OPINION
DOCTORS' Lounge
wallets of the true believers. The dangerous
part is that true believers may be convinced
to try medically unnecessary and harmful
things. For instance, Ms. Paltrow recom-
mends the outright ridiculous device called
the “Mugwort V-Steam” from an LA spa
called Tikkun. Ms. Paltrow describes this
vaginal steam treatment thusly: “You sit
on what is essentially a mini throne, and
a combination of infrared and mugwort
steam cleanses your uterus, et al. It is an
energetic release, not just a steam douche,
that balances female hormone levels.” For
men, there is the “A-Steam,” (in case you
were feeling left out) which is said to “clear
lactic acid and improve cardiovascular per-
formance.” You could double up on this
cleansing business with Charcoal Lemonade
for your guts.
believers in a community of sorts, where
other conspiracy theories can hold sway. The
staggering amount of misinformation on
vaccines, for instance, got its impetus from
people who believed in “only natural things,”
as if nature were kind, or reasonable, or fair.
Mother Nature is none of those. Although
breathtakingly beautiful, she is violent, de-
structive, infectious and heedless of such
virtues as mercy or forgiveness. Scientific
medicine respects her, uses her for any ad-
vantage we can get to diagnose and heal,
and fears her mightily. Just one mutation
in the HIV genome can render a previously
effective medicine useless; Ebola has risen
again in the Congo; global warming has
caused the death of glaciers and eventually
will cause the flooding of inhabited coast-
lines. What true believers in the nature-only
dogma fail to understand is that all pharma-
ceutical medications are not equally “bad” even though they are all “processed” and
not “raw, whole and organic.” Otherwise
reasonable and educated people are terrified
of prescription medicine. And, over many
years of practicing preventive medicine, I
have seen the terrified ones suffer the vas-
cular consequences of uncontrolled blood
pressure in the setting of high familial risk
for atherosclerosis. It saddens me.
August 16, 2018 from employment to caregivers. Administrator Seema
Verma As a former Kentucky Medical Association
officer, I have gained policy insight into the
essential role of Medicaid and Expanded Med-
icaid to our many rural hospitals providing
community care, and to our larger safety-net
hospitals that back them up for trauma and
complex emergency crises. Virtually all these
hospitals now struggle for financial survival,
and the losses from uncompensated care ex-
penses threaten the existence of many. Veri-
fiable data shows that for each one-half mil-
lion persons returned to uninsured status, 2.2
billion dollars is lost in uncompensated care
each year, the costs of which will be inflicted
on these hospitals. In more affluent regions,
some of these losses are shifted in payment
negotiations with commercial insurers, and
are passed on in premium increases to policy
holders. However, hospitals serving the many
poverty-afflicted areas of our state have few
commercially insured patients to offset such
losses. These will likely be the first hospitals to
fail and to leave their counties with no nearby
care. fiscally conservative, stabilizing to our society,
and a hallmark of a compassionate nation.
Herbal cleanses and coffee enemas and
the fear of “inflammatory foods” join true
Centers for Medicare
& Medicaid Services
Washington, DC
Dear Ms. Verma,
I write this open letter in response to the
comment period on Kentucky HEALTH 1115
Waiver litigation and CMS reconsideration. As
a physician in a key Kentucky safety-net hospi-
tal that serves many Medicaid recipients, I wit-
ness directly the substantial health benefits to
them from Medicaid and Expanded Medicaid.
These health benefits are clearly threatened by
coverage loss from work requirements, verifi-
cation complexities or any such undermining
of health care access. Verifiable data shows
that for each half-million persons returned
to uninsured status, 250 to 500 preventable
deaths will result each year. These deaths prin-
cipally come from delayed cancer screening
that misses early cure opportunities, and from
loss of skilled medical management of chronic
diseases, such as diabetes, hypertension and
their disabling effects. Thus, care costs escalate
enormously, with diminished effectiveness.
Also these preventable illnesses convert many
from productive workers and taxpayers to
disability, and convert many family members
I conclude that Medicaid work require-
ments and other threats to coverage are de-
structive from every point of analysis. Policy
that enhances coverage and lessens numbers
of uninsured persons merits strong protection.
Increasing access to care is life-saving, solidly
Doctors like the old axiom, trust but
verify. Show us your research and not your
ads, and maybe we’ll go for something new.
But don’t hold your breath – or you might
need the “Optimal Breathing Self-Mastery
Kit,” only $148.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Bar-
ret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
Sincerely,
Gordon R. Tobin, MD
The above letter was sent to CMS administra-
tor, Seema Verma, in response to a reopened
comment period on the work requirements for
Kentucky Medicaid proposed by the Bevin ad-
ministration in its 1115 waver application, and
previously granted. The comment period elicited
an enormous response, with 8,500 responders
opposing the work requirements, 374 support-
ing them, and 167 submitting mixed opinions.
Nevertheless, CMS then re-approved the work
requirements. The program still remains on
hold, however, awaiting appeal of a Federal
District Court decision that voided the work re-
quirements as inconsistent with the original law
that allowed such wavers. The ultimate decision
has far-reaching implications, as three other
states have been given wavers to impose such
work requirements, and about another dozen
are preparing similar waver applications.
Dr. Tobin is a professor at the University of Louis-
ville School of Medicine, Department of Surgery,
Division of Plastic and Reconstructive Surgery.
He practices with UofL Physicians-Plastic and
Reconstructive Surgery.
OCTOBER 2018
37