation” is known as Photobiomodulation (PBM). It is the process where a specific range of the light spectrum at the right intensity, when directed to the body for the right period of time, can restore the function of stressed cells to normal healthy operation. It is non-invasive, non-toxic, and has no reported side effects.

There are over 32 trillion cells in the human body. Each cell has hundreds of microscopic factories called mitochondria which combine oxygen with nutrients from the blood stream to make the cellular energy called ATP. This energy is used to help the cell live and to conduct its various roles in our body: keeping the heart beating, the brain thinking, the body moving, and the all the other functions that keep us alive and healthy.

Mester’s discovery was an epiphany. If specific light band waves can help cells to regrow hair, can they wake-up cells to do other things? Now over five-hundred human clinical trials and 4,000 laboratory studies have shown the answer to be an overwhelming YES!

PBM is now a common veterinary treatment for improving the lives of animals suffering from hip dysplasia and kidney failure. Throughout the world, forward thinking Doctors and Dentists are using PBM to successfully treat Oral Mucositis (side effect from chemotherapy), Dry Macular Degeneration, Multiple Sclerosis, Parkinson’s Disease, Lyme Disease, and diabetic wounds. It also reduces pain and inflammation in various orthopedic conditions such as tendonitis, neck pain, low back pain, and carpal tunnel syndrome.

Chronic pain costs Americans over $635 billion a year in additional healthcare costs and lost productivity. PBM is used for recovery and endurance by champion athletes. At the 2016 Rio Olympics, many Nike sponsored athletes used a whole body PBM product called NovoTHOR to help them train, recover, and win more medals. This led NFL, MLB, NHL and NBA teams to add “light beds” to their training regime.

A growing number of doctors and public health officials are exploring PBM therapy as an alternative pain treatment to Opioids. This may help solve the addiction crisis facing America.

If PBM is so effective, why is not everywhere?

Outside of the U.S. it is. Australia, Canada, England, the European Union, and NATO all recognize PBM, promote its use, and accept insurance coverage. The Food and Drug Administration (FDA) is slowly moving towards regulatory clearances for PBM light equipment to officially treat diseases and conditions. Currently, the FDA labels PBM devices in the basic category of infrared or heat lamps.

Until the FDA moves forward, U.S. insurance companies, except for a few BCBS affiliates, refuse to reimburse for PBM treatments. They remain a solid wall of resistance.

Medicare and Medicaid refuse to reimburse for PBM treatments. Federal Officials have labeled PBM “mumbo jumbo” and declared its successes “placebo effect”.

The International Day of Light is an opportunity to alert everyone who could benefit from PBM therapy of its existence and promise. It is a time to ask public officials about ways to bring PBM into the mainstream of American healthcare. It is a time to ask your Doctor, Dentist, Veterinarian, and local gym/wellness center if they offer PBM therapy and if not, why not.

May 16 is an annual reminder that bringing light therapy into healthcare is long overdue.

It is up to all of us, for ourselves, our families, and our communities, to make the promise of light a reality.

[Scot Faulkner advises global organizations and universities on healthcare reform and innovation. He served as the Chief Administrative Officer of the U.S. House of Representatives. He also served on the White House Staff, and as an Executive Branch Appointee.]

TRUMPING HEALTHCARE

The blamestorming has begun over the failure to repeal and replace Obamacare.

Congressional Republicans have only themselves to blame.  Since returning to majority in the House in January 2011, Republicans have formally voted 54 times to address all or part of Obamacare.  Six were votes on full appeal.

In 2015, H.R. 132 is typical of these efforts.  It simply stated: “such Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted.”  Why didn’t Republicans vote on this last week?

Republicans did not vote on simply going back in time, because they thought government should play a significant role in healthcare.  It should not. Crippling regulations need to be changed and the private sector needs to be encouraged.  Last week’s legislation did not clear the way for these solutions.

The Republicans’ problem is squandering six years with legislation designed more for fundraising and campaigning than governing.  Instead, they could have viewed their repeal & replace efforts as prototyping or beta-testing a new product or APP.  They could have tested ideas and built Republican consensus.  Not doing this led to disaster.

What next?

In 2013, I outlined a patient-centric versus politician-centric approach.  Maybe now it will be followed.

