The Brain: Look Deep Into the Mind's Eye

The Brain: Look Deep Into the Mind's Eye

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My Take on the Health Insurance Debate

Many of my friends, family and patients have asked me my take on health care debate. What is going on in Washington right now with this debate is sheer insanity. What we have there is a bunch of lawyers, lobbyists, senators and congressmen trying to decide what system is best for the medical world. Perhaps what we need to do is to let a bunch of doctors reform the legal, politician and lobbying profession. Doctors as a whole are pretty bright people...so don't you think they could do a good job reforming those professions. Do you think they will go for that? Of course, I am being facetious here...that would never happen but hopefully within that description you can see what is so inherently wrong with this debate.

The current system we have now is imperfect and it needs fixing but overall it is an effective system. I think most people out there will agree with this last statement. According to many polls, Americans are overall happy with their health care plans. As I see it there are a few issues that need to be remediated.

1) End the discount system- Our current system is a discount for services system. Every year I get a CD from Medicare with all the codes on it that tell me what it will pay for every service I will offer. Private insurance is usually somewhat higher on what it will pay us for the same codes. What we have to do is set our fees higher than that so that we will get the best possible reimbursement. For example, if Medicare will pay me $70 for the procedure, I will have to set my fee at $100 so that I can get $70. If I charge $70 for that procedure, they will pay me $50 for that same procedure. So as you might see, Medicare artificially elevates medical fees charged to patients by being a discount system.

2) Portablity- People change jobs, careers, locations etc more than ever now. Insurance benefits need to be able to transfer between insurance companies without a loss of benefits. Within this is the concept of competition. Another reason we need portability is it will allow for more competition between insurance companies. An example, my company is with ABC insurance for three years and have just decided to raise my rates for the third time. So, I decide to shop my companies health insurance. I find that XYZ insurance will save my company significant money without loss of benefits. So, if I am smart I will move my companies insurance. Now if ABC knows that XYZ is out trying to get my business, don't you think that ABC might not want to increase me this year in order to maintain my business? This is competition and this is a good thing.

3) Pre-existing conditions- We have to eliminate pre-existing conditions from our vocabulary. Medical insurance should cover any legitimate condition.

4) Care for the uninsured- There are far too many uninsured out there for a variety of reasons. I do think by eliminating Pre-existing conditions and improving portability, many more would be insured. However, what about those who are not working, don't want to work or kids who need medical care? I hope to address this below.

So far all I have done is to state the most obvious problems with out any answers...so here it comes...my concept of what healthcare should be like in the near future.

MY HEALTHCARE PLAN

There are systems already in place that can be the basis for healthcare without the government being involved or taxing us further. Health insurance should take care of major catastrophes and preventative care first and foremost.

The system that I prefer is a high deductible healthcare plan with a health savings account (HSA). The deductible can be determined by the family income. For example, people who make 50K or below we limit to a $1000 deductible; those who make 75K, $2000 deductible; those who make $150k might have a $5000 deductible. OF course the premiums for high deductible insurance are much lower than most plans now offered. Add on top of this a Health Savings Account-each month you can take pre-tax dollars and put aside money to cover your deductible costs to the limit of your family deductible. For healthy families, once you reach the maximum, you do not need to add money into the system unless you use some. Ultimately, the money belongs to you and not the government or an insurance company, you control it as long as it is used for a medical cost. Furthermore, your company can choose to match part of your contribution to this HSA. What needs to be added to the current system is portability and elimination of the pre-existing condition clause. This could cover the largest percentage of the population.

The un or under-insured: There have been several proposals that have been put out- the government option, expansion of medicare and expansion of medicaid. These government options are all fatally flawed as those systems already have significant financial limitations-especially in the current economy and would end up taxing all (don't believe when they say they will tax just the rich--the middle class will probably get it the worst). The other problem that exists is that there just aren't enough primary care physicians out there to serve the people we would have to put in this system. So any proposed system will have to fix the problem of too few physicians at the same time that it provides cost-effective care.

