President Bush would not have been hurt by the ACA

Marc Siegel has an editorial in USA Today praising President Bush’s physicians and hitting the Affordable Care Act:

It was only knowing the concerning results of the CT angio that led Dr. Tony Das to perform the actual angiogram, where a catheter was threaded from the femoral artery in the groin up to the arteries supplying the heart. A tiny balloon was dilated across the lesion, and a tiny metal alloy mesh stent was floated into place. It is covered with a drug that will help keep plaque from forming and there is greater than an 85% chance that the artery will stay open. Blood thinners including aspirin (dual anti-platelet therapy) as well as cholesterol-lowering statins complete the picture, and will help keep further blockages from forming.

By Monday, the former president was back exercising on the elliptical machine, visiting his father in Maine, and he has returned to the golf course in advance of hisWarrior Open golf tournament next month.

The lesson for all of us is that we could be next. If a role model for fitness in older people such Bush can have significant heart disease, so can we. In terms of treatment, stents are neither good nor bad, they are simply useful when appropriate. The flawed COURAGE trial — published in 2007 in the New England Journal of Medicine and cited by critics claiming Bush was unnecessarily over-treated — attempted to demonstrate that cardiac stents don’t have an initial survival advantageHowever, the study deliberately excluded patients with as severe a lesion as Bush. A 2008 landmark study recommended either stent or Coronary Bypass Surgery in patients with this kind of heart lesion.

The Affordable Care Act may be pushing us in the direction of one-size fits all medicine, but President Bush’s case demonstrates that a more personalized approach often still works the best. Hats off to his doctors in Dallas.

First of all, it goes without saying that I’m thrilled President Bush got excellent care and is doing well. I wish that for everyone. But Siegel seems to be making the point that we’re all potentially in danger of not getting such care. Huh? He attacks a straw group of “critics” saying that President Bush shouldn’t have had the procedure. I haven’t seen a lot of people saying that, but perhaps he’s railing against this:

But even a healthy lifestyle won’t prevent all heart disease, McPherson says. And while the stent indicates that Bush has an increased risk of heart attack, managing his risk factors, such as his cholesterol and blood pressure, will help keep him healthy.

The Cleveland Clinic’s Steven Nissen questions whether Bush will really benefit from a stent. Doctors typically place stents only in patients who are having heart attacks or significant symptoms, such as chest pain, says Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. Stents can help keep blood flowing and reduce the risk of a heart attack in these patients.

But stents haven’t been shown to reduce the risk of heart attacks in patients without symptoms, says James Beckerman, a cardiologist at the Providence Heart and Vascular Institute in Portland, Ore. Stents also don’t help these patients live longer. And Nissen notes that stents themselves can become clogged up, causing greater problems.

Those are all legitimate statements. Siegel doesn’t recognize – at all – the counterfactual to rushing to treatment. He doesn’t know what would have happened if President Bush had been monitored and then undergone intervention when he was symptomatic. The procedure he had is not without risk, and had things gone poorly, we’d be having a completely different discussion. He doesn’t know how the stent will affect him in the future. He can’t claim some awesome benefit at this point. Research tells us that it’s likely to be small. But this is America, and if President Bush wants a stent, he can have one.

But what really set me off was the transition into an attack on the ACA. Here, Siegel is way off base. The ACA is not one-size-fits-all medicine. It says nothing about stopping people from getting the care they want. It says nothing about what private insurance can cover. If people want to buy insurance for stents that don’t meet criteria, go right ahead. If they want to pay for them themselves, go right ahead. The ACA does not prohibit insurance, or people, for covering or getting anything.

What the ACA will do is give tens of millions of people insurance, and, perhaps, better access to stents when they need them. It will allow millions the opportunity to, perhaps, get the care that he’s praising in so much of his piece. Eliminating the ACA would likely do more to prevent people from getting this care.

Is it just me, or are columnists attacking the ACA trying too hard these days?


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