Those wanting an expanded governmental role in healthcare and those opposing it are fighting the wrong battle in the wrong way.

The debate over national healthcare policy has lasted over a century – intensifying during the Clinton Administration. It has always been about coverage, liability, and finance, never about care protocols and patients. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7871.pdf

If making health affordable is everyone’s stated goal then why not focus on the actual care, health, and wellness of Americans?

America remains the best place on Earth to have an acute illness or shock-trauma injury. Our nation’s emergency rooms and first responder protocols are unequaled. Princess Diana may have lived had her car accident happened in New York City instead of Paris. America’s diagnostic methods and equipment are unequaled. That is why patients from all over the globe seek answers to complex symptoms by visiting the Mayo Clinic, the Cleveland Clinic, Johns Hopkins, Sloan Kettering and countless other world class facilities.

The other side of American healthcare is its failings in chronic care, expense, and a system that is controlled by the medical profession, pharmaceutical companies, and insurance industry. This triad of entrenched interests has prevented the widespread use of substances and therapies deemed effective in most of the world.

Thankfully, an increasing number of healthcare professionals are embracing global best practices, virtual technology, and patient-centric methods. Some are even exploring homeopathic and nutritional treatments that are common place around the globe, but viewed as “nontraditional” in America. These innovations are improving the health of patients while driving down costs. This is the arena where policy-makers should check their partisanship at the door. Seeking ways to improve healthcare, not health financing, will ultimately make health affordable to us all.

I have personal experience with the convergence of these worlds. Since 2007, I have been the primary caregiver to several family members with serious chronic conditions. These conditions have been punctuated by emergency care and major surgeries. Making decisions and managing treatment across this spectrum has been a real education.

This education has helped me identify four major areas of opportunity for healthcare improvement. These four areas will improve our health and healthcare, while addressing the affordability of private and public health services.

First, not all ailments require doctors and prescription medications. Government and industry policies drive people away from cheaper and more effective natural remedies. Herbal remedies have been successfully used since the first humans. For example, Apple Cider Vinegar has completely solved acid reflex. Cayenne Pepper has improved heart function. However, natural substances are not covered as a medical expense either by insurance or tax deductions. Instead, acid reflex sufferers must pay for over-the-counter treatments (which are also not covered by insurance or tax deductions), or must obtain expensive prescriptions after paying to see a doctor or a specialist. Being a natural treatment, the vinegar regime also avoids side effects and drug interactions. http://www.healthcentral.com/diet-exercise/c/299905/155581/potential?ic=506048  Why not go “back to the future” and find ways to support these more affordable and effective treatments?

Second, nurse practitioners form one of the new front lines of care http://www.aanp.org/. The overwhelming majority of my family’s office visits are with a nurse practitioner interacting with the patient and the lab technicians. Occasionally, a doctor will review the information and discuss treatment options with the patient. Supporting the evolution to Nurse Practitioners through education, professional certification, protocol modifications, and pricing would bring down costs and expand health opportunities both for professionals and patients.

Third, community caregiving is another new frontline of achieving and sustaining wellness. In 2009-2011, I was part of the planning team for developing a community-based care system for the Atlanta area. We found a disturbing pattern - patients, especially Medicare/Medicaid patients, arrive in hospital emergency rooms when their chronic conditions, such as Diabetes, congestive heart failure, and Chronic Obstructive Pulmonary Disease (COPD), become acute. These patients are treated at the most expensive point of care (emergency room). Once they are released, many do not have the support (family, friends, neighbors) or the capacity (some form of dementia) to follow a treatment regime that would prevent the next emergency room visit. These revolving door patients drive-up costs and end-up in a cycle of deterioration.

Our solution was to develop a community-based healthcare network. Such networks are known as “Accountable Care Organizations” (ACOs) http://innovation.cms.gov/initiatives/aco/.

They break-out of traditional hospital and doctor office environments to forge partnerships with the community – churches, social workers, local government, neighbor associations, and nonprofits. A needy patient with chronic conditions is assessed holistically. This includes risk factors (i.e. smoking, alcoholism, drugs) and environmental factors (family & home environment). A care plan is developed and assigned to a multi-faceted care team (comprising community resources) and a care manager. Doctors and nurses are part of the team. The majority of health actions take place among family and community - driven by Electronic Medical Records, aided by remote sensors and virtual care, and guided by the managed care team.

