Part of the health care overhaul due to kick in this September could strip more than 1 million people of their insurance coverage, violating a key goal of President Barack Obama’s reforms.

Under the provision, insurance companies will no longer be able to apply broad annual caps on the amount of money they pay out on health policies. Employer groups say the ban could essentially wipe out a niche insurance market that many part-time workers and retail and restaurant employees have come to rely on.

This market’s limited-benefit plans, also called mini-med plans, are priced low because they can, among other things, restrict the number of covered doctor visits or impose a maximum on insurance payouts in a year. The plans are commonly offered by retail or restaurant companies to low-wage workers who cannot afford more expensive, comprehensive coverage.

Depending on how strictly the administration implements the provision, the ban could in effect outlaw the plans or make them so restrictive that insurance companies would raise rates to the point they become unaffordable.

A cadre of employers and trade associations, including 7-Eleven, Lowe’s, the National Restaurant Association, the National Retail Federation and the U.S. Chamber of Commerce, have asked the administration to allow the plans — at least through 2014, when the insurance exchanges are set up and tax credits become available for low-wage workers.

Less Health Care is Better, Not More

by Jeffrey Dach MD

A shocking “medical heresy” was quietly stated in a mainstream medical journal last week.(1)   Less health care is better than more health care.  Dr. Deborah Grady’s editorial in the May 10 Annals of Internal Medicine throws a giant egg on the face of mainstream medicine.  It is generally assumed and expected that health care offers some benefit to our health.  Yet, Dr Grady points out that when health outcomes are actually studied, the data shows that more health care leads to worse outcomes. (2,3)  This revelation isn’t new, and is actually old news, like a worn and familiar shoe.  The real news story is that this kind of “medical heresy” somehow  eluded censorship by the editorial board and appeared in print in a mainstream medical journal.  Are mainstream doctors getting fed up?  Is this the opening salvo of a medical revolution?

Examples of Harmful Medical Care

Dr Grady cites specific examples of treatments that result in harm, with adverse effects outweighing the benefits.  The first example is synthetic “monster” hormone therapy used by the mainstream medical system, which was found to cause cancer and heart disease in the famous 2002 Women’s Health Initiative study. (4)   It seems incredible, but true.  The mainstream medical system used Synthetic “monster” hormones for years until the WHI (Women’s Health Initiative) study finally convinced millions of women to switch to safer and more effective bioidentical human hormones.  My previous articles on the safety and importance of bioidentical hormones discusses this at length. (5)(6)

Dr. Grady’s second example is the discredited practice of arthroscopic surgery for osteoarthritis.  Millions of these useless procedures were performed in the late 90’s until it was abandoned after randomized trials showed no benefit.(7) My previous article on the power of the placebo discussed this.(8)

A third example is the case of SSRI antidepressant drugs which have little benefit for patients with mild to moderate depression.  The benefits of SSRI drugs are equivalent to placebo pills.(9)  Dr. Grady points out that in cases of mild depression, the known adverse effects of SSRI antidepressants clearly outweigh the benefits.  My previous article on SSRI antidepressants discussed this.(10)

A Fourth example is screening mammography.   “The adverse effects of mammography—false-positive findings, biopsies, anxiety, and overdiagnosis and treatment of latent cancers may overwhelm the benefit.” (11)  My previous article on screening mammography discussed this.(12)

Dr Grady’s final example is the over-use and misuse of antacid drugs called proton pump inhibitors (PPI’s), which have serious adverse effects of increased rates of fractures, Clostridium difficile infection, and increased risk of pneumonia. (13-18) I discussed the harms and benefits of acid blocker drugs in a previous article . (19)

Reducing Medical Care Opposed as “Rationing”

Dr Grady reminds us that the term “rationing” is frequently misused and abused in health care debates.  In politics, those who want more health care oppose those who propose less health care.  Less health care is called ”rationing”,  a term originating in the wartime practice of rationing food, fuel and other scarce goods, and services, and may not apply to over use of health services which causes harm rather than benefit.

http://jeffreydach.com/2010/05/12/less-is-more-mainstream-goes-alternative-by-jeffrey-dach-md.aspx