To: Rep. David Schweikert (R, AZ), Rep. David Kustoff (R,TN)
From: Sean Smith
Subject: Fix OSA and Save the U.S.A. $150B-$1T a Year – A Basic Plan
A Basic Plan to Save the United States of America $150 Billion to 1 Trillion Dollars a Year by Effectively Reducing the Prevalence of Sleep Breathing Disorders:
Introduction
I watched Rep. David Schweikert’s March 19th 2024 speech on the House floor regarding the debt crisis in the United States and that he notes one of the most productive things that we could do to stabilize our nation’s economy and our debt would be to improve the health of Americans [R1]. I agree and would like to assist in that endeavor. In this letter I will explain my background and communicate a plan that could save our country $150 billion to $1 trillion dollars a year. This plan aims to drastically reduce the prevalence of Obstructive Sleep Apnea and Upper Airway Resistance Syndrome in the United States by supplying state of the art education to clinicians and issuing mandates to private and state operated health plans to provide hassle free coverage of services needed to facilitate rehabilitative care for the jaws and airways of children and adults. It is a plan that can be easily implemented and produce substantive benefits to individuals and communities in a short time frame, while over the long term stabilizing the health and economic prosperity of the American people.
My Background:
I am a 38 year old disabled adult man living in Memphis Tennessee. My disabilities began in childhood and after graduating high school I transitioned immediately to SSI and Medicaid. The etiological cause of my disabilities is that my jaws underdeveloped which compromised my airway and led to the development of pediatric obstructive sleep apnea. The symptoms of my jaw, airway, sleep breathing disorder, and other issues were misattributed to psychiatric diagnoses which delayed the diagnosis of my pediatric obstructive sleep apnea until the age of 17, in 2004. The treatment rendered to me at age 17 was inadequate. My remaining symptoms were once again misattributed to psychiatric illnesses. In my mid-20s the severity of my disabilities required me to drop out of college, cease efforts to try to work, give up my interests, hobbies, personal studies, and devote myself to managing health and trying to figure out what underlying health conditions were causing my medical disabilities.
Over the last 10 years of engaging with healthcare specialists, reading scientific publications, reviewing continuing education materials, writing reports and medical appeals, and engaging in many other forms of study, I discovered that I am disabled by fully treatable even curable health conditions. In short, I need to fix my underdeveloped jaws to stabilize my airway to rehabilitate my breathing so I can have proper sleep to restore and maintain my physical and mental health and well being.
I’ve been unable to get the rehabilitative care that’s necessary to treat my health conditions primarily because of the misconduct of private and state operated health insurance plans. The misconduct of health plans is extensive and blatant, and actively discriminates against people with specific disabilities like mine. A secondary contributor is that the education necessary to understand how jaws affect airways and can disorder breathing that disrupts sleep, and how all of these impact a person’s health, is education that most medical doctors do not have, and specialists who one might expect to understand this, such a sleep medicine specialist, can also lack needed education. However, there are many physicians from a variety of specialties, including sleep medicine, who are among the most educated physicians in this subject matter, and are deserving of our respect and attention.
That said, it is highly educated and specialized dentists that have the expertise required to facilitate the necessary rehabilitative treatment of a person’s jaws and airway. As things are, there are too few such dentists to provide care to all of the people who need it. There is an intense need for physicians to become more educated and gain clinical expertise treating patients for these jaw-airway issues.
The laws that are intended to protect disabled adults from the abuse and exploitation of health insurance plans or not being enforced. Disabled adults are usually indigent and cannot afford attorneys, and at least in Tennessee attorneys do not offer pro bono legal representation to disabled adults that are being abused and exploited by health insurance plans. I am currently engaged in a pro se lawsuit against my State Medicaid health plan, Sean Smith v. Tennessee Department of Finance and Administration, Div. TennCare, filed January 26th 2024 at the Davidson County Chancery Court. My disabilities make doing the job of a lawyer impossible and I do not expect to succeed. But it is important for me to try so that my complaint is documented in the public record and presented in a court of law. The likelihood that I’ll be incapacitated or injured while attempting to meet the burdens of litigation is very real so much so that the first motion I filed in my case is for accommodations to be granted in the event that I am incapacitated and killed during the litigation process.
