Thursday, August 20, 2009

Update3: Doctors Against ObamaCare

Another day, another twothree practicing doctors vocally announcing their opposition to ObamaCare.

(1) Practicing Anesthesiologist Ronald Dworkin in the Wall Street Journal discusses the inevitable adverse effects of ObamaCare on his profession. He writes:
...Incredibly, Congress's proposed health-care reform plan risks skimping on anesthesia. According to one of the health-care bills in Congress, H.R. 3200, the public option would reduce reimbursement for anesthesia by over 50%.

More broadly, the bill reflects the incorrect assumptions progressive politicians have made about the mindset of today's doctors and how the health-care system operates.

The first error involves the new taxes on high wage earners.


A second thing progressives fail to grasp is the genius of the American health-care system: It unites rich and poor in a common private insurance system.


The progressives' third mistake is to skimp on anesthesiology. In no medical specialty is the spread between the Medicare rates and private insurance rates greater. Progressives expect to pay anesthesiologists Medicare rates, which are 65% less than private insurance rates, without any change in the system. But there will be changes.

Some anesthesiologists will leave the field. They are already faced with lawsuits at every turn. Something else has happened in America that threatens to tip the balance for anesthesiologists. Americans have grown very fat. This complicates anesthesia tremendously. Putting in IVs, spinals and epidurals is harder. Inserting breathing tubes is much more dangerous.

Quality of care will inevitably decline. That decline will come first in obstetrics. At the hospital where I work, two anesthesiologists work in obstetrics almost around the clock, so that a woman in labor need not wait more than five minutes for her epidural. Other hospitals are less fortunate, and have on staff at most one anesthesiologist in obstetrics. The economic crunch will eventually force these hospitals to cover obstetrics "when anesthesiology is available," meaning in between regular operating room cases.

During an obstetrical emergency, these short-staffed anesthesia departments will scramble to send someone to perform the C-section. Don't forget, a baby has only nine minutes of oxygen when the umbilical cord prolapses, so time is of the essence.

At the very least, pregnant women will be waiting a lot longer for epidurals. But more pain on the labor floor is only the beginning. If hospitals delay the administration of anesthesia because Congress skimped, needless deaths will certainly result.
Sounds awesome, Ronald! Thanks!

(2) Practicing Orthopedic surgeon Marshall Ackerman piles on in response to our President's ridiculous claims that doctors like to remove appendixes and appendages for a little extra cheese:

Physicians have been cast as the villains in the drama that our national health-care debate has become. We stand accused of raising charges to private insurers to compensate for low Medicare and Medicaid reimbursements as well as care of the uninsured or illegal immigrants; doing more to get paid more; seeing patients more often than necessary to increase revenue; and providing inefficient and ineffective care to patients in the hospital. Our motives are impugned. The care we render is being disparaged and our professionalism disregarded -- yet somehow it is assumed that doctors are merely passive pawns to be moved around the chessboard of health care.

Where are the investigative journalists? How many physicians who are not radiologists own their own MRI machine, CT scanner, PET scanner or other sophisticated diagnostic equipment to which they refer their patients? Why would President Obama blast pediatricians for doing tonsillectomies for profit, when any intelligent person knows that pediatricians do not do surgery? They care for sick children and refer them to ear, nose and throat specialists when surgery is needed. Why does no one seem to be aware that surgeons have functioned under a "global reimbursement" system for more than 35 years? Surgeons are paid a set fee for the care rendered for surgery or fracture care for a fixed period (frequently 90 days) regardless of how often they see a patient or how long the patient remains in the hospital.


I have been a practicing orthopedic surgeon for 40 years. I have observed profound changes in my profession since the advent of Medicare, changes that have affected patients' access to care. As reimbursements plummeted, internists abandoned hospital care to the new specialty of hospitalists, created boutique practices and stopped participating with health insurance companies. Physicians in all specialties have been retiring at earlier ages than ever before. In my own office, our staff has doubled over the past 40 years to enable us to handle the growing stream of government and insurer mandates. Our reimbursements continue to drop -- with no ability to pass on these costs. We are not the Mayo Clinic. There is no foundation to provide computers and electronic medical records or research grants to supplement salaries. Everything we do must come out of the reimbursement we receive for the care we provide to each patient.

Total joint replacement surgery for an arthritic hip and knee is a prime example of the difficulties physicians face and of the implications of health-care reform as envisaged by Congress and academic "experts." In 1971 I was paid $1,000 for a total hip replacement. Today, I would be paid approximately $1,600 for the same service. There is no multiplier -- a surgeon can only do one patient at a time. We continue in our practice for the immense satisfaction we receive from knowing that this surgery does more to restore a high quality of life to patients than any other surgery, and for the gratitude patients show. We implant devices because we believe, based on medical literature, that they are the best choices for patients. The overwhelming majority of surgeons have not received fees from implant manufacturers -- many times lowering the profitability of our hospitals.

Consider the implications when a global fee will be paid to the hospital: Then hospital and physician incentives will be aligned, and patients will bear the cost of the search for ever-cheaper implants and techniques, such as a return to cemented total hips. Forget metal-on-metal bearings, resurfacing, rotating platforms, high-flex knees, navigation systems or bilateral replacements. And if our hospitals are financially penalized for occurrences such as infection and deep-vein thrombosis after surgery, who will operate on the obese, the hypertensive or the diabetics among us? Experience with government funding reveals a never-ending spiral of decreased reimbursements in the name of restraining costs. In the end, this will come out of the care we all receive.

At your next visit to your specialist, take a tip from the drug company ads and "ask your doctor": Does he or she plan to retire early if reform legislation passes close to its present form? Does he or she plan to continue to participate with Medicare/Medicaid or participate with insurers that will not reimburse adequately? How does your doctor think health-care reform will affect the care you receive in his or her specialty? Access to a waiting list is not access to health care. Let's stop pointing fingers and start considering the real flaws and strengths of our system and how to improve it.
(3) Finally, practicing nephrologist and associate dean of clinical education at the University of Pennsylvania School of Medicine Stanley Goldfarb gives us a glimpse of European-style healthcare in today's Weekly Standard:
There are many problems with the U.S. health-care system, but access to resources and this form of rationing is not one of them. For example, survey data, as reported in a study published by the OECD (Organization for Economic Cooperation and Development), suggest that there are very short waiting times for elective surgery in the United States. Robert Blendon of the Commonwealth Fund reported the percentage of respondents to a phone survey in 2001 who had experienced elective surgery in the previous two years and who said they had waited longer than four months for elective surgery: 5% of patients had been waiting for at least 4 months in the United States, as opposed to 23% in Australia, 26% in New Zealand, 27% in Canada, and 38% in the United Kingdom. Tulane University cardiac surgeon Robert Carroll, in another study, found that the percentage of the respondents in need of elective coronary bypass surgery who had been waiting for more than three months was 0% in U.S., 18.2% in Sweden, 46.7% in Canada, and 88.9% in the United Kingdom.

For those who want to avoid these waits, supplemental private insurance and access to a discrete private system is one solution. While some countries have expanded access in the public system because wait times became intolerable, this has led to costs rising at rates that have themselves become a major issue.

So much for cost control.

And still nothing from a single practicing doctor vocally praising the utopia that would be ObamaCare.

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