published Monday, April 23rd, 2012

Letters to the Editors: Preventive care is the way to go

Preventive care is the way to go

I mostly agree with Thomas Friedman's column, April 14, that we need to act boldly. However, it is incorrect that we have to destroy Social Security in order to save it. Without making a single change, SSI is solvent for a long time. That's not to say that there will not be political pain associated with developing the general fund revenues required to replace those which Congress absconded to make their books look better. Truth requires we acknowledge that the system, as designed, works fine.

Medicare and Medicaid have problems because of our approach to caring for our health. We believe we have "the best" health care in the world, but what we have is the most expensive and exhaustive set of procedures without the comprehensively positive outcomes.

Other nations have far better results. and we have some things to learn if we want to control our cost spiral. Rationing is not what I mean. ObamaCare strives to drive behavior toward preventive care, applied well before bad circumstances necessitate drastic (expensive) action.

In any rational world, the Republicans, whose system ObamaCare is, would be claiming victory, but their chosen politics of party before country deny them the option. The only losers are the people.

HARRY CLARK

Decherd, Tenn.

Bill would ensure quality care

An advertisement in the April 19 paper paints an erroneous picture of a bill to safeguard patients who receive spinal injections for pain. HB 1896 would require that these invasive procedures be performed or supervised by a qualified physician. Supervision would be required if the procedure is performed by an advanced practice nurse (APN). The bill applies only to procedures in unlicensed facilities.

The bill covers only invasive procedures and injections that involve the spinal cord, or surrounding structures and other large pain nerves. If performed improperly these techniques may not relieve pain, can worsen pain, and can even lead to paralysis or open spinal surgery.

Presently, APNs may perform these procedures with little training and without supervision. No school of anesthesia in Tennessee teaches nurse anesthetists any of these procedures beyond occasional observation. The standard clinical requirements of nurse practitioner schools do not grant certification in these procedures.

While it is never advantageous to have immediate access to substandard care, taxpayers should also be concerned about the costs.

Medicare data shows that 58 percent of spinal column (spine bones) facet injections performed and billed by mid-levels nationwide were performed in the state of Tennessee. Tennessee physicians only billed for 2.9 percent of nationwide injections by physicians. Tennessee citizens do not suffer chronic back pain 20 times more frequently than people in other states. It is logical to conclude that APNs greatly over-utilize these procedures.

This bill will help to ensure quality patient care and will conserve substantial health-care dollars. Patients deserve nothing less.

JOHN McCARLEY, M.D.,

President,

Chattanooga-Hamilton County Medical Society

Nation follows Europe's lead

Paul Krugman, the highly regarded financial expert and economics professor, got on the wrong side of Wednesday's editorial page (April 18). He should have gone from "left to right" with his brilliant oversight of "Europe's economic suicide." In reading his comments, especially the sidebar, he summed up America's current financial dilemma very succinctly. He said, "Rather than admit that they've been wrong, European leaders seem determined to drive their economy -- and their society -- off a cliff." Nothing could more accurately describe the present economic state of our nation and the drastic need for "change" in the coming election. We too ... are committing "economic suicide."

Thanks, Paul. You are right! Welcome to the world of reason.

C. BRUCE SPENCER

Update uranium processing plants

Re: Uranium processing facility in Oak Ridge, Tenn.

In response to skyrocketing costs as well as concerns by GAO and UNFSB government agencies about the design and criticizing the rush to accelerate construction of the uranium processing facility, I request letters to Congress asking their careful consideration of alternative options such as suggested modernization of existing facilities.

Cost estimate for UPF continues to go up. Current estimates place the price tag at $6 billion to $6.5 billion -- 1,000 percent growth from the original estimate of $6 million just five years ago for this stockpiling life extension program. A combined program to consolidate operations and upgrade current facilities sufficient to maintain manufacturing and production capacity for the foreseeable future could be accomplished at dramatic savings compared to construction of a new facility.

