The Emperor Has No Clothes - “Healthcare Reform”

This was submitted to us by a big fan who is very troubled with the direction this nation is going..He is troubled with Healthcare reform and how that will impact us all both in the short and long term.  Our generation and those to come are in trouble if something is not done.   Great piece and worth the read and if you like what you read pass it along AS WE NEED TO SPREAD THE WORD…. (cut, paste, steal all are OK with me!!)

It is a basic fact of economics: 

Expenditures = price per item or service multiplied by the rate of usage or consumption.  With regards to health care, there is another more intangible variable in the equation….quality.  Never fear, however, because with Obamanomics, he will increase access (i.e. increase usage), maintain a fair wage for providers of the service, and not only maintain but actually increase quality.  And it will be budget neutral.

As much as he wants to get you to believe that most of the money is already in the system, do not be misled by him being “perfectly clear”.  Without any facts to support his claims, he dismissively and condescendingly states that we just have to get doctors (those damn doctors!) to stop looking at fee schedules when deciding treatment regimens and instead actually care for their patients, stop those useless tests and surgeries (sorry greedy doctors…again), increase efficiency and decrease waste (if that isn’t a generic unquantifiable catch-all, I don’t know what is; kind of reminds me of save or create jobs!), and take away the profits of those evil pharmaceutical and insurance companies.  Anything else we need, we’ll just soak the rich and tax businesses because they don’t need it.  Essentially, if you pass his plan (but hurry, because it turns into a pumpkin after August), you’ll get unlimited care, no cost adjustments for risk factors (so go ahead and smoke and drink and don’t exercise, because someone else will pay your bill), higher quality and service (?England, ?Canada), and it will cost you less.  Not only that, in Obamanomics land, health care legislation must pass in order to reduce the deficit (yes, he actually said that!)

Pardon me if I laugh out loud.  Is this stimulus part 2?  Remember, all that “shovel ready”, “transparency”, “timely and targeted” and “jobs, jobs, jobs” hocus pocus?  After “misinterpreting” the data, “guessing”, and hiding the unread bill under the cover of night, we have a social welfare program under the guise of stimulus.  And we have more unelected and unregulated czars (financial, energy, auto, health, etc.) than 20^th century Russia.  With the stimulus plan, Nancy Pelosi, Biden, etc. all seemingly drew their inspiration from none other than comedian John Lovitz.  I could almost hear him saying, “That’s it.  That’s the ticket.  We’ll create a trillion jobs…..a trillllllion jobs!”  Fool us once, shame on you, fool us again, shame on us all.

Just a few facts to ponder in this complex discussion.