I provide this background to communicate that my suggestions do not come from a cursory understanding but from over a decade of diligent persistent effort to understand my own situation and try to get care. From my research and the understanding that it provides I form the expectation that there are many other disabled adults like myself. But even those who are not disabled adults suffer from many of the same health conditions that I do and likewise find themselves unable to get the care that they need due to their health insurance plans misconduct and/or their physicians lack of education on the subject matter.
People like me don’t have to be disabled. With care we can be rehabilitated. And upon being rehabilitated we can become productive members of society that engage in gainful employment. Which is the purpose of the Medicaid programs. It is one of the core reasons that they are provided funding by Congress [42 U.S.C. 1396-1]. To rehabilitate disabled adults so that they “attain or retain capability for independence or self-care” and where possible, return to the workforce.
Hopefully you can understand the implications from my allegations of health plan misconduct preventing me and other disabled adults from receiving rehabilitative treatment for the health conditions causing our disabilities. When Medicaid plan administrators engage in misconduct that prevents plan beneficiaries from receiving rehabilitative care of the health conditions causing their disabilities, they are then defrauding the state and federal governments. Medicaid plan administrators are paid to do a job that they’re not doing. If either Rep. Schweikert or Rep. Kustoff would like to hear the full legal argument behind that allegation I would be happy to supply it upon request.
Enough background, time to communicate the basics of the plan.
The Basic Plan
What I’m going to supply is a small portion of the data that’s available to me. If Rep. David Schweikert or Rep. David Kustoff are interested in pursuing this matter please contact me and request more data. I have reports and medical appeals that I have previously written which I can readily supply and I can try to make myself available to provide tailored information or discuss the subject matter over the phone or video conference.
What I’m presenting in this letter is very rough; limited; incomplete. I have to prioritize focusing on my health and my legal case and so I’m not taking the time to provide in this letter the extensive scientific references that validate all of my statements. It’s worth mentioning that alongside my petition for judicial review I filed an “Exhibit B” which has the full contents of my 2023 medical appeal and complaint sent to my health plans. Exhibit B contained about 20 pages of quotations from scientific publications that spell out in great detail how jaw airway issues are causing my disabilities. I would provide a copy of that Exhibit now except that the Representatives message submission system doesn’t allow uploading a PDF document and I’m not about to mail 90 pages of documentation unless I know you’re interested.
I am a person that shies away from making claims unless I have data to corroborate my claims; It is important to me to differentiate between what I believe and what I know. I hope that members of Congress really truly wish to and will seek to take action to improve the health and economic prosperity of our Nation. There is a community of individuals like myself and specialized physicians who simply want to be allowed to get to work on that.
There have been many reports estimating the economic impact of Obstructive Sleep Apnea (OSA) on the United States. In general it is estimated that OSA costs the United States ~$150 billion a year [R2, R3, R4, R5]. However those reports have a somewhat narrow understanding of how many societal problems, workplace injuries, industrial accidents, and diseases and disorders that Obstructive Sleep Apnea and Upper Airway Resistance Syndrome (UARS) causes or contributes to. Nevertheless, those reports establish what is the bare minimum economic impact of OSA on the United States; It is at least ~150 billion USD a year.
A presentation made by Ben Waldman [Footnote 1] at the Greater New York Dental Meeting 2018 Airway Summit, based upon a more expansive understanding of how jaws and airways affect health extrapolates from the data a much greater estimate of up to 1 trillion dollars a year. Please watch the video presentation: Ben Waldman: Policy Implications of Treating Sleep & Airway Pathology. (https://vimeo.com/337890092/1655efbe59) [R5].
If one finds cause to exercise some skepticism and take a more moderate view, I would suggest to at least entertain the premise that the cost burden of sleep breathing disorders to the United States is somewhere in the middle, and average it out to $450-$650 billion dollars a year.