We rely on our elected officials to make prudent decisions about spending our tax dollars. It is a difficult task. I believe Sen. Lamar Alexander, as a respected leader of the Energy and Water Committee, can make a difference by taking a strong stand to oppose any "rush up" funding of the UPF in Oak Ridge until further study and findings are available. It's your money!

BETTY B. JOHNSON

Editor's rants always the same

I've been reading the Free Press editor's opinions since well before the merger, and every day it's been the same ol' same old. I'd say he started the daily rant long before the rant became a feature in the Sunday paper.

His two tenants have always been (1) lower the tax rates (benefit the wealthy), and (2) broaden the tax base (eliminate the federal earned income credit, or tax the poor. The low-income people turn their tax breaks into necessities like food and medicine, while the wealthy turn theirs into summer homes and yachts, but if we mention this, the Free Press editor accuses us of envy and promoting class warfare.

We see many pictures of him smiling, but that's because he and his kind have sunk the knife so deep into our backs.

The Free Press editor, along with the Mitt Romneys in our country, verify an old saying: A working person voting for a Republican is like a chicken voting for Col. Sanders.

There's no reason for income earned on investments to be taxed at a lower rate than income made from labor. Republican greed is palpable and unsatiable, and they are willing to put our most vulnerable at risk to feed it.

ALLAN BAGGETT

Trion, Ga.

'Science' still looks for a bone record

Once again a reader/writer asserts that "religion" is ignorance and "science" is truth. That's like saying that apples are ignorant but oranges are brilliant. There is almost nothing that can be seriously compared either between the two nor even within each one.

Within "religion," Christianity embraces life for every person. Within "science," I learned that the atom was the smallest form of matter. Now if a quark came up and bit me from behind, I would not know how to react unless I read a more modern textbook. The point: "religion" tends to be fixed while "science" treads a zigzag, back-and-forth trail while it tries to reverse-engineer how it all happened.

Narrowing within the Darwinian branch of stubborn thought, it might be informative to know how Mr. Darwin saw his theory. It is reported that he personally wrote the foreword to its seventh printing, and as he looked ahead down the dark corridors of the future, he said that it all depended on finding a bone record of species "A" warping itself into species 013." "Science" is still looking. Outside the Bible. (Could it be a religion?)

CLIF TINKHAM

7
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ALLAN BAGGETT, now don't you go offering reason to the right, they have their guts, and their guts tell them that bottom 47% is a bunch of shiftless nogoodniks.

They ought to be taxed so they won't want to be poor.

CLIF TINKHAM, want to find some older Christian texts that don't embrace life for every person, some that even describe how taking lives is a Christian duty against say the Musselman? Believe it r not, religions do change, mostly to suit an agenda. If you actually learned about science, you'd realize that it doesn't "zig-zag" as you put it, but goes forward, and it actually does teach you what to do in the event of something you thought was true being false.

As for Darwin, I think you're taking a quote out of context, and certainly far too literally. But yes, sciences is still looking while too many in religion are still denying.

April 23, 2012 at 12:48 a.m.
Livn4life said...

Happy, you just proved the point, you have completely bought into science as religion. Thanks a heap and have a good day. Science has proven a lot but solid evidence of evolution as it is presented by many of its faith proponents is just not there. So go on BELIEVE!

April 23, 2012 at 7:06 a.m.
lkeithlu said...

L4L: solid evidence is there, in many branches of science. You just refuse to look.

April 23, 2012 at 7:39 a.m.
riverman said...

The economic illiteracy of people like Allan Baggett is just overwhelming. Even intelligent Democrats have recognized over the years that people must be encouraged to put their money at risk in start-up companies that produce jobs. What idiots like Baggett don't understand is that a lot more start-up companies fail with the investors losing their entire investment than succeed. Just stick to your government or union job Baggett and quit making a fool out of yourself publicly.

April 23, 2012 at 9:42 a.m.

What you don't understand riverman, is most of those losses are at the low-end, while the ultra-rich take advantage of those same rules without any actual risk, or even make the rest of us pay the consequences of their risk-taking by holding us hostage to their gambling and manipulation.

