MPPA Meeting Minutes – 1/21/21

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The MPPA Meeting in its 24th year was held Thursday, January 21, 2021 at 6-8 PM using our new donated Zoom account technology. It worked well!

Focus: Covid-19 pandemic clinical cases, clinician and political responses, as well as November 3 medical system fallouts predicted from general election.

THOSE PRESENT: BOB GEIST MD, WAYNE ZUEHLKE CPA, DAVE FEINWACHS JD, PHD, DOUG SMITH MD, MARIE OLSETH, MD, SCOTT JENSEN MD, NOEL COLLIS MD OF HUTCHINSON, MN, PROF. SUE MCCLERNON PHD, REP. GLENN GRUENHAGEN, CAROLYN MCCLAIN MD, PETER NELSON JD OF WASHINGTON DC, DAVE RACER MLITT, CHRIS SCHNEEMAN CLU, CHFC, RHU, DR. ROBERT KOSHNICK OF DETROIT LAKES, MN, TIM HERMAN OF MANY TALENTS, AND LYLE SWENSON MD. I CAN ONLY APOLOGIZE IF I MISSED SOMEBODY. A TOTAL OF  25 RESPONDED TO THE MEETING INVITATION—ABOUT AVERAGE. ATTENDANCE OF 16VAT THIS MEETING WAS GREATER THAN THE USUAL AVERAGE OF 12—WE ARE GRATEFUL FOR THE PARTICIPATION OF SO MANY TALENTED FELLOWS. INCIDENTALLY, OVER 40 PARTICIPATE IN OUR MANY EMAIL LOOPS.

Once again please note that my own opinions in these minutes are always enclosed in [brackets].

Covid-19 Pandemic Experiences

  1. Covid-19 cases.
    • We first had a brief review of the McCollough Group’s November 2020 graphics regarding the cascading events that occur during viral infection and the sequence of treatments developed as symptoms progressed. [p. 6].
    • Dave Feinwachs presented our 1st two pandemic cases—he and his wife. He self-treated with hydroxychloroquine (HCQ)with success. His wife required hospitalization when her oxygen saturation fell << 90. Both are doing well, but with residual fatigue. During the meeting we heard many others had been afflicted—some worse than others. [I noted that during later discussions that HCQ was a popular first-line self-remedy; this despite HCQs earlier political-medical shot-gunning barrages disparaging the drug. Maybe because President Trump thought it a possible remedy? So much for national unity and “science”.] 
  2. Covid-19 in the Clinics.
    • We had many insights into pandemic problems at the ER from Carolyn McClain, at a family practice by Doug Smith and at a psychiatric practice by Marie Casey Olseth. The various treatments begun in the ER, the surges of cases in a family practice, and the anxieties of many patients regarding themselves, as well as others. Those present related the experiences close (especially elderly) relatives and friends.
    • It was interesting to hear from Chris Schneeman that his insurance business employees were not only anxiety ridden, but some almost in panic thinking about exposure, if someday returning to the business offices for work.
  3. Lockdown Covid-19 Political Responses.
    • Bob Geist showed background information regarding national and state case and mortality statistics. He showed the cartoonist jibes at state politician responses and jibes at the variable mixed messages from mixed “science expert”, which politicians tried to follow or  not.. He displayed the Ireland and Israel case surges after strict national enforcement of face masking. We looked at last October’s public hostility to some absurd lockdown protocols. A significant response to lockdowns were voiced by hundreds of scientist led by Stanford, Harvard, and Oxford University scientists (the Barrington MA Declaration)hundreds; they noted that lockdown had caused unnecessary medical and economic depredations. Last, our local hostility to MN Governor Walz’s lockdown responses were noted. [Maybe we should pity politicians, who were and often are still  flying blind as they try to follow the advice of experts equally ignorant and blind early in a pandemic surprise; this might expected when the natural history of the infection is unknown as are treatments that work. Expert were flying blind as happened internationally at WHO, nationally from federal agencies, and locally from one of the nation’s finest experts—all regularly disparaged anecdotal reports some of which gave clues to valid treatments. A growing resistance to lockdown restrictions continues. For instance, wearing of masks is to be “patriotic” and became a felony for an unmasked mother alone in a soccer stadium bleacher watching her child’s match. Tyranny often becomes unmasked in its insane rages against comm sense.]

      Reproduced below is a table showing the national and state covid-19 mortality rates on the date of our meeting, 1-21-21.