The negative consequences of underdeveloped jaws and airway issues causing sleep disorders aren’t just limited to the immediate economic burden OSA has. For example, it is well known that pediatric obstructive sleep apnea will reduce the IQ of children by 10 points on average. That children with sleep breathing disorders develop behavioral problems and learning difficulties. So much so that some pediatric sleep medicine specialists assert that ADHD in children is primarily caused almost entirely by disrupted sleep. Such sleep disruption doesn’t necessarily have to be caused by a sleep breathing disorder, but if a child does have a sleep breathing disorder and has ADHD then the cause of the ADHD is almost certainly due to their sleep breathing disorder, which typically occurs because of issues with their jaws and airway.
The behavioral and academic problems that a child with a sleep breathing disorder experiences can also disrupt the learning and well-being of their siblings and their peers. A child with academic difficulties or behavioral issues has a negative impact on their family and the families they maintain relationships with and that in turn affects the communities those families are a part of. I know this first hand as throughout my childhood and adolescence I observed the impact my struggles had on my siblings, my peers, my parents, and the families we maintained relationships with.
When evaluating the operational cost and efficiency of a business or program one might calculate the number of man hours spent and the cost per man hour. If we look at sleep breathing disorders like OSA and UARS throughout the population as the number of IQ points lost throughout a community, we could estimate how many lost IQ points children and adults in the United States have lost because of OSA/UARS. Moreover, while the neurological injury and brain disorder induced by OSA in children is a severe problem necessitating that immediate and decisive treatment be rendered, 80 to 90% of people with OSA are not diagnosed, so the child with OSA usually grows into an adult with OSA/UARS, and the brain damage continues throughout all that time. Meaning, the estimate of IQ point loss for children with sleep breathing disorders in the U.S. would be a small fraction of what it would be in the adult population.
While estimating the number of lost I.Q. points in our Nation’s children and adults is not what I would consider a scientific argument, it is an interesting way of thinking about the problem, and it does communicate the pervasive detrimental effects that sleep breathing disorders are having on our Nation, and the potential benefits from effectively treating these conditions. It causes one to contemplate the economic impact of our society being made less cognitively able than they otherwise could be. It helps us model the shape, size, and mass of the thing.
Given what I know about how throughout clinical practice and in research studies flawed methodologies are often being used to assess whether or not a person does or does not have a sleep breathing disorder, the existing estimates of the prevalence of OSA within populations can be expected to be underestimates. But for the purposes of this thought experiment, according to the National Council on Aging, “Approximately 39 million U.S. adults have obstructive sleep apnea (OSA).” [R6]. As the brain damage from pediatric OSA continues throughout development and into adulthood let’s expand the average 10 IQ point loss known to occur in children to be a 10 to 20 IQ point loss in adults [R7]. This would means that OSA has caused adults in the United States to have collectively lost 390,000,000-780,000,000 IQ points. The average person has an IQ of 100. In terms of the lost capacity of applied intelligence in society we have lost at least 3,900,000-7,800,000 ‘people units of applied intelligence’ to OSA.
If we had 7.8 million people show up out of nowhere volunteering to work for free for the entirety of their life, how could we squander such a resource and still think ourselves in service of the common good?
How stupid would we be if we had the ability to provide rehabilitative treatment for people’s jaws and airway such that we could prevent or almost cure OSA/UARS, but we didn’t do it? What we do now will answer that question.
If we were to eliminate OSA from the pediatric population we would have smarter and healthier more capable children that would grow into smarter and healthier more capable adults. And if we were to provide rehabilitative care to adults with OSA/UARS they too would significantly improve in their ability to function and participate more fully in society.
Note that rehabilitative care for one’s jaws and airway is not achieved with CPAP or other PAP therapies. PAP therapies are nothing more than bandaids. For CPAP treatment to be considered medically successful, it only has to reduce the AHI by 50%. Meaning, if someone is choking to death the entire night, CPAP is successful if they choke to death for half the night. If your Bank considered safeguarding your assets to be successful if they allowed someone to steal 50% of your earnings, would you bank with them? I suggest if as a country we are going to invest in our future we make sure we will get a good return on investment.