If it were simply about a hard-working man building his business, that'd be one thing, but that does not honestly describe the market as it is.

And if you really want people to have an incentive to labor, you won't make them suffer while those that already have get a life of ease.

Livn4life: Sorry, but no, if you look very little of what I had to said reflected upon evolution, so you don't get to excuse the misrepresentations of Clif Tinkham. But in reality, there is actually genuine evidence not only of evolution, but many other things in this world, whereas most religions expect us to take things based on scriptural texts which are subject to constant reinterpretation to set an agenda. It's not in bones though, as what Darwin couldn't expect was DNA. Fortunately scientists have had no problem with it, nor would Darwin if he were a genuine scientist. They were quite easily able to recognize how DNA works much more clearly in understanding life than simple bones.

But keep believing science is like a religion, it's not, and never will be. If it were, it would stop being science. Note, for example, how "Christian Scientists" aren't scientists.

April 23, 2012 at 11:03 a.m.
riverman said...

You make some good points bulbs. I agree that crony capitalism is a huge problem with both Democrats and Republicans and should be punished severely. Saw 60 minutes last night about Lehmans bankruptcy and the guy appointed as investigator recommended criminal charges be brought 2 years ago. However neither the SEC or Justice Dept has done anything.

April 23, 2012 at 5:25 p.m.
lisabowler1 said...

Bill Would Ensure Quality Care Response:

On behalf of the TN Association of Nurse Anesthetists and over 1800 Certified Registered Nurse Anesthetists CRNA's) represented in the state of TN, it is evident that there is an inherent lack of knowledge in regards to the scope of practice for nurse anesthetists. First, every CRNA is required to receive training in pain management including both didactic and hands-on experience as per the requirements set forth by the Council of Accreditation (COA) and for those who specialize in Pain Management; a post graduate fellowship in Pain Management is usually completed. Second, each CRNA must pass a national Board Certification Exam in Nurse Anesthesia in order to practice. Third, CRNAs have been providing anesthesia and pain management services safely in TN for more than 100 years. In response to the data referenced by Dr. McCarley’s in his opinion letter, the following should also be noted as well: In the year 2008, CRNAs, NPs, and PAs performed only 5,813 facet injections (13%) while TN physicians performed 38,877 facet injections (87%). In 2009, CRNAs, NPs, and PAs performed 7,599 injections (16%) while Physicians performed 39,402 facet injections (84%), and in 2010 CRNAs, NPs, PAs performed only 6,126 (14%) facet injections while Physicians performed 37,051 facet injections (86%). Clearly CRNAs, NPs, and PAs are only performing a small fraction of the Pain Injections within TN. It should also be noted that research into why physicians are performing such a disproportionate number of injections has not been evaluated. After analyzing HB1896/SB1935, the public should be informed that CRNAs have an unblemished safety record with NO complaints recorded with the Board of Nursing or Department of Health in regards to care by CRNAs providing Interventional Pain Management Services. Recently the Federal Trade Commission (FTC) commented on this bill stating, “We are unaware of evidence that the licensed physicians and APNs subject to new limits under the Bill – acting within their respective scopes of practice – increase the risk of harm to patients. Nor have we seen evidence of systematic failure in the current supervision and collaboration arrangements between physicians and APNs.” In conclusion the FTC made the final statement in regards to HB1896, “Absent evidence of specific safety issues, however, staff recommends that the Bill be rejected, because it is likely to raise costs and limit access to health care.” The Tennessee Association of Nurse Anesthetists agrees with the FTC in their summation of the current proposed legislation. The reason that Tennesseans need to vote NO to HB1896/SB1935 is that this bill will significantly reduce access to care as CRNAs are the only anesthesia provider in 39 of the 95 counties within TN. The TANA will continue to be an advocate for Tennesseans.

Mark J. Haffey CRNA, MSN, APN TN Association of Nurse Anesthetists(TANA) Public Relation Committee Chair

April 24, 2012 at 2:08 p.m.
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