A system that can work is a system modeled not after medicaid or medicare but instead the Veterans Administration (VA). OK, pick yourself off the floor, its not that simple--but it does have some things within that system that are very useable. I am not advocating expansion of the VA system but instead another system similar to the VA that can be run privately if we so choose (and I would personally choose a private system).

So here are the things within the VA system that can be effective:

1) Community health clinics: They have clinics set up throughout the country to serve the needs of the veterans. In a new system, community clinics can be set up to serve the needs of the un-insured/under-insured. The current problems with the community health clinics in the VA are that people have to travel to them and sometimes they have to be triaged for care. Truthfully, "free" health care" should not be an easy thing or everyone would want it. We need to make it somewhat difficult but not impossible to access the care so that people will strive for getting out of this system and into the HSA based system. A triage based system makes the most sense for community health clinics.

2) Many of the doctors currently in the VA come out of school in significant debt...oftentimes that is why they choose a setting like a VA. The VA has programs that will pay off the student loan debt in place. So, this would solve a few problems...most docs choose to specialize so they can make more income so they can pay off their high debt loans (at least initially). So, why can't we put together a similar plan for doctors coming out of school to pay off their student loans for at least 5 years of service in this system. They would also receive a reasonable compensation on a similar level to what VA docs make for that time of service. This will also allow many more docs to go into primary care because they won't have to worry about their long term student loan debt.

3) Who could run this: There are many models of clinics out there that are privately run that can run a system similar to this...they can be hospital based community clinics, insurance company based clinics, private company based clinics that can be part of this system. My last choice would be the government but this is possible too (although they haven't proven to me that they can run anything effectively- See- post office, amtrack etc.).

4) How can it be paid for? This is the most difficult part. But these clinics can be run at low cost due to economies of scale and can be supplemented by government, religious organizations, charitable organizations etc to keep the costs down and so that it doesn't significantly effect our economy. This part requires people much smarter economic people than myself to figure out...but it can be done...cost effectively and provide the care that is needed so much.

Ok here is a general model for the future of medical care...it too is not perfect but I think it is a lot better than anything being proposed in Washington. I open it up to debate...maybe someone out there will be able to take some of these ideas and run with it.

Thanks for listening...my best as always,

Charles Shidlofsky, O.D.

Review of the book: "Fixing My Gaze" by Susan Barry

I just finished the book "Fixing my Gaze" by Susan Barry. This true story is about a neuroscientist who discovered the wonders and beauty of binocular vision at the age of 50.

Sue had strabismus as a child and while 3 surgeries managed to "straighten" her eyes she never developed binocular vision. This is actually very common among those who have had strabismus surgery. Only about 1/3 of all patients who undergo strabismus surgery develop binocular vision. Sue became a very successful neuroscientist despite her so-called disability. She really didn't think she had missed anything by not having binocular vision.

When she was in her late 40's she was referred to an Optometrist not far from the University that she taught and did research. The Optometrist evaluated her and determined that with a prescribed program of Vision Therapy, Sue might gain binocular vision. After some hard work, Sue did indeed gain binocular vision.

Susan describes in great detail what it feels like to gain binocular vision for the first time, citing specific examples in her everyday life. As with anything this journey had its ups and downs but the end result was very positive.

This book was very easy to read and understand. There are many references at the end for further study. I would strongly recommend this book for anyone who has a child who has strabismus or for any adult with strabismus. Additionally, anyone interested in neuroscience would also benefit by this book as it does break down barriers between what was long thought to be the visual gospel and what the true reality is in visual science. Lastly, I feel like it should be required reading at Optometry and Ophthalmology schools so that we can throw out the old, disproven rules and develop the new corrected views on the treatment and remediation of strabismus.

Regards,
Charles Shidlofsky, O.D.