The health of the United States is being Robbed from its citizen by many factors. And people like me, disabled adults, are the ones who are being made the most destitute. I know the main suspects faces, names, and habits and I am asking you to help catch them and put them behind bars.
According to one of the largest studies assessing the prevalence of Obstructive Sleep Apnea that I know of, about 1/7 of the world population has OSA [R8]. It is my personal belief that more than one seventh of the worlds population has a sleep breathing disorder like OSA or UARS. That belief stems from understanding the flaws of sleep scoring methodologies that are often used in many sleep clinics and research studies. An understanding I gained from educators such as Dr. Jeff Rouse.
I advise that Rep. David Schweikert (R, AZ) reach out to Dr. Jeff Rouse, who lives and practices in Texas but teaches at Spear Education in Scottsdale Arizona. Dr. Rouse is one of the few educators in this area who comprehensively understand this subject area. There are only a handful of such educators across the United States. Dr. Rouse is one of the best. There are other educators that I favor more than Dr. Rouse but seeing as Spear Education is in Arizona it seems most appropriate to direct Rep. Schweikert towards him.
Instructions to Achieve the Basic Plan:
- Form a taskforce or organization consisting of educators such as Dr. Jeff Rouse (DDS, TX), Dr. Mark Cruz (DDS, CA), Dr. Barry Raphael (DMD, NJ), Dr. Richard Roblee (DDS, AR), Dr. Kevin Boyd (DDS, IL), Dr. Steve Carstensen (DDS, WA), Dr. Jerald Simmons (MD, TX), Dr. David Gozal (MD, WV) and other key figures in this field of jaws-airway focused physicians. Have this group create a synthesis of continuing education materials that will be provided free of charge as a comprehensive ‘big picture’ course accessible online to all physicians (medical, dental, physical therapy, chiropractic, etc) throughout the entire United States.
- Collaborate with professional organizations and taskforces.
- American Dental Associations Children’s Airway Screen Taskforce (CAST), headed by Dr. Simmons.
- American Academy of Physiologic Medicine and Dentistry, of which Dr. Simmons is a board member.
- As determined necessary by the team of educators I have mentioned, the inclusion of other professional organizations and government agencies.
- Such as The American Academy of Sleep Medicine and/or the American Academy of Dental Sleep Medicine and/or the American Academy of Orthodontics, etc.
- Collaborate with professional organizations and taskforces.
- Have federal and state agencies, such as the Centers for Medicare & Medicaid Services (CMS) and Department of Labor and State Insurance regulators, write guidelines and issue bulletins/orders that make it very clear that the rehabilitative care of the jaws and airways of children and disabled adults to prevent or diagnose and treat Obstructive Sleep Apnea and Upper Airway Resistance Syndrome is to be reimbursed in full at a rate that is equitable to the healthcare professionals delivering these services without undue burdens or delays to clinical practice or patient care. That any instance in which health plan misconduct prevents a child or disabled adult from getting their jaws and airway treated will cause the health plans to be fully liable for any damages that the child or disabled adult suffers as a result and be required to pay additional punitive damages.
- Have CMS do whatever is required to compel state operated health plans to provide care to disabled adults with jaw-airway issues and/or OSA/UARS such that they can receive full and complete rehabilitation including requiring CMS to adopt as it’s standard for scoring sleep studies the American Academy of Sleep Medicines recommended scoring criteria for hypopnea (a 3% desat and/or an arousal) as defined in the AASM’s 2012 Update to the 2007 Scoring Manual [R9] and recognize and reimburse for diagnosing Upper Airway Resistance Syndrome so that people can get their OSA/UARS properly diagnosed and thereby access rehabilitative treatment for their jaws-airway. Reduce the barriers to getting jaw-airway treatment so that the medical necessity of treatment isn’t primarily based upon the Apnea Hypopnea Index or Respiratory Distress Index (AHI/RDI) and its grading of mild, moderate, or severe OSA, but based primarily upon the patients medical history, clinical presentation, anatomical risk factors, and the opinions of the patient’s doctors.
