Obamacare’s Health Fascist Meddling in Medicare

The Center for Medicare and Medicaid Innovation, which was created under Section 1115A of the Social Security Act (added by section 3021 of the Affordable Care Act), has commenced the initial stages of tyrannizing the details of older peoples’ lives in the name of supposedly reducing heart disease risks. Its “Million Hearts®: CVD Model” will be recruiting 360 control and 360 intervention practices, with about 150,000 Medicare fee-for-service patients in each group. Needless to say, the American Heart Association is the primary instigator. And it’s coming under cover of the US Secretary of Health and Human Services announcement of their intention to shift 85% of all traditional (fee for service) Medicare payments to “quality and value” [sic] by 2016.

Medicare beneficiaries will be encouraged to “know [their] numbers,” share decision making with their physicians, and choose from a menu of options (for example, controlling blood pressure through exercise, taking daily aspirin, or eliminating tobacco use) tailored to the patient’s readiness. The model’s value-based payment design will reward not specific blood pressure values or cholesterol target numbers but rather reduction in predicted risk of myocardial infarction and stroke. On the payment side, clinicians will be rewarded on a sliding scale tiered by absolute risk reduction across their entire high-risk patient panel, which increases incentives for health management of entire cohorts of patients. (Paying for Prevention: A Novel Test of Medicare Value-Based Payment for Cardiovascular Risk Reduction. Darshak M. Sanghavi, MD; Patrick H. Conway, MD. JAMA. Published online May 28, 2015. http://jama.jamanetwork.com/article.aspx?articleID=2300705
 http://millionhearts.hhs.gov/

They invoke the estimated $315.4 billion annual cost of cardiovascular disease as a pretext, while ignoring the fact that it may not save money if people simply die of it a few years later, or die of something else instead. And rather than tie rewards to actual improvements in health, these will be based on “surrogate end point[s] of predicted risk” – which permits them to falsely blame peoples’ lifestyles for heart disease that’s really caused by infection, while triumphantly announcing “improvements” that are really based on mere conjecture. (Which is nothing new – it’s how they’ve been concocting the number of lives supposedly saved by quitting smoking, while actually having no clue.)

The single largest disease claim against smoking is for heart disease, not lung cancer. And those heart disease claims are based on studies based primarily on lifestyle questionnaires that ignore the role of cytomegalovirus. “[T]he most striking finding of Simanek et al.’s study is that the relatively modest OR of CVD associated with CMV infection translates into an estimate of the population attributable risk or attributable fraction of CVD of ∼ 40%… What is striking about this 40% attributable fraction estimate is the implication that eliminating CMV infection would prevent as many CVD cases as the complete removal of smoking and almost twice as many as the elimination of either hypercholesterolaemia or hypertension from the population.” (Commentary: Understanding the pathophysiology of poverty. FJ Nieto. Int J Epidemiol 2009 Jun;38(3):787-790.)

http://ije.oxfordjournals.org/content/38/3/787.long

Persistent pathogens linking socioeconomic position and cardiovascular disease in the US. AM Simanek, JB Dowd, AE Aiello. Int J Epidemiol 2009 Jun;38(3):775-787.

http://ije.oxfordjournals.org/content/38/3/775.full

All the subjects in this cross-sectional study were 45 years and older, so the most important thing it couldn’t evaluate is the age at which people were infected. Poorer people get infected at younger ages, and smokers are more likely to be less wealthy, so an earlier age at infection would account for earlier onset of heart disease, such as the anti-smokers blame on smoking.

But this important infection, whose elimination “would prevent as many CVD cases as the complete removal of smoking and almost twice as many as the elimination of either hypercholesterolaemia or hypertension from the population,” has no role to play in promoting the officious schemes of the public health establishment, so as far as they’re concerned, it doesn’t exist!

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