The result of this holistic approach is improved care, sustainable health, and reduced costs. It is the one way Medicare and Medicaid costs can be substantially reduced while enhancing quality of life. There are initiatives to promote this methodology within the Center for Medicare and Medicaid Services (CMS), but it is occurring too slow and is too isolated.

ACOs are making a difference, but no major politician has embraced the concept and neither party has promoted them as a way to reduce Entitlement costs.

Fourth, families have always been a pivotal component in healthcare. Whether it is a parent staying home to care for sick children, or adult children caring for ailing parents, family caregiving is vital, but also emotionally and financially draining.

Having been the care manager, Medical Power of Attorney, and patient advocate for both my parents and my wife, I know how much time is spent with ailing family members. Current IRS regulations provide for listing parents as dependents based only upon financial support. http://www.irs.gov/pub/irs-pdf/p501.pdf

However, there are no tax credits or deductions for those who have the Medical Power of Attorney and devote countless hours to direct care or acting as the patient’s advocate for managing their care. Politicians at both the state and federal levels should provide relief for this indispensable and growing volunteer service sector.  Supporting Family-based assistance will save billions in public assistance.

According to the National Alliance of Caregiving, 70 million Americans provide unpaid assistance and support to older people and adults with disabilities. Forty percent of these caregivers provide care for 2-5 years, while approximately 29 percent provide care for 5-10 years. Unpaid caregiving by family and friends has an estimated national economic value (in 2004) of $306 billion annually—exceeding combined costs for nursing home care ($103.2 billion) and home health care ($36.1 billion). This value is increasing as the population ages. http://www.caregiving.org/data/CaregivingUSAllAgesExecSum.pdf

These four areas of opportunity will not address every health issue or entirely diffuse the fiscal bombs strapped to medical entitlements, but they are a good nonpartisan start. It is time for politicians to focus on the wellbeing of patients, not themselves.

[Scot Faulkner was Chief Administrative Officer for the U.S. House of Representatives. He served on the ACO team for the Southeast Atlanta Health Care System [SAHCS], as an advisor to Kinexum, a medical research consortium, and as an advisor on professional standards and ethics to the American College of Dentists. He has been the Medical Power of Attorney and primary caregiver for his spouse and parents since 2007. http://citizenoversight.blogspot.com/ ]

Medicare Plans to Penalize Hospital Use

Guest Contributor Paul Burke

Published at: http://www.ireachcontent.com/news-releases/medicare-plans-to-penalize-hospital-use-267175701.html

Medicare plans to penalize hospital use for 4.9 million seniors who get health care from Accountable Care Organizations (ACOs). ACOs are groups of doctors and hospitals which sign up to receive rewards from Medicare if they cut Medicare spending on their patients. They also receive protection from antitrust and kickback rules.

 

The rewards which ACOs receive are changing. Out are rewards for cholesterol management and anti-clotting treatment. In are rewards for keeping patients out of hospitals.

 

Three quarters of ACOs do not cut costs enough to get rewards, so the changes are not aimed at them. Most ACOs include hospitals, so the new incentives to avoid hospital stays are not aimed at them either; they will just bring other patients into the hospitals, with little or no net saving.

The new rewards do show Medicare's thinking about how to care for seniors.

 

Medicare plans to penalize ACOs when patients in three categories have unplanned hospital stays. The three categories are: diabetes, heart failure and multiple chronic conditions. Even when these patients need hospital stays, such as for appendicitis or heart attacks, Medicare proposes a penalty on each stay.

 

ACOs are already penalized when their patients go to hospitals for treatment of heart failure, emphysema, chronic bronchitis or asthma, on the reasoning these can be treated without hospital stays. ACOs are supposed to minimize hospital stays for those treatments, and now are also supposed to minimize hospital stays for patients with diabetes, heart failure or multiple chronic conditions.

 

ACOs have also faced penalties each time a patient leaves a hospital and is readmitted within 30 days to the same or another hospital, for related or unrelated treatment. An extra penalty will apply in the future if the patient goes to a nursing home in between. Penalties are additive, so six penalties will apply for example to a patient with multiple chronic conditions who goes into a hospital for emphysema, then to a nursing home and back to a hospital for heart failure within 30 days.

