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Open Letter to Congressman DeFazio on Health Care

Mr. DeFazio I attended your town hall meeting on health care in Cave Junction and was not impressed. I went to defend you against the right wing, and ended up agreeing with them. Why should we pay taxes for the insurance companies to get windfall profits? We need real health care reform and the public option is just more of the same.
My concern is three fold, and then I ask that I am allowed follow up.

First, anti-trust law does not have a history of being an effective efficient way to ensure competition in the market place, and I fail to see why we should continue to spend 1/3 of our health care dollars on insurance company profits. Health care reform is headed in the direction of windfall profits to insurance companies rather than improved access and reduced costs. Given that Single Payer would eliminate the waste of 1/3 of our health care dollars to insurance companies, something we should both know anti -trust laws will not do, why are you supporting public option over single payer?

Second, while we clamor for access to health care, quality problems are going unaddressed. Our health is not only dependent upon access to health care but also the quality of health care we receive. A for profit health care system has run amok. Physicians refer patients to imaging and lab facilities in which they have investments or get kickbacks for sometimes harmful tests they do not need. Physicians run up our medical bills by performing exams and procedures that are unindicated. The American medical establishment repeatedly guards the employment of outdated ideas, exams, and equipment, to protect high profits and recover costs of expensive but outdated and cumulatively harmful equipment. Would you propose and support a change in the health care reform bills that address such conflict of interest issues such as physician investment in imaging and lab facilities, and fee base medical care?

Finally, western medical care has a long history of failing to treat patients as full subjects, particularly in the area of informed consent. Women, slaves, mental health patients, the poor have all been used against their knowledge as lab rats and living cadavers. The truth is in the state of Oregon, at OHSU, PDX VA, Sacred Heart, Three Rivers, Providence, and more patients are being told an experienced surgeon will be performing their surgery, only to have interns on rotation supervised by a resident or two step in at the last moment. Consent is sometimes sought less than 48 hours before the surgery when patients should be informed at the time of scheduling. Even then, the patient will often be lied to about who will perform the surgery; the consent form makes it sound like students may assist, but does not confess they will be performing the surgery. When staff fears that the pressure of late notice will not suffice to gain consent to this switch, the use of drugs, in fact, date rape type drugs, are employed to facilitate consent. The drugs have a compliance inducing, memory whipping effect so the patient will do what they are told and not remember the violations of trust, of autonomy, of dignity. If the use of "conscious sedation" drugs is not successful, if the patient still declines the inexperienced interns, supervised by a resident you never met being substituted for your surgeon, depending on your economic status, you ability to file a suite, the patient is often simply fully sedated and the surgery goes on as the staff, not the patient planned. Patients never know unless they poor over the medical records including the "soft" or handwritten notes rarely released to patients even upon request.
Under these conditions, where patients autonomy is violated as a matter of course, where profits, education, the arrogance of medical staff have more to do with your care than your health and needs, where patient's right to set limits to their marginal risks are undermined, where medical staff with conflicting interests get to determine what is a patients duty and how much duty will be extracted, the risks and price the patient will pay, patients health will suffer.

Research shows that a sufficient number of patients would consent if asked that such violations of patient's rights are not necessary for medical education. Research shows that what limits patients do place on such practices in terms of things like numbers, sedation, and level of supervision, are not only reasonable, but medical staff respect of patient autonomy to set such limitations improves health care, teaches medical students good ethics, and reduces lawsuits.
While patients are reduced to lab rats and cadavers, while less than 6% of injured patients who should sue do so, while the myth of frivolous lawsuits is just that a myth, the history of Oregon is one of attempting to limit patient legitimate ability to seek damages, rather than cleaning up physician practice. Oregon has some of the most lax informed consent laws in the country.
Within the context of all this, you have been informed that OHSU/PDX VA is using drugs to facilitate consent, that they are violating patient's rights, and you have done nothing. Why?


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