• 1. Doctors take a Hippocratic Oath. While the president chose to slander physicians by saying that we review a fee schedule prior to deciding on the optimal treatment for our patients, that is nothing less than insulting. Physicians certainly are well compensated, but let me be perfectly clear…despite what you say, doctors costs have not increased in the 14 years that I’ve practiced medicine. We have not had a raise in our fee schedules in 14 years. In fact, our reimbursement per patient service has decreased over time. Our total salaries may have stayed the same, but only because we see more patients and have significantly increased our workload. Another fact is that as a hospital-based physician, the doctors who are ordering those “unnecessary” CT scans and MRI’s get no financial remuneration from the studies. None. Zero. Quite the contrary, we constantly search for the most cost effective ways to care for patients. And by the way, we care for anyone who needs care. Every single person. Insured or not. Citizen or illegal immigrant. And we do it with the same commitment to each patient’s health and dignity every time.
• 2. Profit is not the enemy. It may be a dirty word right now, but it would be a mistake to eliminate it from the system. It is not the motivator, but it is a needed component for a successful system. What do we think is the engine for technological advances, drug research and development, equipment purchases and capital investment, human resources, etc? If we take the money out of the system and let government administrate and allocate the resources in its ever so efficient way (post office? Amtrak? IRS computer system?), there are bound to be profound effects. Not to mention the unintended consequences of shifting money from the private to the public sector. Our hospital, for example, is the #2 employer in our community. It provides tax revenue, supports the local businesses and housing, and invests in the community. Unlike the dead end handouts of the so-called stimulus plan, this actually has a multiplier effect and creates more money per dollar spent than is actually put into the system. If you gut the health care system, it will devastate the economy.
• 3. Medicare and Medicaid are inefficient, lumbering goliaths that don’t even know their own rules, have different rules for different states, and change their rules without telling anyone. Many times, there is no one even to ask about policy. Medicaid, in particular, is fraught with abuse. This may be another dirty word, but it is patient abuse, not doctor abuse. When you don’t see a bill of any kind, not even a nominal co-payment, you have no incentive to be cost efficient. An emergency room is used for convenience, and that is the only variable in the equation. Even with the insured, the incentive changes when you’ve met your deductible. Admit it…it’s the end of the year…do everything you can after the deductible is met because it is not out of pocket. Now imagine a system where the majority of patients have either no cost or have effectively met their deductible. If there is no skin in the game, no incentives to be healthy, the consequences are disastrous.
• 4. The mythical quest to provide only the care people need via outcome analysis is clearly no panacea. Do you not think Medicare and insurance companies have in effect directed care through pre-certification requirements determined by extensive outcome analysis already? Do you not think physicians have already developed guidelines and treatment protocols based on evidence based medicine? The only change that government could introduce is to turn the guidelines into policy, thereby injecting social judgments and rationing into the system. Do you really know which brain injury patient will recover, which particular premie will grow up to be a star athlete, or where a cancer patient will fall on the 5 year survival curve? We are walking down a slippery slope where ultimately decisions may be taken out of the hands of doctors and patients and treatments determined purely on statistical analysis.

Don’t get me wrong, I support health care reform.  But as my parents told me, “If it’s the right thing to do today, it will be the right thing to do tomorrow.”  The sky is not falling.  The uninsured figures are distorted, though clearly unacceptable nonetheless.   But reform should be comprehensive, not just cost control.  And cost control shouldn’t just be I’ll pay you less for what you do or limit your services.  We need thoughtful, comprehensive reform.  Insurance reform is key.  Risk pooling; sell policies across state lines; include the insurance companies in the cost pool that handles the uninsured rather than allowing only the medical providers and hospitals to absorb the costs of charity; allow patients to customize policies to meet their own needs rather than a generic coverage plan; and limiting the cherry picking of “healthy lives” are but a few of the many suggestions.  Tort reform is paramount.  To ignore the contribution of defensive medicine is a terrible omission in the health care plan.  Medicaid reform is crucial.  Immigration reform should not be ignored.  And finally, we need to include patient responsibility in the equation, no matter how controversial.  End of life care will be an ongoing discussion for years to come.

In closing, I want to make a more general commentary on the tone of this administration.  Bill Press wrote a column (”No More Excuses for Dems”) on how the democrats should “seize the moment”.  “Forget compromise.  Forget bipartisanship.   They should flex their muscles and do what they want.”  His reasoning?  Like a child, he defends his stance by saying “….well, they (Republicans) would have done it to us.”  This seems to me to encapsulate the feelings of the Obama administration.  “We won.” “The American people voted us in.”  Which begs the question, who are the American people that Nancy Pelosi so freely refers to when justifying her unilateral policy making?  Does it apply only to the 52% who voted for President Obama?  Is it only the mythological “working families”?  I have never felt so unrepresented.  So vilified.  It is ironic that an African American president would embrace such majority rule, effectively ignoring and suppressing the needs of the “minority”.  More than any other president, he should understand that just because the majority has a particular opinion does not necessarily make it right…or make it the only voice.  Stimulus, budget, energy policy, cap and trade, and now health care.  I can’t decide if we are embarking on a Madoff-like Ponzi scheme for the entire country, one in which you squeeze the blood out of the top to support the masses…..until there is no more top.  Or whether the administration is a UAW on steroids, where you promise everything, do not deliver the goods, blame someone else, default on your obligations, and then break contract law to perpetuate the institution using someone else’s money.  Be afraid.  Very, very afraid.

Dr. Mike from Indiana

Do you agree or disagree? Love to hear your thoughts