 

Doctors and Medicare patients can avoid these penalties on hospital stays. They can try to identify ACOs which have cut costs enough to care about the penalties and avoid them, or avoid all ACOs, or choose hospice, which ends all curative care. Avoiding ACOs is wise, according to Regina Herzlinger, PhD, of Harvard Business School, when patients have serious issues such as "diabetes, cancer, or congestive heart failure. You need specialists for that. They are the opposite of organizations, such as ACOs, that do everything for everyone."

 

ACOs may not want seriously sick patients anyway. Simon Prince, MD, President of Beacon ACO in New York, which does earn rewards, presciently said before Beacon became an ACO, "If they're going to put the risk back onto the ACO and onto the physician, it's going to be more difficult and we could start self-selecting which patients we want to include in our ACO."

 

In each measure ACOs need to be above the 90^th percentile to get full rewards, so for example they get full rewards if they hospitalize fewer diabetes patients than 90% of their competitors. This high target shows Medicare's high priority for reducing hospital use. Medicare has already extended hospital readmission penalties to patients outside ACOs. It also cuts general hospital payments based on total patient cost from 3 days before the stay to 30 days after.

 

As Medicare extends penalties outside ACOs, it will be harder for patients with chronic illnesses to avoid the penalties and keep getting complete care.

 

Many goals of quality medicine are not covered in this reward system. There are no rewards for keeping patients alive or for prevention or treatment of most conditions, such as cancer, HIV, disabilities, osteoporosis, kidney disease, or pain. Tonya Saffer of the National Kidney Foundation says, "Quality measurement is not exactly where it needs to be yet. We need true outcomes measures that are associated with morbidity, mortality, and patient quality of life."

 

Medicare struggles even to follow medical guidelines. They are dropping rewards for cholesterol management and anti-clotting therapy because guidelines changed.

 

Aco.globe1234.com lists all the rewards, and it lists the 369 ACOs, which serve 4.9 million patients. Most doctors, 61%, do not plan to join ACOs, so patients have choices. Medicare accepts comments until Sept. 2 on the new reward structure. ACOs which cut costs will start earning the new rewards in October 2015.

Saving Yourself from Medicare Cut

Guest Contributors Paul Burke and Jan Kletter, MD

 

People know that Obamacare changed private insurance. It also changed Medicare, to save money.

 

Seniors with both Medicare and private health insurance need to think about dropping Medicare Part B, which covers doctors, outpatient procedures and equipment, but also imposes restrictions. This is a serious decision.

 

Medicare is changing the way it pays hospitals and physicians who agree to work together in alliances. These alliances are known as accountable care organizations. Essentially the alliance keeps half the savings when it cuts the care of Part B patients: it gets more money for doing less. Therefore Part B patients with complex medical problems may not get the type of care that was available in the past, and that private insurance still covers.

 

Additionally, hospitals can get hit with a penalty imposed by Medicare when patients have too many hospital stays. Medicare rates hospitals on the number of Part B patients admitted twice in 30 days, even if the stays are unrelated and the hospital is not at fault. Every readmission above average, in any of six categories, incurs a penalty of $30,000 to $265,000, far more than Medicare pays to treat a patient in the first place. The penalties are supposed to encourage better care; the side effect is to discourage certain hospital stays. Instead, hospitals use other resources to keep complex Part B patients, with above-average chance of readmission, out of hospital beds.

 

The American College of Surgeons warned Medicare on June 14 about "the potential that these hospitals will decrease their care for such patients, thereby creating an access issue." Hospitals can afford to avoid these Part B patients, because Obamacare sends them many new private patients. The question is whether or not this is going to lead to better outcomes for patients.

 

Part B premiums cost $1,300 to $4,000 per person per year. Dropping Part B puts that money back in the patient's pocket. It also shields patients from the new restrictions on Medicare coverage.

 

According to the respected Guide to Health Plans, most federal retirees will save money by dropping Part B and keeping their federal health plan. "Medicare Part B will rarely save you nearly as much money as you spend on the Part B premium... Medicare Part B is of limited value to someone already covered by a good health plan."

 

Patients need to be certain of their own situation, but many have already bypassed Part B. Skipping it makes sense for many more, now that Medicare restrictions are in place.