      The cartoonist jibes in July at NY governor Cuomo’s strict lockdown mortality compared to Florida’s governor DeSantis’s open response remain true 6 months later. FL  continues to do twice as well as NY. But, a caveat: CA governor’s strict lockdown (although ludicrous at sandy beaches and absent at his own winery bistro) seems to have worked—I’ll have to leave figuring that out to someone better able than me.

      See mortality rate table on the next page…

January 21, 2021 US national and state mortality statistics:

  • Doug Smith then led a discussion of political lockdowns. He noted that patients had real lack of trust in government data and in the political lockdown responses. He has seen the bad effects of isolation. [Parenthetically, we should note here Dr. Charles Crutchfield’s well-publicized admonition early this week to the black community to get vaccinated despite the community’s distrust generated from old government experiments on blacks.] Others pointed out that covid-19 is indeed dangerous and that precautions in crowded places ought to be followed. Efforts to protect those old and those afflicted with comorbidities of obesity, diabetes, alcohol abuse (a real promoter of viral virulence) and other maladies must remain our public health concern even when restrictions are lifted for those young (e.g., school age) and those otherwise healthy. Sue McClernon noted that Duluth’s pandemic surge hit last September and is now relenting. Wayne Zuehlke noted that local parochial schools were open—only 2 infections have been found;  one a school principle. An exception was noted by Glenn Gruenhagen where  school had to temporarily shut down when infection cases increased.

    4. November 3 Election Fallouts.
    • Four colleagues addressed various aspects of the election and the turnover from one party to another. Peter Nelson resigned from CMS early this week; typical for those at executive levels. For four years he mostly worked on insurance matters. For instance, trying to alleviate some of the problems created by Obamacare regulations. This resulted in the paradox of writing new regulations to counter the ill effects of old regulations! His work created state insurance flexibility to include the private sector, created price transparency, and helped alleviate other glitches. [See a complete view of these changes he sent us two days ago: Setting the Record Straight: CMS’s Successful Work to Improve Access to Private Health Coverage from 2017 to 2021” by CMS director Seema Verma, Randy Pate, and Peter Nelson—see this paper in email forwarded to the MPPA roster on 1-20 at 4:35 PM] It is possible for the new administration to repeal some of the changes, e.g., state flexibility rules, and the new 12 month “short term” insurance policies, but many are protected unless congress itself acts to change the regulations. Nelson also thought the Biden administration would attempt to pass something like a public option for insurance.
    • Dave Racer noted that Peter has done an incredible and difficult job at CMS. They both pointed how a public option would probably negatively affect clinician pay. Lyle Swenson thought such attempts to restrict pay further were absurd, since most doctors now work at fixed pay in some [“provider”] insurance corporation. [Physician market-place power and pay have eroded over many decade—rwg]
    • Dave Feinwachs pointed that physicians are in the backseat of health care bus. He said that we should all read “Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare Paperback” by N. Al-Agba and R.  Bernard (Amazon, $25.16). [This was once known as “dumbing down” to control costs-. A further analysis of enlisting a federal (or state) public option for the insurance market place to cuts cost is needed, since all such price cut panaceas have failed to control medica cost inflation for over 5 decades—more on that another time. This is not to say that all new attempts to increase competitive prices are not good. Too bad prices are not asked if services are “covered”—rwg]. Dave Racer is planning a book regarding a public option and will be researching physician opinions.
    • Carolyn McClain discussed her battles over congressional bills regarding “surprise billings”. There are now two 900-pound gorillas in the medical market place—the old MCO corporation industry vs. private equity firms buying clinic practices. [I suspect that neither care about clinician pay per se; they do care about their profit margins—rwg] McClain thought that the deal may end up with independent clinician pay fixed at the average of what an MCO insurance corporation may pay its own employees and that physician arbitration with the either private equity or MCO corporation may be difficult. Doug Smith then asked, What happened to the corporate practice of medicine laws? Dave Feinwachs replied that they long ago were “burned down”.

The meeting was thought excellent by all; I was thrilled with the caliber of the discussion leaders and the insightful discussions by all attending. But as usual, we did not complete our agenda. We never got to critique many 2021 medical syst4m bills being introduced at the legislature by Rep. Gruenhagen. In addition, the new website is yet to be vetted by our Library Committee before its ready for prime time. It should be noted that a year’s subscription to the Zoom program has been donated to MPPA.

Next meeting: TBD—probably late spring. I look forward to your suggestions for items. We could look at, for instance, the fate of legislative bills regarding patient and clinician protection, as well as procedure price and corporate rationing transparency.. We might want to look at the public option bills being bandied about. Contact me with other suggestions.

Respectfully submitted,
Robert W. Geist MD

About the author

Minnesota Physician-Patient Alliance

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