Let people work with doctors who know what they’re doing so they can receive rehabilitative care for their jaws and airways. Some people with ‘mild’ OSA have severe impairments and desperately need care. People with mild OSA are more likely to be successfully rehabilitated than those with Severe OSA. - Mandate that the National Institutes of Health fund research into these areas related to exploring why a pandemic of underdeveloped jaws plagues modern humans, and further elucidates how jaw structure affects the airway, and how disordered breathing that disrupts sleep affects human health. There is a pressing need for studies that accurately assess the prevalence of OSA within vulnerable populations such as those with severe psychiatric illness, dysautonomia, mast cell activation syndrome and other immune disorders, chronic pain conditions (i.e. fibromyalgia), epilepsy, and many other chronic diseases.
- I can supply many ideas for research studies that desperately need to be done based upon my past reviews of the scientific literature.
- I would encourage the representatives to also query the educators I mentioned on what studies they believe need to be funded and performed.
Sincerely,
Sean Smith
Footnotes:
FN1. Ben Waldman is a board member of the American Academy of Physiologic Medicine and Dentistry (AAPMD). The AAPMD was founded by physicians that have a comprehensive understanding of jaws and airways.
Ben Waldman’s background:
https://aapmd.org/ben-waldman
“He has addressed thousands of dentists worldwide on subjects touching both clinical and commercial areas in dentistry but focuses on the public policy implications of Sleep and Airway disorders and how they’re diagnosed, treated and reimbursed in the dental arena.
Prior to his career in the dentistry industry, Mr. Waldman had a career in Public Policy, serving in the Reagan White House as Associate Director of Presidential Personnel and as the Associate Director of the Office of Public Liaison as well as stints at the General Services Administration and the Department of Housing and Urban Development. He was also a candidate for U.S. Congress in 1992 and 1994.”
References:
R1. Forbes Breaking News. (Mar 19, 2024). “I’m Tired Of People That Don’t Think’: Schweikert Issues Fiery Warning About Debt And Spending”. https://youtu.be/EzZGoF8mNjA?si=j6Btpp4jsNQdB9yP
R2. Nayef AlGhanim, et al. (2008). The Economic Impact of Obstructive Sleep Apnea. Lung. 186; 7-12.
R3. Watson NF. (2016). Health care savings: the economic value of diagnostic and therapeutic care for obstructive sleep apnea. J Clin Sleep Med. 12(8):1075–1077.
R4. American Academy of Sleep Medicine. (2016). Hidden health crisis costing America billions. Underdiagnosing and undertreating obstructive sleep apnea draining healthcare system. Darien, IL: Frost and Sullivan. Retrieved from: http://www.aasmnet.org/sleep-apnea-economic-impact.aspx.
R5. Foundation for Airway Health. (May 22, 2019) Bed Waldman: Policy Implications of Treating Sleep & Airway Pathology | GNYDM 2018 Airway Summit. [web video]. Retrieved from: https://vimeo.com/337890092/1655efbe59
R6. Vanessa Ling. (Oct 2023). Sleep Apnea Statistics and Facts You Should Know. National Council on Aging. Retrieved: https://www.ncoa.org/adviser/sleep/sleep-apnea-statistics/
R7. University of Chicago Medical Center. (Mar 17, 2017). Untreated sleep apnea in children can harm brain cells tied to cognition and mood. Retrieved: https://www.sciencedaily.com/releases/2017/03/170317082507.htm. “MRI scans link chronically disrupted sleep to widespread brain cell damage”
R8. Benjafield, A. V., et al. (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. The Lancet. Respiratory medicine, 7(8), 687–698. https://doi.org/10.1016/S2213-2600(19)30198-5
R9. Berry, R. B., et al. & American Academy of Sleep Medicine (2012). Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 8(5), 597–619. https://doi.org/10.5664/jcsm.2172
Defend The Disabled 