 

Private insurers also want to cut care; Medicare has gone further, since it has more power. To drop Part B, patients file form 1763 with Social Security. They can re-enroll online the first three months of each year, which would take effect in July, with a 10 percent higher premium for each year without Part B. As the Guide to Health Plans says, "Thus, dropping Part B is not an irrevocable decision, and later rejoining Part B need not be highly costly."

 

It is understandable why Medicare has these restrictions. Seniors who get less treatment and die save money for both Medicare and Social Security. These programs are under intense pressure to cut costs. Patients who can pay doctors' bills with other insurance will avoid Medicare's reductions in care by dropping Part B.

 

Paul Burke is a retired federal researcher who manages a watchdog site, Globe1234.com

Jan Kletter currently practices general surgery in West Virginia.

AFFORDABLE HEALTHCARE 2.0

Published in http://hnn.us/article/154172

Those wanting an expanded governmental role in healthcare and those opposing it are fighting the wrong battle in the wrong way.

The debate over national healthcare policy has lasted over a century – intensifying during the Clinton Administration. It has always been about coverage, liability, and finance, never about care protocols and patients. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7871.pdf If making health affordable is everyone’s stated goal then why not focus on the actual care, health, and wellness of Americans?

America remains the best place on Earth to have an acute illness or shock-trauma injury. Our nation’s emergency rooms and first responder protocols are unequaled. Princess Diana may have lived had her car accident happened in New York City instead of Paris. America’s diagnostic methods and equipment are unequaled. That is why patients from all over the globe seek answers to complex symptoms by visiting the Mayo Clinic, the Cleveland Clinic, Johns Hopkins, Sloan Kettering and countless other world class facilities.

The other side of American healthcare is its failings in chronic care, expense, and a system that is controlled by the medical profession, pharmaceutical companies, and insurance industry. This triad of entrenched interests has prevented the widespread use of substances and therapies deemed effective and traditional in most of the world.

Thankfully, an increasing number of healthcare professionals are embracing global best practices, virtual technology, and patient-centric methods. These innovations are improving the health of patients while driving down costs. This is the arena where policy-makers should check their partisanship at the door. Seeking ways to improve healthcare, not health financing, will ultimately make health affordable to us all.

I have personal experience with the convergence of these worlds. Since 2007, I have been the primary caregiver to several family members with serious chronic conditions. These conditions have been punctuated by emergency care and major surgeries. Making decisions and managing treatment across this spectrum has been a real education.

This education has helped me identify four major areas of opportunity for healthcare improvement. These four areas will improve our health and healthcare, while addressing the affordability of private and public health services.

First, not all ailments require doctors and prescription medications. Government and industry policies drive people away from cheaper and more effective natural remedies. Herbal remedies have been successfully used since the first humans. For example, Apple Cider Vinegar has completely solved acid reflex for two of my family members. However, natural substances are not covered as a medical expense either by insurance or tax deductions. Instead, acid reflex sufferers must pay for over-the-counter treatments (which are also not covered by insurance or tax deductions), or must obtain expensive prescriptions after paying to see a doctor or a specialist. Being a natural treatment, the vinegar regime also avoids side effects and drug interactions. http://www.healthcentral.com/diet-exercise/c/299905/155581/potential?ic=506048 Why not go “back to the future” and find ways to support these more affordable and effective treatments?

Second, nurse practitioners form one of the new front lines of care http://www.aanp.org/. The overwhelming majority of my family’s office visits are with a nurse practitioner interacting with the patient and the lab technicians. Occasionally, a doctor will review the information and discuss treatment options with the patient. Supporting the evolution to Nurse Practitioners through education, professional certification, protocol modifications, and pricing would bring down costs and expand health opportunities both for professionals and patients.

Third, community caregiving is another new frontline of achieving and sustaining wellness. In 2009-2011, I was part of the planning team for developing a community-based care system for the Atlanta area. We found a disturbing pattern - patients, especially Medicare/Medicaid patients, arrive in hospital emergency rooms when their chronic conditions, such as Diabetes, congestive heart failure, and Chronic Obstructive Pulmonary Disease (COPD), become acute. These patients are treated at the most expensive point of care (emergency room). Once they are released, many do not have the support (family, friends, neighbors) or the capacity (some form of dementia) to follow a treatment regime that would prevent the next emergency room visit. These revolving door patients drive-up costs and end-up in a cycle of deterioration.