Interesting article

I know I haven't blogged in a while...things have been very hectic but when I find an interesting article I will post it....so here is an interesting article on Visual Attention:

http://www.sciencedaily.com/releases/2009/03/090325132326.htm#

Enjoy

Vision and Sensory Processing disorders

So many people tell me that they don't realize that people on the Autistic Spectrum have vision problems outside the realm of the typical nearsightedness, farsightedness or astigmatism. But the fact is, many on the spectrum have difficulty with visual spatial and visual processing difficulties. These may be the sole visual problem or can be combined with the typical vision problems mentioned above. This week I have decided to post a video that I did about a year ago on a website called Autsimspot.com. I hope the verbal explanation given in this video will help you understand the type of visual processing problems seen in this population. I have five other videos on the autism spot website...feel free to peruse them as well. Lastly, there are many other videos on this website that are exceptional...so have at it...watch as many as you can...it is truly an terrific website. Here is the link:
http://www.autismspot.com/videos/Sensory-Processing-Disorders-and-role-vision

Enjoy,

Charles Shidlofsky, O.D.
www.dr-s.net
Follow me on twitter: CShidlofskyOD

Great websites to learn more about Neuro-Vision

I frequently get asked by patients for some good web resources that talk about the work I do.
So, I will list a few great websites that I really enjoy and truly explain some of the work I do and a brief description of each site:

www.autismspot.com This website has tons of useful information on autism spectrum disorders and lots of videos of parents and providers who can help. I have 5 or 6 videos uploaded on their therapies section...so please go check this out.

www.sharp-sighted.org This website I recently discovered talks about the visual processing system from the viewpoint of dyslexia. However, there is some great scientific information on this sight about vision and perception and includes the latest and greatest information.

www.nora.cc This is the website for Neuro-Optometric Rehabilitation Assn. There is a ton of information for the doctor and patient on this emerging area of vision care. I have gone to their meetings the last five years and will be going again in March.

www.covd.org College of Optometrists in Vision Development This site discusses vision care for children who have a variety of vision problems from a developmental point of view. There is a lot of great patient information here.

And last but not least: my website www.dr-s.net has a lot of great links to other sites that have wonderful information about vision and vision processing.

I hope everyone has a wonderful week.

Case of the week 1-17-2009

I always seem to have a multitude of interesting cases from week to week, but one in particular this week seemed to stand out. Perhaps the reason it stood out is because it involved someone who I have known for a while who plays a I sport that I really do enjoy, both as a player and spectator.

This particular patient has been playing ice hockey most of his life. I got to know his father in one of the leagues he and I played in about 10 years ago. Shortly thereafter the whole family came to see me as patients mostly for routine care. The son and the patient in this case went from High School hockey to Juniors up in Canada and then last year played Juniors right here in the Dallas area. He played well enough to earn a college scholarship to play hockey this year. Unfortunately, over the last year he has sustained numerous concussions and was deemed unable to play. He then enrolled at University of Oklahoma and was playing club hockey there when he got a few more concussions.

When he came in for his routine annual exam this week, he was telling me about his hockey misfortune over the last year. I asked him if he has noticed anything different in his memory skills and visual skills since the concussions. He said, in fact, he has noticed many differences. He is far more sensitive to light, he was deemed mildly dyslexic at school this year (which has never been a problem for him) and he had trouble focusing from the board to his work. He also held his books and near point work closer to his eyes. This certainly raised the red flag in my mind.

During my testing, I noticed reduced focuing ability, abnormal convergence skills and some tracking difficulties. All these finding had previously been normal when tested. I brought him back in and did some electo-diagnostic tests looking at the whole sensory system: from visual; to vestibular; to proprioceptive and their ability to integrate. We also did a neuro-cognitive test for memory skills. What we saw on the results was quite astonishing for an athlete. Most skills were significantly reduced from normal.

I prescribed therapeutic lenses and occlusion therapy for this patient and I will report on his results when he comes back in. I am optimistic though, that we will make a significant impact on his skills. I feel that his diagnosis of mild dyslexia is probably a mis-diagnosis but instead he was suffering from Post-Trauma Vision Syndrome. For more information on Post-trauma Vision Syndrome you can refer to the Neuro-Optometric Rehabilitation Assn. website: www.nora.cc .

Hope everyone had a great week.
Charles Shidlofsky, O.D.