Our solution was to develop a community-based healthcare network. Such networks are known as “Accountable Care Organizations” (ACOs) http://innovation.cms.gov/initiatives/aco/. They break-out of traditional hospital and doctor office environments to forge partnerships with the community – churches, social workers, local government, neighbor associations, and nonprofits. A needy patient with chronic conditions is assessed holistically. This includes risk factors (i.e. smoking, alcoholism, drugs) and environmental factors (family & home environment). A care plan is developed and assigned to a multi-faceted care team (comprising community resources) and a care manager. Doctors and nurses are part of the team. The majority of health actions take place among family and community - driven by Electronic Medical Records, aided by remote sensors and virtual care, and guided by the managed care team.

The result of this holistic approach is improved care, sustainable health, and reduced costs. It is the one way Medicare and Medicaid costs can be substantially reduced while enhancing quality of life. There are initiatives to promote this methodology within the Center for Medicare and Medicaid Services (CMS), but it is occurring too slow and is too isolated.

ACOs are making a difference, but no major politician has embraced the concept and neither party has promoted them as a way to reduce Entitlement costs.

Fourth, families have always been a pivotal component in healthcare. Whether it is a parent staying home to care for sick children, or adult children caring for ailing parents, family caregiving is vital, but also emotionally and financially draining.

According to the National Alliance of Caregiving, 70 million Americans provide unpaid assistance and support to older people and adults with disabilities. Forty percent of these caregivers provide care for 2-5 years, while approximately 29 percent provide care for 5-10 years. Unpaid caregiving by family and friends has an estimated national economic value (in 2004) of $306 billion annually—exceeding combined costs for nursing home care ($103.2 billion) and home health care ($36.1 billion). This value is increasing as the population ages. http://www.caregiving.org/data/CaregivingUSAllAgesExecSum.pdf

I know how much time is spent with ailing family members. Current IRS regulations provide for listing parents as dependents based only upon financial support.

http://www.irs.gov/pub/irs-pdf/p501.pdf However, there are no tax credits or deductions for those who have the Medical Power of Attorney and devote countless hours to direct care or acting as the patient’s advocate for managing their care. Politicians at both the state and federal levels should provide relief for this indispensable and growing volunteer service sector.

These four areas of opportunity will not address every health issue or entirely diffuse the fiscal bombs strapped to medical entitlements, but they are a good nonpartisan start. It is time for politicians to focus on the wellbeing of patients, not themselves.

[Scot Faulkner was Chief Administrative Officer for the U.S. House of Representatives. He served on the ACO team for the Southeast Atlanta Health Care System [SAHCS] and as an advisor on professional standards to the American College of Dentists. He has been the Medical Power of Attorney and primary caregiver for his spouse and parents since 2007. http://citizenoversight.blogspot.com/ ]

MEDICARE KILLS

[Guest Contributor - Paul Burke]
Photo of Paul Burke's Father - age 98

Ironically after all the effort to expand coverage, Obamacare pays doctors to deny care.

In the first place doctors who advise Medicare patients against treatment can sign up to keep half the savings as a kickback.

Second, hospitals which talk Medicare patients into hospice, or out of coming back to a hospital, keep as much as $265,000 for each readmission they avoid.

With less treatment, seniors die, saving money for both Medicare and Social Security. Hospitals in Maryland, where Medicare and Social Security have their head offices, are exempt. So are military hospitals, where members of Congress go.

Medicare has become adversarial, because doctors and hospitals get these kickbacks from cutting care. As long as Democrats refuse all amendments of Obamacare and Republicans insist on complete repeal, the kickbacks will continue, and patients need to protect themselves by avoiding doctors who sign up for kickbacks, and by hiring a nurse-advocate in the hospital, just as we hire a lawyer in court.

My father was 98, active, and articulate about choosing life, in five languages. He used a wheelchair, worked out twice a week with a personal trainer, read the daily paper and the Atlantic, enjoyed restaurants and the opera. Before retiring he managed the Latin American business operations of Time-Life magazines and books.

He was fragile, and by some standards not so old. Many people live and contribute past 100. Yet hospitals urged him to give up the life he enjoyed. They tried to talk him into stopping dialysis, which would have meant death in a week. They urged palliative care and a "do not resuscitate" (DNR) order, contrary to his advance directive. They kept him without food for three days because of suspected swallowing problems. They started blood thinners, which gave them a reason not to operate to drain his chest. They convinced his assisted living to evict him unless he went on hospice and gave up dialysis. He refused.

His doctors had not signed up for kickbacks, but they did face Medicare penalties if above-average numbers of patients returned to a hospital within 30 days. A readmission penalty after congestive heart failure, which he had, cost the hospital $35,000. After knee or hip replacement it would cost $265,000. They paid no penalty when he died. We heard, and anyone who might come back in 30 days starts to hear, "Not a good candidate for treatment... Side effects can be bad... Palliative care... Hospice... DNR." We knew nothing of readmission penalties and did not hire an advocate. The readmission penalties propelled both the refusal to treat him and the pressure on his home to evict him, which left him in despair, and in two days he died.

Hospitals cannot bill patients or other insurance for readmission penalties, so they face draconian costs for treating anyone who might come back in 30 days. We all know readmissions save lives. Dr. Hawking, Senator Byrd and President Mandela were readmitted when needed. But Senator Byrd used an Army hospital, exempt. Medicare staff and retirees use Maryland hospitals, also exempt.

A penalty for readmission can be a death penalty when it drives hospitals to avoid treating you. The American College of Surgeons has warned about "the potential that these hospitals will decrease their care for such patients, thereby creating an access issue" (letter to Medicare 6/14/13).

Medicare recommends death penalties in nursing homes too, for excess rehospitalizations. If that penalty is adopted, fragile patients would not be accepted into nursing homes, and if already there, would be urged to forego needed hospital stays.

Four published studies, from Veterans Affairs, New England Journal of Medicine, New York Hospital Association, and Medicare's own contractors at Yale, show as you would expect, that when fewer patients return to hospitals, more patients die. Three other studies, from an Oklahoma hospital, Kaiser, and Healthgrades, show that patients with palliative care or DNR die sooner than they would otherwise, so signing up patients leads to more deaths and fewer readmission penalties.

Medicare knows its penalties can lead to more sickness and death, "We are committed to monitoring … increased patient morbidity and mortality" (Federal Register 8/31/12 p. 53376). Its contractor has already found higher deaths. Any NIH study would monitor deaths and stop the experiment when death rates rose. Medicare does not.

Medicare is explicit that "end-of-life/palliative care" is an "efficiency" which should increase kickbacks to doctors (2009 p.6). MedPAC, a Congressional agency, recommends "hospice use and the presence of advance directives" as methods to decrease rehospitalizations (2012 p.195). MedPAC did the original unpublished 2005 study justifying readmission penalties. They said 76 percent of readmissions within 30 days were "potentially preventable," but the study was based on experimental software without clinical reviews (2007 p.108).

If you think 20%-55% of your care is unnecessary, you will do fine, since kickbacks are designed to cut your care that much. Be aware that quality controls are minimal. Or if you have no interest in life, the system will oblige. My mother had cancer and died on hospice at age 88. But people deserve to choose. Seniors have paid for insurance and count on treatment without the government micro-managing hidden penalties and kickbacks to sway professionals against their wishes.

With research you can avoid doctors who sign up for kickbacks. Readmission penalties are harder to avoid. Your own doctors do not manage your hospital stay. Staff doctors do, and they need the hospital to be financially strong. Patients need to hire independent expertise during hospital stays, to get full information. We cannot trust hospitals which face $35,000-$265,000 penalties.

A bipartisan majority should repeal the penalties. In the meantime Medicare needs to exempt more patients, as it now exempts people under 65, or without Part B, or in Maryland. It should exempt patients over 95 or 100, since they are most at risk of improper pressure to die, and they are too few to affect the statistics. Medicare should also offer demonstration programs to exempt patients who pay an extra premium, or patients willing to have a copay for every hospital stay. Currently only the first stay in each 60 days has a copay, of $1,200. These alternatives reduce Medicare costs, while leaving hospitals willing to readmit when needed.

Paul Burke is a researcher who has analyzed data for HUD, Congress' Office of Technology Assessment, and the UN Development Programme. He manages a watchdog site, Globe1234.com, and is not connected to the health care industry. He has declined Medicare for himself to avoid its interference in his healthcare.